Antidepressant Use Drops During Pregnancy Without Psychotherapy Increase

Claire Boone, PhD

Credit: McGill University

A recent study discovered a large decrease in antidepressant use during pregnancy without an increase in psychotherapy.¹

Without increased psychotherapy to offset stopping antidepressants, women face a greater risk of depression relapse. Women have the greatest risk of depression during and after pregnancy, and this risk is particularly high among women with a history of depression.

Many pregnant women worry about the consequences of antidepressants on their unborn child. Research has shown safety concerns of utero exposure to some antidepressant medications.² When born, babies may experience short-term symptoms of quitting the medicine, such as jitters, irritable behavior, poor feeding, and respiratory distress, which can last up to 2 weeks.

The biggest concern of taking antidepressants during pregnancy is causing the baby to have a birth defect. However, the risk of birth defects due to antidepressant exposure in the womb is low.

Conversely, depression during pregnancy may be harmful to the baby. The expected mothers may not bother to seek prenatal care, eat healthy foods, or care for themselves. Depression during pregnancy raises the risk for babies of premature birth, low birth weight, less growth in the womb, and other problems after birth. Untreated depression during pregnancy also increases the risk of postpartum depression, resulting in new mothers to struggle bonding with their babies.

According to the Mayo Clinic, generally safe antidepressant options during pregnancy include citalopram, sertraline, escitalopram, fluoxetine; these antidepressants have risks of high blood pressure during pregnancy and premature birth, but risks are small.² Most SSRIs are not linked with birth defects, except paroxetine might slightly raise the risk of heart defects in babies if taken during the first trimester. Antidepressants slightly linked to heart defects include bupropion, nortriptyline, and amitriptyline.

Due to safety concerns of antidepressants during pregnancy, many women choose to stop antidepressants. Current guidelines recommend women who discontinue antidepressants during pregnancy should switch to psychotherapy, but as was seen in this recent study, that does not often happen.

Investigators, led by Claire Boone, PhD, from the department of economics at McGill University in Montreal, Canada, used Merative MarketScan Research Databases with claims data for a large sample of privately insured US individuals. ¹ The sample included women who gave birth between 2011 and 2017 and had prescription drug insurance coverage the month they gave birth and 24 months before and after; spouses were analyzed too if they were on the same insurance (56.5%). Among 385,731 new mothers, the mean age at childbirth was 31.8 years, 74.8% were employed, and the mean income was $84,577.

The team measured antidepressant medication fills, as well as psychotherapy claims of women and spouses for 2 years before and 2 years after the birth of a child. Before pregnancy, 4.3% of women filled an antidepressant prescription in the year before pregnancy, and this dropped to 2.2% during pregnancy, a reduction of 48.8%. Antidepressant use among 217,877 spouses had no similar changes, indicating that the reduction in antidepressant use was not linked to other changes in the couple’s life.

The analysis showed that women did not substitute antidepressant use with psychotherapy. In fact, there was a slight decrease in psychotherapy claims during pregnancy.

A month after giving birth, women’s mean medication fills returned to pre-pregnancy levels. This suggests that women only stopped taking antidepressants during pregnancy, not that they were trying to avoid treatment altogether. However, the time delay for antidepressants to begin working left many women untreated during the postnatal period, a time when women are at a high depression risk.

“These findings, coupled with evidence of mental health challenges during and after pregnancy, suggest the need for increased focus on and discussion about mental health treatments by pregnant women and their clinicians,” investigators concluded.

References

1. ^{Boone C, Colina C, Pope D. Antidepressant Use Before, During, and After Pregnancy. JAMA Netw Open. 2025;8(1):e2457324. doi:10.1001/jamanetworkopen.2024.57324}
2. ^{Pregnancy Week by Week. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/antidepressants/art-20046420. Accessed February 7, 2025.}