Depression is highly prevalent during pregnancy and the postpartum period, yet treatment decisions remain complex as women weigh safety concerns of in utero exposure to antidepressant medications. A recent study published in JAMA Network Open used longitudinal insurance claims data from over 385,000 privately insured women who gave birth between 2011 and 2017 to determine antidepressant use before, during, and after pregnancy.
The study found that antidepressant use dropped by nearly half during pregnancy, from 4.3% in the year before pregnancy to 2.2% during pregnancy (Figure). This decrease was not accompanied by an increase in psychotherapy, suggesting that many women were left without treatment during this period (Figure). Within one month of childbirth, antidepressant prescriptions returned to pre-pregnancy levels, indicating that women resumed treatment once their pregnancy ended. However, given the delayed onset of antidepressant efficacy, this pattern suggests a critical window in which many women may experience untreated perinatal depression, a known risk factor for both maternal and infant health outcomes.
The study also examined whether this drop in antidepressant use reflected broader lifestyle changes among couples by performing the same analysis in 217,877 spouses that were on the same insurance plans. Spouses had no comparable decline in antidepressant use, suggesting that the decrease in antidepressant use in women was specific to their pregnancy.
These findings emphasize the urgent need for enhanced clinical guidance and patient-centered discussions about depression treatment during pregnancy. While concerns about fetal exposure to antidepressants are valid, untreated perinatal depression carries significant risks including worsened maternal mental health, impaired infant bonding, and increased risk of postpartum psychiatric disorders. As many women discontinue medication without substituting psychotherapy, there are clear gaps in provider counseling, mental health access, or patient decision-making that need to be addressed to prevent negative patient outcomes going forward.
Reference:
Boone C et al. JAMA Netw Open. 2025;8(1):e2457324. Abstract