What does the latest clinical evidence on risks of discontinuing antidepressants during pregnancy imply for obstetric guideline revisions, pharmaceutical labeling, and cross‑national regulatory harmonization?
The convergence of clinical evidence on antidepressant discontinuation during pregnancy reveals a complex risk landscape that challenges existing guidelines, pharmaceutical labeling frameworks, and regulatory harmonization efforts across jurisdictions. Current data indicate that discontinuation decisions carry substantial risks that must be weighed against the generally transient and manageable neonatal effects of continued treatment.
Women with severe or recurrent depression who discontinue antidepressants during pregnancy face significantly elevated relapse risks. A systematic review and meta-analysis found that pooled data showed a risk ratio of 2.30 (95% CI, 1.58-3.35) for relapse among populations with severe or recurrent depression, though populations with mild to moderate depression did not show statistically significant increased relapse risk (RR = 1.59; 95% CI, 0.83-3.04)The Risk of Relapse of Depression During Pregnancy After Discontinuation of Antidepressants: A Systematic Review and Meta-Analysis - PubMednih . Individual studies report relapse rates ranging from 15% to 68% among women who discontinue antidepressants during pregnancy04. The Risk of Relapse of Depression During Pregnancy After ...psychopharmacologyinstitute .
A nationwide South Korean cohort study found that approximately 95% of pregnant women discontinued antidepressants during pregnancy, with nearly half re-initiating medication during pregnancy or the postpartum periodDiscontinuation and re-initiation of antidepressants during pregnancy: A nationwide cohort study - ScienceDirectsciencedirect . Women with markers of severe depression—psychiatric comorbidities and long-term antidepressant use before pregnancy—were less likely to discontinue, suggesting clinical recognition of heightened relapse vulnerability in this populationDiscontinuation and re-initiation of antidepressants during pregnancy: A nationwide cohort study - ScienceDirectsciencedirect .
Importantly, the interpretation of discontinuation studies is complicated by methodological challenges in distinguishing antidepressant withdrawal symptoms from depressive relapse. Some studies have defined relapse as any restart or increase in antidepressant dose, which conflates relapse with withdrawal phenomena and makes interpretation difficult04. The Risk of Relapse of Depression During Pregnancy After ...psychopharmacologyinstitute .
The clinical evidence establishes that untreated depression during pregnancy carries measurable risks that must factor into discontinuation decisions. Meta-analytic data demonstrate that depression during pregnancy is significantly associated with preterm birth (odds ratio: 1.46; 95% CI: 1.20-1.78) and low birthweight (OR: 1.90; 95% CI: 1.31-2.74)Meta-Analysis Of Antenatal Depression And Adverse Birth Outcomes In US Populations, 2010–20 | Health Affairshealthaffairs . These risks are substantially amplified for African American populations, with depression-associated preterm birth risk at OR 2.33 (95% CI: 1.37-3.98) and low birthweight at OR 2.47 (95% CI: 1.31-4.65)Meta-Analysis Of Antenatal Depression And Adverse Birth Outcomes In US Populations, 2010–20 | Health Affairshealthaffairs .
Beyond birth outcomes, untreated gestational depression has been associated with adverse effects on newborns including increased cortisol and norepinephrine levels, decreased dopamine levels, altered EEG patterns, reduced vagal tone, stress-like behaviors, and increased rates of neonatal intensive care unit admissionUntreated depression during pregnancy: Short- and long-term ...ibroneuroscience . Children exposed to untreated maternal depression show increased salivary cortisol levels, internalizing and externalizing behavioral problems, and central adiposityUntreated depression during pregnancy: Short- and long-term ...ibroneuroscience .
An earlier meta-analysis found that premature delivery and decreased breastfeeding initiation were significantly associated with maternal depression (OR = 1.37; 95% CI, 1.04-1.81 for preterm birth; OR = 0.68; 95% CI, 0.61-0.76 for breastfeeding initiation)The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis - PubMednih .
Poor neonatal adaptation syndrome (PNAS) represents the most frequently cited concern with continued SSRI/SNRI use through the third trimester. Evidence consistently indicates that PNAS occurs in approximately 25-30% of neonates exposed to SSRIs and SNRIs during the third trimester Poor Neonatal Adaptation After Antidepressant Exposure During the Third Trimester in a Geographically Defined Cohort - PMC nih +1. The most commonly observed symptoms include jitteriness, restlessness, irritability, increased muscle tone, and rapid breathingWhat Causes Poor Neonatal Adaptation in Antidepressant-Exposed ...womensmentalhealth .
Critically, these symptoms are transient and typically resolve spontaneously without specific medical intervention. The vast majority of affected neonates recover within 5-7 daysNeonatal Adaptation Syndrome and Antidepressants During Pregnancyyoutube . Severe cases requiring NICU admission or respiratory support are rareNeonatal Adaptation Syndrome and Antidepressants During Pregnancyyoutube . For context, approximately 9% of unexposed babies also experience similar adaptation symptomsNeonatal Adaptation Syndrome and Antidepressants During Pregnancyyoutube .
The clinical terminology itself remains inconsistent. Neonatal adaptation syndrome and neonatal withdrawal syndrome are used interchangeably in the literature, and there is no well-defined consensus on the exact symptom profile or diagnostic criteriaHow can depression in pregnancy be treated?youtube .
The association between SSRI exposure and persistent pulmonary hypertension of the newborn (PPHN) has generated significant regulatory attention. A large population-based study of over 1.2 million live-born children found that antidepressant exposure after 20 weeks' gestation was associated with increased PPHN risk (adjusted OR 2.01; 95% CI, 1.32-3.05), while exposure at or before 20 weeks showed no increased risk (OR 0.80; 95% CI, 0.51-1.25)Association of Persistent Pulmonary Hypertension in Infants With the Timing and Type of Antidepressants In Utero | Cardiology | JAMA Network Open | JAMA Networkjamanetwork .
The absolute risk remains low. The absolute risk difference for PPHN after late pregnancy antidepressant exposure was 1.3 per 1000 infants (95% CI, 0.2-2.4), meaning between 417 and 5000 women would need to be treated with antidepressants in late pregnancy to result in one additional PPHN caseAssociation of Persistent Pulmonary Hypertension in Infants With the Timing and Type of Antidepressants In Utero | Cardiology | JAMA Network Open | JAMA Networkjamanetwork . Among unexposed children, PPHN occurred in 1.3 per 1000 live births; among those exposed to antidepressants, the rate was 2.6 per 1000Association of Persistent Pulmonary Hypertension in Infants With the Timing and Type of Antidepressants In Utero | Cardiology | JAMA Network Open | JAMA Networkjamanetwork .
A Quebec-based study found that SSRI use during the second half of pregnancy was associated with PPHN (adjusted OR 4.29, 95% CI 1.34-13.77), though the baseline prevalence remained low at 1.8 per 1000 children SSRI and SNRI use during pregnancy and the risk of persistent pulmonary hypertension of the newborn - PMC nih . Swedish data suggested a more attenuated risk, with the association showing an increase of approximately 2.4-fold after adjusting for other risk factorsSSRIs and Pulmonary Hypertension Riskwomensmentalhealth .
ACOG has taken a clear position supporting continued access to SSRIs during pregnancy. ACOG President Dr. Stephen J. Fleishman stated that "Robust evidence has shown that SSRIs are safe in pregnancy and that most do not increase the risk of birth defects"Maternal Mental Health Updates from ACOG — Maternal Mental Health Leadership Alliance: MMHLAmmhla . ACOG asserts that all treatment options should remain available for pregnant individuals with mental health concernsMaternal Mental Health Updates from ACOG — Maternal Mental Health Leadership Alliance: MMHLAmmhla .
ACOG guidelines historically have recommended antidepressants as preferred initial therapy for depression during pregnancy, independent of symptom severity, which represents a departure from other international guidelines that prioritize psychotherapy for mild to moderate cases Guidelines on treatment of perinatal depression with antidepressants: An international review - PMC nih .
The NICE 2024 guideline takes a more nuanced approach, recommending individualized decisions based on depression severity and treatment history. For women with mild to moderate depression who become pregnant while taking a TCA, SSRI, or SNRI, NICE recommends discussing gradual medication cessation and considering facilitated self-help[PDF] Antenatal and postnatal mental health- clinical management ... - NICEnice .
For severe depression, NICE recommends discussing options including continuing current medication, changing to a medication with lower risk of adverse effects, combining medication with high-intensity psychological intervention, or switching to psychological intervention if the woman decides to stop medication[PDF] Antenatal and postnatal mental health- clinical management ... - NICEnice .
NICE specifically notes that when choosing an antidepressant, clinicians should consider "the risk of discontinuation symptoms in the woman and neonatal adaptation syndrome in the baby with most TCAs, SSRIs and (S)NRIs, in particular paroxetine and venlafaxine"[PDF] Antenatal and postnatal mental health- clinical management ... - NICEnice .
The Canadian Network for Mood and Anxiety Treatments developed a perinatal-specific guideline aiming to reach clinicians beyond psychiatrists, including family physicians, midwives, nurses, obstetricians, and pediatriciansCanadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l'humeur, des troubles anxieux et des troubles connexes périnatals - Simone N. Vigod, Benicio N. Frey, Crystal T. Clark, Sophie Grigoriadis, Lucy C. Barker, Hilary K. Brown, Jaime Charlebois, Cindy-Lee Dennis, Nichole Fairbrother, Sheryl M. Green, Nicole L. Letourneau, Tim F. Oberlander, Verinder Sharma, Daisy R. Singla, Donna E. Stewart, Patricia Tomasi, Brittany D. Ellington, Cathleen Fleury, Lesley A. Tarasoff, Lianne M. Tomfohr-Madsen, Deborah Da Costa, Serge Beaulieu, Elisa Brietzke, Sidney H. Kennedy, Raymond W. Lam, Roumen V. Milev, Sagar V. Parikh, Arun V. Ravindran, Zainab Samaan, Ayal Schaffer, Valerie H. Taylor, Smadar V. Tourjman, Michael Van Ameringen, Lakshmi N. Yatham, Ryan J. Van Lieshout, 2025 sagepub . CANMAT recognizes that links between most antidepressants and adverse pregnancy outcomes are significantly attenuated when confounding by indication is properly managedCanadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l'humeur, des troubles anxieux et des troubles connexes périnatals - Simone N. Vigod, Benicio N. Frey, Crystal T. Clark, Sophie Grigoriadis, Lucy C. Barker, Hilary K. Brown, Jaime Charlebois, Cindy-Lee Dennis, Nichole Fairbrother, Sheryl M. Green, Nicole L. Letourneau, Tim F. Oberlander, Verinder Sharma, Daisy R. Singla, Donna E. Stewart, Patricia Tomasi, Brittany D. Ellington, Cathleen Fleury, Lesley A. Tarasoff, Lianne M. Tomfohr-Madsen, Deborah Da Costa, Serge Beaulieu, Elisa Brietzke, Sidney H. Kennedy, Raymond W. Lam, Roumen V. Milev, Sagar V. Parikh, Arun V. Ravindran, Zainab Samaan, Ayal Schaffer, Valerie H. Taylor, Smadar V. Tourjman, Michael Van Ameringen, Lakshmi N. Yatham, Ryan J. Van Lieshout, 2025 sagepub .
For perinatal depression treatment, CANMAT identifies sertraline as first-line in pregnancy, with venlafaxine as second-line and paroxetine as third-line due to its risk profileCanadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l'humeur, des troubles anxieux et des troubles connexes périnatals - Simone N. Vigod, Benicio N. Frey, Crystal T. Clark, Sophie Grigoriadis, Lucy C. Barker, Hilary K. Brown, Jaime Charlebois, Cindy-Lee Dennis, Nichole Fairbrother, Sheryl M. Green, Nicole L. Letourneau, Tim F. Oberlander, Verinder Sharma, Daisy R. Singla, Donna E. Stewart, Patricia Tomasi, Brittany D. Ellington, Cathleen Fleury, Lesley A. Tarasoff, Lianne M. Tomfohr-Madsen, Deborah Da Costa, Serge Beaulieu, Elisa Brietzke, Sidney H. Kennedy, Raymond W. Lam, Roumen V. Milev, Sagar V. Parikh, Arun V. Ravindran, Zainab Samaan, Ayal Schaffer, Valerie H. Taylor, Smadar V. Tourjman, Michael Van Ameringen, Lakshmi N. Yatham, Ryan J. Van Lieshout, 2025 sagepub .
A systematic comparison of 16 international guidelines revealed substantial variation in recommendations. During pregnancy, four guidelines explicitly advise continuing antidepressants, five mention the possibility without specifically recommending it, and three discourage switching medications Guidelines on treatment of perinatal depression with antidepressants: An international review - PMC nih . Most guidelines reach consensus that psychotherapy should be initial treatment for mild to moderate depression, with antidepressants considered for severe depression Guidelines on treatment of perinatal depression with antidepressants: An international review - PMC nih .
Regarding specific medication preferences, sertraline and citalopram emerge as preferred agents in multiple guidelines (CANMAT, Danish), while paroxetine and fluoxetine are frequently designated as non-preferred Guidelines on treatment of perinatal depression with antidepressants: An international review - PMC nih . The Netherlands and Canada explicitly recommend hospital delivery for women on antidepressants given that home births remain common in these jurisdictions Guidelines on treatment of perinatal depression with antidepressants: An international review - PMC nih .
The FDA convened an expert panel in February 2025 to discuss SSRI use during pregnancy. The panel discussion generated significant controversy within the reproductive psychiatry community. Critics noted that the panel "did not include leaders in the field of reproductive psychiatry but rather relied mostly on the opinions and comments of individuals who are longstanding outspoken critics of the use of psychiatric medications"Weighing the Evidence: Response to the FDA’s Recent Panel on Antidepressant Use in Pregnancy. - MGH Center for Women's Mental Healthwomensmentalhealth . Only one of the ten panelists was a clinician treating women with psychiatric disorders during pregnancyWeighing the Evidence: Response to the FDA’s Recent Panel on Antidepressant Use in Pregnancy. - MGH Center for Women's Mental Healthwomensmentalhealth .
Three of the ten panelists were from outside the United States, including one who runs a clinic specifically to help people taper off psychiatric medicationsFDA panel promotes misinformation about antidepressants during pregnancy, psychiatrists saynbcnews . The panel discussion "focused largely on the risks of SSRIs during pregnancy but ignored or diminished the risks associated with untreated depression in the mother"Weighing the Evidence: Response to the FDA’s Recent Panel on Antidepressant Use in Pregnancy. - MGH Center for Women's Mental Healthwomensmentalhealth .
While the panel did not reach consensus on new regulatory actions, many panelists agreed that stronger warnings on SSRI labels are needed to inform users of potential maternal or fetal risksFDA considers warning against antidepressants use during pregnanciesyoutube . The panel did find agreement on the need for more randomized controlled trials in pregnant women, with appropriate informed consent processesSSRIs in Pregnancy: What the FDA Panel Revealed About Mental Health, Medicine & Misinformationyoutube .
Public Citizen filed a citizen petition requesting several labeling changes for serotonin reuptake inhibitors. The petition characterizes current PNAS warnings as "inadequate given that the available evidence suggests that it affects up to 30% of neonates with third-trimester exposure"Public Citizen Petitions the FDA to Require Balanced, Evidence-Based Pregnancy Warnings for Serotonin Reuptake Inhibitors - Public Citizencitizen .
The petition proposes adding specific warning language: "Use of SNRIs and SSRIs (including x drug) in the third trimester of pregnancy can cause PNAS in about 30% of exposed neonates. Signs of PNAS include apnea, respiratory distress, cyanosis, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, change in muscle tone, hyperreflexia, tremors, jitteriness, irritability, and constant crying"Public Citizen Petitions the FDA to Require Balanced, Evidence-Based Pregnancy Warnings for Serotonin Reuptake Inhibitors - Public Citizencitizen .
The proposed warning recommends that "pregnant patients taking SNRIs and SSRIs to deliver in a hospital to ensure that management by neonatology experts will be readily available upon delivery" and that "at least 24 hours of close monitoring of these neonates is recommended"Public Citizen Petitions the FDA to Require Balanced, Evidence-Based Pregnancy Warnings for Serotonin Reuptake Inhibitors - Public Citizencitizen .
The petition also proposes adding warning language that addresses benefit-risk considerations: "Untreated maternal depression during pregnancy is associated with profound negative effects on the mother and the baby. Therefore, it is important to treat maternal mental illness (including depression) whenever it occurs"Public Citizen Petitions the FDA to Require Balanced, Evidence-Based Pregnancy Warnings for Serotonin Reuptake Inhibitors - Public Citizencitizen .
The proposed language includes cautionary statements about potential effects on fetal brain development: "Evidence from animal reproductive studies and uncertain evidence from human neuroimaging and population-based studies suggests that prenatal exposure to SNRIs or SSRIs may affect fetal brain development in ways that may predispose the exposed offspring to altered behavior — including depression and anxiety disorders — that does not manifest until middle childhood or early adolescence"Public Citizen Petitions the FDA to Require Balanced, Evidence-Based Pregnancy Warnings for Serotonin Reuptake Inhibitors - Public Citizencitizen .
Critically, the petition acknowledges discontinuation risks: "Due to the potential serious health consequences of mental illness, especially around the time of delivery, and the potential risk of antidepressant discontinuation symptoms, SRIs should not be discontinued suddenly, but tapered gradually, as needed"Public Citizen Petitions the FDA to Require Balanced, Evidence-Based Pregnancy Warnings for Serotonin Reuptake Inhibitors - Public Citizencitizen .
Health Canada released an advisory in 2004 warning of potential adverse effects of SSRIs on newborns. The advisory stated that women should discuss benefits and risks with healthcare professionals but emphasized that "it is very important that women do NOT stop these medications without consulting their doctor"SSRI'S and other antidepressant use during pregnancy and ... - PMCnih . Notably, the advisory stated that physicians "may consider slowly decreasing the dose in the third trimester of pregnancy" but nowhere stated that women should avoid antidepressants during pregnancySSRI'S and other antidepressant use during pregnancy and ... - PMCnih .
A subsequent Health Canada advisory noted the association between SSRIs and PPHN based on studies suggesting exposed babies were six times more likely to develop the condition, though this information was characterized as "preliminary"Health Canada issues antidepressant warning for pregnant women - CBCcbc .
The Australian TGA issued warnings about paroxetine specifically, noting that early results suggested an association between first-trimester use and cardiovascular birth defects, with risk potentially doubling from 1% to 2%Anti-depressant warning issued for pregnant womenabc . The TGA urged women not to suddenly stop taking SSRIs as withdrawal may cause harmful side effectsAnti-depressant warning issued for pregnant womenabc .
Australian clinical practice places SSRI/SNRI prescribing among the highest in OECD countries, making these regulatory decisions particularly consequentialPerinatal mental health and psychotropic medicines in pregnancy (1 October 2024)youtube . Australian guidance indicates that 80% of patients exposed to SSRIs/SNRIs in the third trimester will notice some form of neonatal adaptation syndrome, though usually mild symptoms like irritability, jitteriness, and difficulty settlingPerinatal mental health and psychotropic medicines in pregnancy (1 October 2024)youtube .
According to Italian expert consensus, depression is not a contraindication to pharmacotherapy during pregnancy, and patients may continue antidepressant treatment if clinically indicated, with priority given to agents with established safety profiles such as SSRIs prescribed at the lowest effective doseAssociation of antidepressant use during pregnancy and ... - PMCnih . This approach aligns with Canadian clinical practice guidelines noting that associations between most antidepressants and adverse pregnancy outcomes are significantly attenuated after adjustment for confounding by indicationAssociation of antidepressant use during pregnancy and ... - PMCnih .
UK prescribing patterns result in higher first-trimester exposures compared to some other jurisdictions due to higher pre-pregnancy prescribing rates, though first-trimester exposure proportions are similar to those in Australia and CanadaSelective serotonin reuptake inhibitor prescribing before, during and after ...wiley .
The evidence strongly supports differentiating recommendations based on depression severity and history. Women with severe or recurrent depression face substantially elevated relapse risks with discontinuation (RR 2.30), while those with mild to moderate depression may have more flexibilityThe Risk of Relapse of Depression During Pregnancy After Discontinuation of Antidepressants: A Systematic Review and Meta-Analysis - PubMednih . Guidelines should provide clear severity-stratified pathways that reflect this differential risk profile.
Clinical guidance from Hopkins Medicine indicates that "there is generally no need to taper off medications during pregnancy, because antidepressants have not been known to cause birth defects"Antidepressants and Pregnancy: What to Know | Johns Hopkins Medicinehopkinsmedicine . However, the American Academy of Family Physicians notes that paroxetine in particular "should be avoided by pregnant women" and that "abrupt discontinuation of this drug is associated with withdrawal symptoms and a high rate of relapse," meaning discontinuation information should be followed carefullyACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation | AAFPaafp .
The evidence does not support routine third-trimester discontinuation to prevent neonatal adaptation syndrome. Clinicians who advise stopping medication in the third trimester significantly increase the risk for maternal mental illness relapseHow can depression in pregnancy be treated?youtube . Given that PNAS is time-limited, self-resolving, and rarely requires intensive intervention, the risk-benefit calculation favors continued treatment in most cases.
Guidelines increasingly emphasize shared decision-making for antidepressant management during pregnancy. Research on this decision-making process found that participants navigated among three clusters of activities: seeking information, making sense of information, and self-soothingFull article: Development of the Creating Comfort in Choice Theory of Decision Making Regarding Antidepressant Use in Pregnancy: “The Biggest Decision I’ve Ever Made”tandfonline . Providing information alone is insufficient; clinicians must support patients in processing information and managing emotions related to the decisionFull article: Development of the Creating Comfort in Choice Theory of Decision Making Regarding Antidepressant Use in Pregnancy: “The Biggest Decision I’ve Ever Made”tandfonline .
Clinical practice guidelines emphasize that healthcare providers should support patients in shared decision-making guided by relational autonomy, rather than informed decision-making guided by individual autonomy aloneFull article: Development of the Creating Comfort in Choice Theory of Decision Making Regarding Antidepressant Use in Pregnancy: “The Biggest Decision I’ve Ever Made”tandfonline .
Decision aids have shown promise in this context. A systematic review of 86 randomized controlled trials found that decision aids result in knowledge gains, increased confidence, more active patient involvement, and in many situations, more conservative treatment choices by informed patientsThe steps involved in deprescribing – shared decision-making with patientsyoutube . However, uncertainty remains about effects on adherence, cost-effectiveness, and use with low-literacy populationsThe steps involved in deprescribing – shared decision-making with patientsyoutube .
Online decision tools for antidepressant use in pregnancy are being developed and tested. These tools provide information about depression and pregnancy risks and benefits of treatment options, help patients identify which considerations are most important to them, and can be shared with prescribing cliniciansPatient Decision Aid for Antidepressant Use in Pregnancyyoutube .
The international guideline comparison reveals fundamental differences in regulatory philosophy. ACOG recommends antidepressants as preferred initial therapy regardless of severity, while most other guidelines (NICE, CANMAT, European societies) recommend psychotherapy for mild to moderate cases and reserve antidepressants for severe depression Guidelines on treatment of perinatal depression with antidepressants: An international review - PMC nih .
Medication preferences also diverge. CANMAT and Danish guidelines prefer sertraline and citalopram, while multiple guidelines (ACOG, APA, BC Canada, Dutch, Norwegian, Scottish) specifically designate paroxetine as non-preferred Guidelines on treatment of perinatal depression with antidepressants: An international review - PMC nih .
The February 2025 FDA panel controversy highlights how the same evidence base can be interpreted differently depending on expert composition and perspective. Concerns were raised that panelists "were really rousing concerns about safety that are not evidence-based or established and not at all balanced with concerns about the risks of untreated depression"FDA panel promotes misinformation about antidepressants during pregnancy, psychiatrists saynbcnews .
Despite differences, several areas of international consensus emerge:
Evidence supports revising guidelines to:
Current evidence suggests labeling should:
Progress toward harmonization requires:
The evidence base indicates that the risks of antidepressant discontinuation during pregnancy—particularly for women with severe or recurrent depression—often exceed the generally manageable risks of continued treatment. Guidelines, labeling, and regulatory approaches should reflect this balance while supporting individualized decision-making that accounts for severity, treatment history, and patient preferences.