Stopping Antidepressants Cold Turkey While Pregnant

What does the evidence say about stopping antidepressants cold turkey during pregnancy?

1. Withdrawal symptoms occur in at least one-third of patients who stop an antidepressant, with common symptoms including anxiety, dizziness, headache, insomnia, irritability, nausea, tremor, and flu-like sensations; one to two-thirds of people have at least one new symptom when stopping abruptly. 1
2. If someone wants to stop an antidepressant during pregnancy, tapering the dose over at least one week is recommended to reduce the chance of withdrawal symptoms, rather than stopping all at once. 2
3. One frequently cited study found that 75% of women with a history of depression who stopped their antidepressant right before or at conception had a relapse during pregnancy, most often in the first trimester, though the study did not separate true relapse from withdrawal-related symptoms, so the relapse rate specific to abrupt stopping may be somewhat lower than that figure alone suggests. 2
4. A Denmark-based study following thousands of matched pairs found that stopping antidepressants during pregnancy, as opposed to before pregnancy, was associated with a higher rate of psychiatric emergencies (5.0% versus 3.7% for those who continued), though the study also noted that 95% of the women who discontinued did not have a psychiatric emergency. 3
5. A review of antidepressant use during pregnancy documents real risks from untreated depression itself, including impaired maternal weight gain and higher rates of preterm birth, and specifically advises against abruptly stopping antidepressants in the third trimester, since doing so has not been shown to reduce newborn withdrawal symptoms and can raise the risk of a relapse. 4

Is stopping antidepressants cold turkey safe in each trimester?

• First trimester. Relapse risk after stopping an antidepressant appears highest in the first trimester in the studies that have looked at timing, one reason providers generally recommend planning any medication changes before conception rather than during early pregnancy.
• Second trimester. By the second trimester, the priority is stability. If a taper is being considered, doing it gradually under medical supervision, rather than all at once, is the standard recommendation throughout pregnancy.
• Third trimester. Stopping an antidepressant abruptly in the third trimester specifically has not been shown to reduce newborn withdrawal symptoms after birth, and it carries a real risk of relapse or postpartum depression, so this is generally the trimester where continuing medication is favored over a late change.