Disparities in antidepressant use in pregnancy

Abstract

BackgroundThe American College of Obstetricians and Gynecologists and the American Psychiatric Association both recommend pharmacotherapy for perinatal depression when the benefits outweigh the risks. While minority adults are less likely to use antidepressant medications compared to Non-Hispanic Whites, whether this pattern occurs among pregnant women is unclear.ObjectiveWe sought to determine the frequency of antidepressant medication use reported during ambulatory care visits for pregnant women and whether these rates varied by race.MethodsWe combined the 2006–2010 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to obtain nationally representative estimates of outpatient preventive care visits for pregnant women. We then obtained estimates of the prevalence of reported depression and antidepressant use during outpatient visits for pregnant women. To determine whether these estimates varied by race, we used multivariable logistic regression analyses accounting for survey design using SAS 9.2 (PROC SURVEYLOGISTIC) to estimate odds ratios of reported antidepressant use after adjustment for age, insurance status and region of the country.ResultsAntidepressant use was reported during 2.2% of all outpatient visits for pregnant women. Providers indicated a depression diagnosis in 4.5% of visits. Among visits for depressed pregnant women, providers reported antidepressant use 25.4% of the time for all visits. Antidepressant use during pregnancy varied significantly by race/ethnicity. Among visits for Non-Hispanic White women, 3.1% included a code for antidepressant use vs. just 1.0% for Non-White women (P<0.0001). After adjustment for age, insurance status, and region of the country, this association persisted with Non-Hispanic White (vs. Non-White) pregnant women having higher odds of antidepressant use (adjusted OR 3.3, 95% CI 2.1, 5.3).ConclusionNon-Hispanic White women were more likely than Non-White women to be using antidepressants during pregnancy. Whether differences in antidepressant use by race/ethnicity indicates over-treatment of non-Hispanic White women or under-treatment of minorities remains unclear. This disparity warrants investigation with the goal of optimizing maternal mental health while minimizing potential adverse sequelae of antidepressants on developing fetuses.

Thalamocortical functional connectivity and behavioral disruptions in neonates with prenatal cocaine exposure

“…Consistent with our findings, antidepressant drugs have been shown to enhance cocaine-induced toxicity (Macedo et al, 2004; O'Dell et al, 2000) and the manipulation of the serotonin system has been shown to alter, and often enhance, the behavioral effects of cocaine in animal models (Muller et al, 2003; Walsh and Cunningham, 1997). Given the common practice of SSRI prescription for depressed pregnant women with drug dependence (Yamamoto et al, 2014), the discovered interaction may have significant clinical implications.…”

Prenatal Depression Risk Factors, Developmental Effects and Interventions: A Review

“…In another study the effects of yoga (physical poses) and peer support group (verbal interaction) were compared on pregnancy and postpartum measures [66,67]. At the end of the first and last sessions the yoga group as compared to the peer support group reported less depression, anxiety, anger and leg and back pain.…”

Predicting Factors of Depression, Antidepressant Use and Positive Response to Antidepressants in Perinatal and Postpartum Women

“…The prevalence of using antidepressants in this study was much higher than in previous studies, in which the prevalence of using antidepressants during the perinatal and postpartum periods ranged from 3.1% to 13.4% [19, 34-36]. In previous studies, the entire pregnant and postpartum populations were investigated, and the researchers did not focus on those with depression symptoms as our study did.…”