Katherine L. Wisner said accumulated evidence suggests SSRI treatment in pregnancy carries little or no risk for serious adverse outcomes, and that care for MDD should not default to stopping medication. The shift matters for pregnant women weighing whether to continue treatment after they have been told to treat depression as the primary problem.
Wisner and co-authors wrote in a special communication in JAMA Psychiatry that once the effect of the drug is separated from MDD and related factors, the evidence points to low risk for serious outcomes. In the U.S., 5% to 6% of pregnant women receive SSRI treatment, while MDD affects about 12% of women.
Kay Roussos-Ross on counseling
Kay Roussos-Ross, a University of Florida physician who was not involved in the report, said counseling should move away from implicitly treating discontinuing medication as the safe choice. Wisner said the opposite approach can ignore the impact of the underlying illness on maternal-fetal health.
Wisner said stopping medication during pregnancy increases the risk of depression relapse, maternal medical complications, and loss of function and resources such as employment and interpersonal relationships. She also said women with MDD have higher rates of pregnancy complications including preterm birth, low birth weight, cesarean delivery, and hyperemesis gravidarum, along with greater risks of hypertension and preeclampsia.
JAMA Psychiatry evidence
The evidence base includes a systematic review and meta-analysis in which women with severe or recurrent depression who discontinued antidepressants during pregnancy relapsed more often than women who continued treatment. That review reported a risk ratio of 2.30, with a 95% confidence interval of 1.58 to 3.35.
A Danish cohort study also found higher psychiatric emergency risk among pregnant women who discontinued antidepressants than among a propensity score-matched group that stayed on treatment. It reported a hazard ratio of 1.25, with a 95% confidence interval of 1.00 to 1.55.
Confounding in pregnancy studies
Wisner and team said observational studies are difficult to interpret because the underlying condition and factors such as smoking, substance use, obesity, and socioeconomic adversity can distort drug-safety findings. A recent meta-analysis found increased autism or attention deficit-hyperactivity disorder risk with prenatal antidepressant exposure before the association disappeared after confounding adjustment.
That leaves clinicians with a practical task rather than a reflex: discuss SSRI continuation in the setting of MDD, weigh relapse risk against the available safety data, and use structured shared decision-making instead of assuming discontinuation is the safer default.
