An Alarming Trend: Discontinuing Antidepressants During Pregnancy Nearly Doubles Risk of Severe Mental Health Crises
Emerging research presented at the 2026 Pregnancy Meeting™ hosted by the Society for Maternal-Fetal Medicine (SMFM) brings critical new insights to the complex intersection of mental health and pregnancy. A recent observational study, led by researchers at the University of Pennsylvania, reveals that pregnant patients who discontinue their antidepressant medications face nearly double the risk of experiencing severe mental health emergencies compared to those who maintain their prescribed treatment throughout pregnancy. This research punctuates the urgent need to reevaluate maternal mental health management policies and underscores the profound consequences of untreated psychiatric conditions during gestation.
Mental health disorders represent the leading cause of maternal mortality in the United States, a stark reality that amplifies public health concern. The physiological and hormonal changes inherent to pregnancy can exacerbate pre-existing psychiatric conditions such as depression and anxiety, making management extraordinarily challenging. Untreated or inadequately treated depression during pregnancy carries myriad risks beyond psychological distress, including elevated chances of suicide, preterm birth, preeclampsia, and low birth weight infants. The prevailing medical consensus supports the relative safety of selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, during pregnancy, as existing data do not associate their use with congenital anomalies, fetal growth restriction, or long-term developmental impairments.
The University of Pennsylvania study meticulously analyzed de-identified health records from a large state-based private insurance database, Independence Blue Cross, encompassing a cohort of 3,983 patients diagnosed with depression and/or anxiety prior to pregnancy. These patients had active prescriptions for SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs) in the three months preceding pregnancy and delivered between January 1, 2023, and December 31, 2024. This robust dataset provided a rare opportunity to assess real-world patterns of antidepressant use and discontinuation during pregnancy and their subsequent clinical outcomes.
Before pregnancy, the patients who would eventually discontinue antidepressants and those who would continue treatment exhibited comparable rates of outpatient and emergency room visits for mental health indications. This finding suggests that baseline psychiatric disease severity was similar across both groups, strengthening the validity of subsequent comparisons. However, striking differences emerged once pregnancy commenced. Those who halted their antidepressant therapy evidenced a nearly two-fold increase in mental health emergencies, including acute crises such as suicide risk, substance overdose, and psychosis. Notably, episode incidence peaked during the first and ninth months of gestation, periods marked by substantial physiological and psychosocial transitions.
Dr. Kelly B. Zafman, MD, MSCR, a maternal-fetal medicine fellow at the Hospital of the University of Pennsylvania and lead investigator, emphasized the critical implications of these results. “Although clinicians and patients alike often anticipate some mental health fluctuations during pregnancy, the near doubling of severe psychiatric emergencies in those who discontinue antidepressants is a clarion call. This study highlights the paramount importance of sustained, evidence-based mental health care throughout pregnancy, including the informed use of medication when clinically indicated,” Dr. Zafman stated. Her remarks highlight the urgent need for integrating psychiatric care seamlessly with obstetric services, thereby ensuring comprehensive maternal-fetal well-being.
These findings compel a reevaluation of existing paradigms that may favor antidepressant discontinuation due to fears of teratogenicity or developmental risks. Concerns historically rooted in limited or conflicting data have often led to abrupt cessation of pharmacotherapy, frequently without alternative management strategies. This study robustly counters such practices by demonstrating the significantly heightened risks of mental health emergencies when patients discontinue SSRIs or SNRIs during pregnancy. Importantly, the safety profile of these medications continues to be supported by extensive research, reinforcing their judicious use when balanced against the maternal and fetal risks of untreated depression.
Beyond immediate clinical considerations, the study implicates broader public health and policy avenues. Maternal mental health crises contribute significantly to maternal morbidity and mortality metrics and intersect with social determinants of health including access to mental health services, stigma, and socio-economic stressors. The doubling of psychiatric emergencies during key gestational milestones signals a potential window for targeted interventions. Prenatal care protocols could integrate stringent mental health monitoring, enhanced patient education, and individualized medication management plans that prioritize continuation where appropriate.
The temporal pattern of emergencies peaking in the first and ninth months of pregnancy is particularly illuminating. The first trimester often involves adjustment to pregnancy and early fetal development concerns, while the ninth month consolidates anticipatory stress around childbirth. These phases may represent heightened vulnerability periods when intensifying psychosocial support alongside pharmacotherapy could mitigate risk. Additionally, this temporal finding advocates for tailored clinical vigilance and resource allocation in prenatal psychiatry.
The reliance on a large, real-world insurance database strengthens this study’s external validity, allowing extrapolation to diverse patient populations in typical clinical environments. However, inherent limitations include the observational design, which precludes causal inferences, and potential unmeasured confounders such as adherence variations, comorbid substance use, or social support disparities. Future prospective trials and broader multi-center investigations are warranted to refine treatment algorithms and elucidate mechanistic pathways linking antidepressant discontinuation with acute psychiatric decompensation.
This pioneering study will be formally published in the February 2026 issue of “Pregnancy,” the peer-reviewed journal of the Society for Maternal-Fetal Medicine. Its findings redefine the clinical landscape surrounding psychiatric care in pregnancy, advocating for a comprehensive approach that balances pharmacologic and psychosocial strategies to optimize maternal and fetal health outcomes.
As the United States grapples with a maternal mental health crisis underscored by rising morbidity and mortality, the integration of evidence-based psychiatric treatments into prenatal care is imperative. This study not only quantifies the risks associated with antidepressant discontinuation but also galvanizes efforts to confront stigma, bridge care gaps, and deliver person-centered interventions during a critical life stage.
In conclusion, the decisiveness of this research message—continuing antidepressant therapy during pregnancy reduces the risk of severe mental health crises—must inform clinical guidelines, patient counseling, and maternal health policymaking. Protecting the mental health of pregnant individuals is not ancillary but foundational to safeguarding both maternal and neonatal outcomes in the evolving landscape of obstetric medicine.
Subject of Research: People
Article Title: Contemporary patterns and outcomes of antidepressant discontinuation in pregnancy
News Publication Date: February 11, 2026
Web References: https://smfm2026.eventscribe.net/
References: Research published in the February 2026 issue of the journal Pregnancy, Society for Maternal-Fetal Medicine proceedings
Keywords: Antidepressant discontinuation, pregnancy, maternal mental health, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, maternal morbidity, psychiatric emergencies, depression, anxiety, maternal-fetal medicine
