Stopping SSRIs or SNRIs in pregnancy was linked to more mental health emergencies

Design

Retrospective cohort, state private insurance claims

Population

1,462 pregnant patients with prior depression or anxiety on an SSRI or SNRI before pregnancy

Primary outcome

Behavioural health emergency department visits in pregnancy and postpartum

Effect

Month 9: 59 vs 29 per 1,000 (P<.01); postpartum: 32 vs 21 per 1,000 (P=.02), discontinued vs continued

A retrospective cohort study used Pennsylvania private insurance claims for people who delivered in 2023–2024 with depression or anxiety diagnosed before pregnancy. Of 3,983 such patients, 1,462 entered pregnancy with an active SSRI or SNRI prescription. Discontinuation was defined as no fills, or a gap of more than 60 days.

Stopping was the norm rather than the exception: 17.8% filled nothing during pregnancy and 64.6% had a gap of more than 60 days, most often in the first trimester. Those who stopped had more behavioural health emergency visits, peaking in the second month (58 vs 37 per 1,000) and the ninth month (59 vs 29 per 1,000), and the excess persisted in the eight months after birth (32 vs 21 per 1,000).

The groups had similar mental health service use before pregnancy, which is reassuring, but the comparison is unadjusted claims data and cannot show that stopping caused the crises. It does show how often treatment lapses without a plan. The practical lesson is to make continuation a deliberate, documented decision at the first antenatal visit and again in late pregnancy, rather than letting a prescription quietly lapse.

• Ask at booking whether she is still taking her antidepressant, and whether she stopped because she was pregnant.
• Record a shared decision on continuing or tapering, with the reasons, in the antenatal notes.
• Recheck mood and adherence in the third trimester, when discontinuation was the second most common.
• Plan postpartum mental health follow-up for anyone who stopped during pregnancy.

Why it matters

Two in three people on an antidepressant had a long gap in pregnancy, and that gap clustered with crisis presentations.

Don't overread it

This was an unadjusted claims analysis — it shows an association, not that continuing treatment prevents emergencies.

The statistics, in plain English

The figures are crude rates per 1,000 compared with simple bivariate tests, not adjusted estimates, so differences in severity between people who stopped and people who continued could explain part of the gap. The P values say the differences were unlikely to be chance, not that they were caused by stopping.

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