Pregnant Women May Not Be Getting the Depression Care They Need
Insurance claims data highlight a critical treatment gap.
- By
- July 03, 2025
- CBR - Health Care
Depression is one of the most common mental health disorders in the world, and women who are pregnant or have just given birth are at a greater-than-average risk of developing the condition. For them, as well as women who go into pregnancy with depression, treatment is particularly crucial, given that maternal depression can affect both mother and child.
But some of these women are not getting the care they need, suggests research by McGill University’s Claire Boone, Stanford PhD student Carla Colina, and Chicago Booth’s Devin G. Pope.
The researchers turned to insurance claims data to understand trends in the use of antidepressants and psychotherapy leading up to, during, and after pregnancy.
They looked at private-health-insurance claims made by more than 385,000 women from two years before they had a child to two years after, and then tallied the number of antidepressant prescriptions filled along with psychotherapy claims made by both the women and their spouses over the four-year period.
In the year before pregnancy, about 4 percent of women had an antidepressant prescription filled. But during pregnancy, the number dropped by nearly half. The spouses of the pregnant women did not show the same pattern, suggesting that the decline wasn’t due to external events such as relocation.
And it doesn’t seem as though women replaced medication with psychotherapy—those claims did not increase. The researchers conclude that some women with depression may not have received treatment for it during pregnancy.
Turning away from treatment
The researchers find that antidepressant use among women who became pregnant dropped by nearly half and psychotherapy visits also fell during the span of their pregnancy. The women’s spouses didn’t exhibit the same pattern, providing an indication that the fall in the use of antidepressants and therapy was pregnancy related.
The rates of filling antidepressant prescriptions rose to even higher levels for women after giving birth than before pregnancy. But Boone, Colina, and Pope note a possible treatment gap. “Given the time delay for antidepressant medication to function, restarting medication after pregnancy may leave many women effectively untreated during the high-risk postnatal period,” they write.
The results could suggest that many women find antidepressants effective (as they took the medications both before and after pregnancy), but may not feel comfortable taking them while pregnant. It’s possible that the women were feeling less depressed during pregnancy or were turning to other treatment strategies, but it’s also possible that they had safety concerns. The researchers note that earlier studies have raised some flags about the effects of antidepressants during pregnancy on the fetus, though the evidence is limited.
The American College of Obstetricians and Gynecologists, in consultation with the American Psychiatric Association, recommends psychotherapy, antidepressants, or both to treat depression newly experienced during pregnancy. It does not recommend that women already taking antidepressants stop doing so. Because the decision around treatment is personal, the ACOG endorses an individualized approach and joint decision-making involving women and their doctors.
Boone, Colina, and Pope suggest something similar, especially given the long-term risks of leaving depression untreated. “We documented a large decrease in antidepressant use without an accompanying increase in psychotherapy during pregnancy,” they write. “These findings, coupled with evidence of mental health challenges during and after pregnancy, suggest the need for increased focus on and discussion about mental health treatments by pregnant women and their clinicians.”
Claire Boone, Carla Colina, and Devin G. Pope, “Antidepressant Use Before, During, and After Pregnancy,” Research Letter Obstetrics and Gynecology, JAMA Network Open, January 2025.
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