Depression during pregnancy presents significant challenges, affecting both maternal well-being and fetal outcomes.^1,2 While effective management is essential, many women discontinue antidepressant therapy due to concerns about potential risks.^1,3 A recent study published in JAMA Network Open provides insight into this pattern, showing that a substantial proportion of women stop taking antidepressants during pregnancy without an accompanying increase in psychotherapy.³ Given the well-documented mental health challenges women face during and after pregnancy, these findings highlight the importance of clinician-patient discussions on maintaining appropriate treatment strategies.^1-3

Antenatal depression and anxiety not only affect maternal well-being but are also linked to adverse birth outcomes, including preterm birth and low birth weight.^1-3 The underlying mechanisms are well-established, influenced by both genetic and socio-environmental factors.² If left untreated, these conditions can also contribute to pregnancy complications, postpartum mental health disorders, and difficulties in maternal-infant bonding.¹ Despite the need for appropriate management, uncertainty remains regarding the best approach to balancing maternal mental health with fetal safety.^1,3 To address this gap, a recent study explores the decision-making process of women and their clinicians regarding depression treatment during pregnancy.³

A large-scale retrospective cohort study conducted by Dr. Claire Boone and colleagues at McGill University, in collaboration with Stanford and Chicago researchers, analyzed antidepressant prescription patterns in over 385,000 women before, during, and after pregnancy.³ The study revealed a nearly 49% decline in antidepressant use during pregnancy, dropping from 4.3% before conception to 2.2% during gestation.³ Furthermore, these women did not appear to substitute antidepressant therapy with psychotherapy.³ The study also observed that postpartum antidepressant use rebounded to pre-pregnancy levels, indicating that the need for pharmacological treatment remained unchanged and that women had voluntarily abstained from it during pregnancy.³

The reluctance to use antidepressants during pregnancy may stem from concerns about fetal malformations and postpartum adjustment disorders.^4,5 While some early studies suggested a slight increase in congenital anomalies with selective serotonin reuptake inhibitors (SSRIs), more recent data indicate that the underlying maternal depression, rather than the medication itself, maybe the primary risk factor for adverse outcomes.^4,5 A 2018 meta-analysis of over nine million births found that when comparing pregnant women with depression who took antidepressants to those with untreated depression, the increased risk of overall major congenital malformations and congenital heart defects was small.⁵

Discontinuing antidepressants during pregnancy may lead to worsening maternal mental health, increasing the likelihood of postpartum depression, anxiety, and impaired maternal-infant bonding.^1,3 Sudden withdrawal can exacerbate depressive symptoms, with an apparent increased risk of psychiatric emergency.⁶ Additionally, untreated maternal depression is associated with lifestyle factors such as poor nutrition, smoking, and alcohol use, which pose greater risks to fetal development than controlled antidepressant use.¹ Concerns regarding neonatal adaptation disorders, such as transient respiratory distress, feeding difficulties, or tremors, have been noted in infants exposed to antidepressants in utero.⁴ These symptoms were generally mild and did not require active medical intervention.⁴ Studies following children exposed to SSRIs during gestation show no long-term cognitive or developmental impairments when compared to siblings or control groups.^7,8 Furthermore, a Danish study found that by age seven years, children born to mothers who continued antidepressants performed comparably to those of healthy mothers, while offspring of untreated depressed mothers exhibited twice as many behavioral difficulties.⁸ These findings reinforce the importance of maintaining maternal mental health to ensure optimal childhood development.²

In summary, the decision to use antidepressants during pregnancy should be guided by scientific evidence rather than fear-based avoidance.^3,5 Sudden discontinuation of antidepressants can lead to significant maternal distress and pose risks to both mother and child.^1,3,6 While concerns regarding fetal health are valid, research indicates that the benefits of maintaining antidepressant therapy generally outweigh the potential risks.^5,6,8 Hence, a personalized, well-informed approach is essential to optimizing outcomes for both the mother and the developing fetus.^5,8