Using antidepressants during pregnancy is a common clinical concern, as many patients stop treatment out of fear of fetal harm. However, discontinuation may carry significant risks for maternal mental health.
Black women in the United States experience significantly higher rates of pregnancy-related complications and mortality than white women, with maternal health disparities driven by structural barriers such as insurance gaps, social determinants of health, and healthcare bias. Mental health plays an important—and often underrecognized—role in these outcomes.
Depression is common during pregnancy and the postpartum period. Black women are reported to experience higher rates of depression than other racial and ethnic groups, yet have some of the lowest rates of antidepressant use and treatment adherence. Reluctance to engage in mental health treatment may stem from distrust of the medical system, fear of side effects, financial strain, and cultural or religious stigma that views medication as a lack of faith.
New research suggests that stopping antidepressants during pregnancy may carry substantial risks: women who discontinued treatment had roughly double the risk of severe psychiatric events compared with those who continued therapy.
The findings highlight the need for clinicians to carefully counsel patients on the risks of untreated perinatal depression alongside potential medication effects.
What The Study Found
Pregnant women who quit their antidepressants are nearly twice as likely to experience a mental health emergency compared to those who keep taking their medications, researchers reported Wednesday at a meeting of the Society for Maternal-Fetal Medicine in Las Vegas.
“This work underscores the need to take pregnant patients’ mental health seriously and to offer the full range of treatment options—including medications when clinically appropriate,” lead researcher Dr. Kelly Zafman said in a news release. She’s a maternal-fetal medicine fellow at the Hospital of the University of Pennsylvania.
Mental health disorders are the largest contributor to maternal deaths in the U.S., researchers said in background notes. Pregnancy can worsen depression, anxiety, and other psychiatric problems a woman might be facing.
Selective serotonin reuptake inhibitor (SSRI) antidepressants are safe to use during pregnancy, researchers said. Evidence has shown they’re not associated with birth defects or developmental problems.
Nevertheless, some women stop taking antidepressants during pregnancy, worried about the possible effects of the meds.
For the new study, researchers tracked insurance health records for nearly 4,000 women who gave birth in 2023 and 2024. All were diagnosed with depression or anxiety prior to pregnancy.
Of those patients, 37% entered pregnancy with a prescription for an antidepressant. About 18% had no prescription fills during their pregnancy, and 65% had a gap of more than 60 days in fills.
Results showed that women who quit their antidepressants had nearly double the risk for a mental health problem such as suicidal thoughts, substance overdose, or psychosis.
The risk peaked in the first and ninth months of pregnancy, researchers found.
“These findings, while not entirely surprising to those who work with pregnant patients who suffer from mental health conditions, are so important to consider for maternal health policy,” Zafman said.
“Confronting the maternal mental health crisis is essential to reducing maternal morbidity and mortality in the United States,” she concluded.
Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
Clinical Interpretation
While concerns about fetal medication exposure may drive mothers to discontinue antidepressants, untreated perinatal depression carries its own risks. Mental health conditions are now recognized as one of the leading causes of pregnancy complications in the United States, with suicide and substance-related overdoses accounting for a significant portion of maternal mortality.
Untreated perinatal depression has been linked to poor prenatal care adherence, inadequate nutrition, sleep disturbance, hypertensive disorder, preterm birth, and impaired maternal-infant bonding.
Medication Safety in Pregnancy: What the Evidence Actually Shows
Selective serotonin reuptake inhibitors (SSRIs) remain the first-line medication for moderate to severe depression during pregnancy. Decades of research have not revealed a consistent link between SSRIs and significant congenital malformations.
Some studies have reported transient neonatal adaptation syndrome (PNAS/NAS)–jitteriness, irritability, weak cry, poor feeding, and respiratory distress–but these effects are typically self-limited. The total risk of serious neonatal outcomes remains low, especially when weighed against the risks of untreated maternal mental illness.
Counseling Pregnant Patients Who Want to Stop Antidepressants
The study’s findings underscore the need for proactive, structured counseling early in pregnancy—or, ideally, preconception.
If a patient wants to stop antidepressants during pregnancy, clinicians can discuss:
- The severity and recurrence of prior depressive episodes
- Any history of hospitalization, suicidal ideation or behaviors, or substance use
- The patient’s support system and access to therapy
- The timing of pregnancy, since the relapse risk is much higher early and late in gestation
Abrupt disruption in treatment should generally be avoided. If tapering is considered appropriate for a patient with mild, well-controlled symptoms and no history of severe relapse, close follow-up is highly recommended. For patients with moderate to severe depression, continuation of pharmacotherapy—possibly with dose adjustments—is often recommended.
Why This Matters for Black Patients
The implications of antidepressant discontinuation during pregnancy can be particularly significant for Black women, who already face disproportionate maternal health risks. Structural inequities, insurance coverage gaps, limited access to culturally sensitive mental healthcare, and stigma surrounding psychiatric treatment all can contribute to lower treatment utilization and higher discontinuation rates.
When mental health conditions go untreated in a patient population already facing a higher risk for maternal morbidity and mortality, the impact can be amplified. Addressing perinatal depression is not just a psychiatric concern—it’s a maternal health equity issue.
The Takeaway
Conversations about antidepressant use in pregnancy should balance fetal safety with maternal stability—especially among populations experiencing maternal disparities. Proactive counseling and personalized care planning are essential components for reducing preventable maternal morbidity and mortality in Black women.