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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.