Antidepressants in Pregnancy: Sudden Withdrawal Is Risky

Depression poses serious health concerns, particularly during pregnancy and after childbirth. Recent data from the United States are alarming, showing that nearly half of women stop taking antidepressants during pregnancy. A study published in JAMA Network Open highlights this trend, which may have serious consequences for both mothers and their children.

The study, led by Claire Boone, PhD, a health economist in the Department of Equity, Ethics and Policy at McGill University in Montreal, Quebec, Canada, along with researchers from Stanford and Chicago, studied antidepressant prescription patterns in more than 385,000 women before, during, and after pregnancy.

The results showed that the use of antidepressants decreased from 4.3% before pregnancy to 2.2 % during pregnancy, showing a drop of 48.8%.

“We often see patients discontinue antidepressants early in pregnancy due to fears of malformations or other adverse effects on the child. Weeks later, they call in completely distraught because they can no longer cope with their everyday lives,” said Wolfgang Paulus, MD, from the Reproductive Toxicology Advisory Center at the University Women’s Hospital in Ulm, Germany, in an interview with Medscape’s German edition. As a result, many resume antidepressant therapy, often at a higher dose.

Postpartum Use

The women did not try alternative treatments such as psychotherapy, and the frequency of antidepressant prescriptions returned to the initial rates after childbirth. “This shows that the women need the medication to treat their depression but do not want to take antidepressants during pregnancy,” said Boone and colleagues.

Many women are concerned that antidepressants may lead to malformations or postpartum adjustment disorders in newborns.

“Psychiatrists frequently tell women they must be off the medication by the time they give birth or in the weeks before,” Paulus emphasized. Psychiatric experts often exert undue pressure on patients.

However, the current study does not suggest that “the commonly used antidepressants in women of childbearing age, such as sertraline, escitalopram, and citalopram, are associated with a noticeably increased risk of malformations,” said Paulus.

Depression Risks

A 2018 meta-analysis of cohort studies involving over 9 million births revealed a slightly increased risk for malformations associated with selective serotonin reuptake inhibitors (SSRIs) during pregnancy compared with the general population. However, this increased risk disappeared when pregnant women taking antidepressants were compared with those who were also depressed but did not receive antidepressant treatment.

“Patients with depression inherently have a different risk profile, including factors such as smoking, alcohol consumption, and dietary habits,” said Paulus. “If an increased risk of malformations is observed, it is likely due less to the medication and more to the underlying disease.”

Paulus explained that concerns about a child developing adjustment disorders after birth due to sudden changes in medication are valid but are often exaggerated. “The risk of severe adjustment disorders after birth is low and affects only about 3% of children,” said Paulus.

Adjustment Disorders

Postnatal adjustment disorders, such as irregular breathing, tremors, or feeding challenges, are usually mild and self-resolving, requiring minimal medical intervention. However, giving birth at a facility with onsite pediatric support is recommended for the proper monitoring and care of newborns.

Current studies indicate no long-term effects in children exposed to antidepressant use during pregnancy. A large cohort study in the United States involving more than 100,000 women examined potential neurologic developmental disorders in their children, following them up to age 14 years. At first glance, there appeared to be an increased risk for conditions such as attention-deficit/hyperactivity disorder and autism. However, when researchers compared siblings from the same families, no significant difference was found. “The higher risk is more due to the underlying maternal depression than to the medication itself,” said Paulus.

Child Monitoring

The authors concluded that pediatricians should closely monitor children born to women with depression. Parents should also monitor behavioral abnormalities to ensure appropriate support and interventions if needed.

Paulus highlighted a Danish study showing that children of treated women with depression developed just as well as children of healthy women by age 6, and children of untreated women with depression had twice as many behavioral problems.

These findings highlight the importance of informed decision-making regarding the use of antidepressants during pregnancy. Abruptly discontinuing antidepressants can lead to serious complications, given the significant changes that occur during pregnancy and the postpartum period.

“The clear recommendation is to continue established SSRIs at moderate doses. The goal must be to balance the mother’s well-being with the child’s health,” Paulus emphasized.

This story was translated from Medscape’s German edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.