Antidepressant Discontinuation During Pregnancy and Risk of Mental Health-Related Emergencies

To evaluate contemporary patterns of antidepressant discontinuation during pregnancy and associated maternal mental health outcomes, including behavioral health-related emergency department (ED) visits, among patients with preexisting depression or anxiety.

This was a retrospective cohort study of a state-based private insurance claims database in Pennsylvania. Patients who delivered between January 1, 2023, and December 31, 2024, with a diagnosis of depression or anxiety before pregnancy and an active prescription for a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) in the 3 months before pregnancy were included. The exposure was antidepressant continuation compared with discontinuation during pregnancy, defined as no prescription fills or a gap of more than 60 days. The primary outcome was behavioral health-related ED visits during pregnancy and the postpartum period. Behavioral health-related ED visit rates were compared between patients who continued and those who discontinued antidepressants with appropriate bivariate statistical tests.

Among 3,983 patients with depression or anxiety, 1,462 (36.7%) entered pregnancy with an active SSRI or SNRI prescription. Of these, 260 (17.8%) had no medication fills during pregnancy, and 945 (64.6%) had a gap of more than 60 days. Among patients with a treatment gap of more than 60 days, discontinuation occurred most commonly in the first trimester (44.9%) followed by the third trimester (30.3%). Patients who continued and those who discontinued treatment had similar rates of outpatient and ED mental health visits before pregnancy. However, discontinuation was associated with a higher risk of mental health-related emergency visits during pregnancy, with peaks in the second month (58 vs 37/1,000, P=.027) and the ninth month (59 vs 29/1,000, P<.01) of pregnancy. This increased risk persisted postpartum, with higher rates of mental health-related ED visits within 8 months after delivery among those who discontinued treatment during pregnancy (32 vs 21/1,000, P=.02).

In this cohort of privately insured patients with preexisting depression or anxiety, antidepressant discontinuation during pregnancy was common and was associated with increased risk of mental health-related ED visits. These findings underscore the need for clinical and policy strategies to support continuation of evidence-based treatment for perinatal mental health conditions and to address preventable contributors to maternal morbidity and mortality.