New JAMA Psychiatry Review Says Stopping Antidepressants in Pregnancy Carries Its Own Risks

For decades, the default advice for pregnant women on antidepressants leaned toward one message: stop taking them if you can. A new review out of Children's National Hospital says that instinct may be doing more harm than good.

The review, led by Katherine L. Wisner, MD, of the Developing Brain Institute at Children's National, was published in JAMA Psychiatry and examined the use of SSRIs and SNRIs for treating major depressive disorder during pregnancy, according to MedPage Today and a GlobeNewswire release distributed through Children's National. Wisner and her co-authors argue the field has been operating under a legacy of fear that doesn't match current evidence.

That fear traces back to thalidomide, a drug prescribed for morning sickness decades ago that caused severe congenital malformations in more than 10,000 children. Wisner's team wrote that this history left a lasting mark: "fear of another drug-associated devastating fetal effect has overshadowed concern about the impact of maternal disorders on maternal-fetal health," according to MedPage Today.

What the Review Found

The core claim isn't that SSRIs are risk-free. It's that once researchers separate the drug's effects from the effects of untreated depression itself, the picture changes. "Once the impact of the drug is disentangled from that of MDD and its sequelae, accumulated evidence suggests that SSRIs carry little or no risk for serious adverse outcomes," the authors wrote, per MedPage Today.

That's a meaningful distinction. Depression itself, especially when moderate to severe, is linked to preterm birth, low birth weight, cesarean delivery, hyperemesis gravidarum, hypertension, and preeclampsia, according to the review as reported by both MedPage Today and the GlobeNewswire release. Psychiatric disorders are already among the leading causes of maternal morbidity and mortality in the U.S.

Wisner told MedPage Today that "the knee-jerk reaction of advising women to stop medication during pregnancy ignores the impact of the underlying illness on maternal-fetal health and increases the risk for depression relapse, maternal medical complications, and loss of function and resources (such as employment and interpersonal relationships)."

Who's Taking These Drugs

In the U.S., 5% to 6% of pregnant women are treated with SSRIs, mostly for major depressive disorder, which affects roughly 12% of pregnant women, according to both sources. That gap between how many women have depression and how many are treated is significant.

A cross-sectional study cited in the review found that among women who delivered in 2023 or 2024, only 17.6% continued antidepressants without any gap in treatment. Another 17.8% never filled a prescription during pregnancy at all, and 64.6% had a gap of 60 days or more, according to MedPage Today's coverage of the review.

The Evidence on Stopping vs. Continuing

A systematic review and meta-analysis found that women with severe or recurrent depression who discontinued antidepressants during pregnancy relapsed at more than twice the rate of those who stayed on treatment, a risk ratio of 2.30 with a 95% confidence interval of 1.58 to 3.35, per MedPage Today.

A separate Danish cohort study found that pregnant women who discontinued antidepressants had a higher risk of psychiatric emergencies compared with a matched group that stayed on treatment, a hazard ratio of 1.25 with a confidence interval of 1.00 to 1.55, according to the same MedPage Today report. That confidence interval brushes right up against 1.0, meaning the finding sits close to the edge of statistical significance.

The Counterargument, Stated Fairly

None of this means SSRIs are risk-free, and the researchers don't claim that. Assessing the safety of SSRI use in pregnancy is made more difficult by the potential for confounding in observational studies from the underlying condition itself and other associated factors, such as smoking, substance use, obesity, and socioeconomic adversity, MedPage Today reported. Women who take antidepressants during pregnancy likely have more severe depression to begin with, which makes it hard to cleanly separate drug effects from illness effects in observational data. A recent meta-analysis cited in the report showed that children exposed to prenatal antidepressants had an increased risk of autism or attention deficit-hyperactivity disorder, but that finding was no longer significant after adjusting for confounding factors.

A parent or clinician skeptical of shifting the standard of care has a reasonable point: evidence defining the benefits of SSRI treatment in pregnancy is, by the review's own admission per the GlobeNewswire release, "more limited than evidence describing risks." In plain terms, we have more data documenting potential downsides of the drugs than data proving how much good they do. Parents making this decision may reasonably want harder answers before committing to a medication regimen for nine months.

Sonia Hernandez-Diaz, MD, DrPH, of the Harvard T.H. Chan School of Public Health, who wasn't involved in the report, told MedPage Today that while these drugs are "not strong teratogens," the discussion over whether they might increase the risk of preterm delivery and other outcomes "is still ongoing." She noted there is consensus that those with severe depression who might face "terrible consequences" without antidepressants should continue treatment, since the benefits will likely outweigh the risks — but that deciding for more moderate depression is "very difficult."

Kay Roussos-Ross, MD, of the University of Florida, who wasn't involved in the review, told MedPage Today there needs to be a "move away from counseling that implicitly treats discontinuing medication as the 'safe' choice," since stopping carries its own risks for both the mother and the baby.

What Comes Next

The review calls for expanded access to maternity, child health, and psychiatric services, especially in communities with limited care, according to the GlobeNewswire release. It also pushes for more structured decision-making that weighs the risks of untreated illness against the risks of SSRI exposure, rather than defaulting to either extreme.

This is a synthesis of existing evidence, not a new clinical trial, and the authors are explicitly asking doctors and patients to have a more balanced conversation, not mandating one outcome. Whether obstetricians and psychiatrists actually shift their default counseling in response remains an open question.