Kelly B. Zafman, MD, MSCR, on the risks of stopping antidepressants during pregnancy – Contemporary OB/GYN

Lead

In a recent Contemporary OB/GYN short, Kelly B. Zafman, MD, MSCR, outlined clinical concerns when pregnant patients discontinue antidepressant medication. She emphasized the elevated risk of depressive relapse and the potential downstream effects on maternal functioning and perinatal outcomes. The interview frames medication decisions as individualized risk–benefit conversations between patients and clinicians. Separately, Christina Paidas Teefey, MD, shared optimism about emerging maternal-fetal medicine topics at SMFM’s 2026 meeting that are shaping how providers approach these trade-offs.

Key Takeaways

• Kelly B. Zafman, MD, MSCR, warns abrupt stopping of antidepressants in pregnancy increases the likelihood of depressive relapse, which can require urgent psychiatric care.
• Unmanaged maternal depression is associated with worsened prenatal care engagement and has been linked in the literature to higher risks of preterm birth and low birth weight.
• Continuing antidepressant treatment may raise concerns about neonatal adaptation symptoms, but abrupt discontinuation carries immediate maternal health risks that often outweigh those neonatal risks.
• Decisions about continuation should use shared decision-making, incorporating psychiatric history, illness severity, prior relapse on discontinuation, and patient preferences.
• Nonpharmacologic options—therapy, enhanced monitoring, social supports—are important complements but may not fully substitute for pharmacotherapy in moderate-to-severe illness.
• At SMFM 2026, experts including Christina Paidas Teefey, MD, highlighted perinatal mental health as a rising priority for interdisciplinary research and clinical guidelines.

Background

Perinatal depression affects a significant portion of pregnant and postpartum people and carries established risks for both maternal and neonatal health when untreated. Clinical guidelines emphasize screening and tailored treatment plans because untreated mood disorders can impair self-care, prenatal visit adherence, and the ability to follow medical recommendations. Antidepressants—most commonly SSRIs—are frequently used before conception; clinicians and patients must weigh the risks of fetal drug exposure against the risks of maternal relapse if medication is stopped.

Historically, clinical practice has varied widely: some patients and providers prefer preemptive continuation to prevent relapse, while others opt for tapering to minimize fetal pharmacologic exposure. Evidence syntheses and cohort studies have documented associations between both untreated depression and certain medications with adverse outcomes, leaving a nuanced trade-off rather than a one-size-fits-all answer. That nuance underlies Zafman’s message: decisions should be individualized and grounded in a patient’s psychiatric history and values.

Main Event

In the Contemporary OB/GYN short, Zafman described clinical encounters in which patients ask whether they should stop antidepressants when they learn they are pregnant. She stressed that abrupt discontinuation often precipitates symptom recurrence, with some patients developing severe depressive episodes during pregnancy. Zafman noted that relapse can lead to increased emergency visits, need for inpatient psychiatric care, or initiation of higher-dose or additional psychotropic medications later in pregnancy.

She discussed practical clinical steps: review prior illness course, document number and severity of past episodes, assess response to medication, and consider prior outcomes when discontinuation was attempted. Zafman recommended a gradual taper when discontinuation is clinically chosen and close follow-up with mental health services, including crisis planning and frequent monitoring for early signs of relapse. She also urged coordination between obstetric and psychiatric teams to ensure both maternal safety and fetal monitoring are optimized.

The short also touched on patient counseling language: providers should present the relative likelihoods and possible consequences of both continuing and stopping medication, emphasize available nonpharmacologic supports, and record the shared decision-making process in the medical record. Christina Paidas Teefey, MD, speaking separately about SMFM 2026, framed these discussions within a broader trend: maternal mental health is gaining interdisciplinary attention and new evidence is expected to inform practice in coming years.

Analysis & Implications

Clinically, the central implication is that the maternal risk of relapse after stopping antidepressants can be immediate and substantial for some patients, and this risk must be balanced against the potential neonatal effects of in utero exposure. For individuals with a history of severe, recurrent depression or prior relapse on discontinuation, continuing medication through pregnancy is often the safer course to protect maternal mental health and functioning. Conversely, patients with a single, mild episode remote in time may reasonably consider tapering under close supervision.

For obstetric practice and health systems, the episode underscores the need to integrate psychiatric expertise into prenatal care pathways. Routine screening alone is insufficient; systems must ensure rapid access to perinatal psychiatry, psychotherapy, and crisis services. SMFM’s emphasis on perinatal mental health in 2026 suggests institutional momentum toward better referral networks, standardized counseling tools, and research investments to clarify long-term outcomes.

From a research and policy standpoint, gaps remain in high-quality randomized data comparing continuation versus discontinuation in well-characterized populations. Observational studies provide signals but are vulnerable to confounding by indication. Future observational designs with careful control for illness severity and prospective registries could help refine absolute risks for maternal and neonatal outcomes and guide guideline development.

Comparison & Data

The table summarizes qualitative trade-offs commonly discussed in clinical guidance and in Zafman’s interview. While absolute numeric risk estimates vary by diagnosis, medication class, and individual history, the clinical pattern is consistent: continuation reduces maternal relapse risk, while discontinuation reduces drug exposure but raises relapse probability. Providers should contextualize these qualitative comparisons for each patient and document the rationale for the chosen path.

Reactions & Quotes

Clinical leaders and attendees at SMFM 2026 described growing awareness of perinatal mental health as central to obstetric outcomes. Below are representative remarks and their context.

“Abruptly stopping antidepressants can precipitate a relapse that endangers both maternal wellbeing and continuity of prenatal care.”

Kelly B. Zafman, MD, MSCR (Contemporary OB/GYN interview)

The citation summarizes Zafman’s clinical emphasis on relapse risk and the practical consequences for prenatal care engagement and safety planning.

“SMFM 2026 highlighted perinatal mental health research as a top priority—teams want clearer data to guide these nuanced treatment decisions.”

Christina Paidas Teefey, MD (SMFM 2026 remarks)

Teefey’s comment reflects the meeting’s focus on cross-disciplinary evidence generation and the need for implementable clinical tools for shared decision-making.

Unconfirmed

• Exact comparative rates of neonatal complications for every specific antidepressant in pregnancy remain under study and vary across datasets.
• Long-term neurodevelopmental differences attributable solely to in utero antidepressant exposure, independent of maternal illness effects, are not definitively established.
• The relative benefit of abrupt versus gradual taper for specific patient subgroups lacks randomized trial evidence and is based primarily on observational data and expert consensus.

Bottom Line

The clinical takeaway from Kelly Zafman’s interview is straightforward: stopping antidepressants during pregnancy can meaningfully increase the risk of maternal relapse, and that risk should be a primary consideration in counseling. Decisions should be individualized—grounded in a patient’s psychiatric history, current symptom severity, and preferences—and made within a coordinated obstetric and mental health care plan.

For clinicians, the practical actions are to screen systematically, document the shared decision-making conversation, arrange timely psychiatric follow-up if discontinuation is attempted, and ensure contingency plans for symptom recurrence. For policymakers and researchers, SMFM 2026’s emphasis on perinatal mental health highlights the need for better prospective data and implementation strategies to support these complex clinical choices.

Sources

• Contemporary OB/GYN — Short interview with Kelly B. Zafman, MD, MSCR (media)
• Society for Maternal-Fetal Medicine (SMFM) — 2026 meeting materials and program highlights (professional society)
• American College of Obstetricians and Gynecologists (ACOG) — practice opinions and committee guidance on perinatal mood disorders (professional guideline)