Risks and benefits of pre-delivery taper in pregnant women taking antidepressants

Background: Serotonin reuptake inhibitors are commonly used for treatment of mental health problems in pregnancy but may cause neonatal adaptation syndrome. It is unknown whether reduction or discontinuation of medication prior to delivery may mitigate this effect. Methods: We present a case series of 38 women who either tapered their medication prior to delivery or maintained or increased their dose. Results: Greater reductions in maternal antidepressant dose just prior to delivery were associated with fewer admissions to the neonatal intensive care unit (NICU) for infants. There was a slightly greater increase in depressive symptoms across delivery for women who tapered, which was not statistically significant. Conclusions: NICU admissions may be less frequent among neonates whose mothers tapered their medication prior to delivery. Large prospective randomized trials are needed to further study this practice.