How Does Antidepressant Discontinuation During Pregnancy Affect Postpartum?

Discontinuing antidepressants like selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) during pregnancy does not appear to increase the risk for adverse psychiatric outcomes in women with depression or anxiety without severe comorbid conditions, according to study results published in JAMA Network Open.

Pregnant individuals with depression or anxiety express significant concern about antidepressant discontinuation during pregnancy, as many patients fear how this decision could affect peripartum mental health. Given that previous studies have offered mixed findings on the risks of discontinuing these medications, researchers conducted a population-based cohort study to clarify the effect of antidepressant discontinuation on postpartum mental health outcomes.

The researchers analyzed data collected between 2006 and 2019 from 27,773 pregnant women in Sweden who had filled SSRI or SNRI prescriptions in the 90 days leading up to pregnancy. The study aimed to assess the association between discontinuing antidepressants and the risk for postpartum psychiatric-related hospitalizations, outpatient visits, and sick leave within 90 days and 1.5 years after childbirth. Women with severe psychiatric disorders were excluded to isolate the effects of antidepressant discontinuation.

Using an observational cohort design, the researchers grouped women based on whether they continued or discontinued antidepressants during pregnancy. The study found that, among the cohort, 47.5% (n=13,184) of the women discontinued their SSRI or SNRI at some point during pregnancy, while 52.5% (n=14,589) continued their treatment throughout pregnancy.

The researchers found that 49 women (0.4%) who discontinued antidepressants experienced a psychiatric-related hospitalization, relative to 59 women (0.5%) who continued their treatment during pregnancy.

In hazard models, the risk for hospitalizations within 90 days of childbirth was not significantly different between the groups (adjusted hazard ratio [aHR], 1.28; 95% CI, 0.85-1.91). By 1.5 years postpartum, the aHR decreased to 0.81 (95% CI, 0.66-1.00), suggesting that antidepressant discontinuation actually conferred a slightly lower risk for psychiatric-related hospitalization.

The researchers also found that outpatient psychiatric visits were less frequent among those who discontinued SSRI or SNRI use at both 90 days (aHR, 0.59; 95% CI, 0.53-0.66) and at 1.5 years (aHR, 0.60; 95% CI, 0.57-0.64).

No significant differences in self-harm, suicide, or sick leave absence were observed between the groups.

“Reassuringly, this cohort study did not find evidence of an association between discontinuation of SSRIs or SNRIs and adverse psychiatric-related outcomes after childbirth among pregnant women with depression or anxiety and no recorded comorbid or severe psychiatric conditions,” the researchers concluded. These findings may help inform health care providers and patients who are navigating decisions about antidepressant discontinuation during pregnancy.

Study limitations include potential misclassification of SSRI and SNRI use patterns due to within-group heterogeneity and the possibility of not excluding all women with comorbid psychiatric conditions, resulting in missed psychiatric-related outcomes managed outside of specialist care.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Psychiatry Advisor