Obstetrics & Gynecology · Psychiatry · 2 h ago
Antidepressant Discontinuation in Pregnancy Linked to More Mental Health Emergencies
A retrospective Pennsylvania insurance-claims cohort study examined antidepressant use and mental health-related emergency department visits among patients with preexisting depression or anxiety. Discontinuation during pregnancy was associated with higher emergency-visit rates during pregnancy and up to eight months postpartum, although the observational design cannot establish causation.
- More than 60% of patients with a pre-pregnancy prescription had a treatment gap.
- Discontinuation was associated with higher ED-visit rates during pregnancy.
- Higher ED-visit rates persisted into the postpartum period.
- The retrospective claims study cannot establish causation.
Researchers analyzed private insurance claims for 3,983 patients who delivered in Pennsylvania between January 2023 and December 2024 and had depression or anxiety before pregnancy. Of these, 1,462 had an active SSRI or SNRI prescription in the three months before pregnancy. Discontinuation was defined as no fills or a prescription gap exceeding 60 days; the primary outcome was behavioral health-related emergency department (ED) visits during pregnancy and postpartum.
Among those entering pregnancy with an active prescription, 260 had no fills during pregnancy and 945 had a gap longer than 60 days. For patients with a gap, discontinuation most often occurred in the first trimester (44.9%) or third trimester (30.3%). Compared with those continuing treatment, patients who discontinued had higher ED-visit rates in pregnancy, including in the second month (58 vs 37 per 1,000; P=.027) and ninth month (59 vs 29 per 1,000; P<.01). Within eight months after delivery, rates were 32 versus 21 per 1,000 (P=.02).
The findings indicate an association, not proof that discontinuation caused emergency visits. Claims data may not capture medication use or clinical circumstances fully, and the cohort was privately insured in one state. The results highlight the importance of addressing treatment decisions for perinatal mental health in clinical care, but do not establish that every patient should continue medication.
In practice
For pregnant patients with preexisting depression or anxiety who used an SSRI or SNRI before pregnancy, this claims-based cohort found that discontinuation was associated with more mental health-related ED visits during pregnancy and within eight months after delivery. The findings support discussing treatment decisions and mental health follow-up during perinatal care, but do not show that discontinuation caused the visits or establish that medication continuation is appropriate for every patient. Applicability may be limited by the privately insured, Pennsylvania-based cohort and reliance on claims data.
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Obstetrics & Gynecology: Antidepressant Discontinuation During Pregnancy and Risk of Mental Health–Related Emergencies ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.