Factors associated with re-initiation of antidepressant treatment following discontinuation during pregnancy: a register-based cohort study

Abstract

Antidepressant treatment when facing a pregnancy is an important issue for many women and their physicians. We hypothesized that women with a greater burden of pre-pregnancy psychiatric illness would be more likely to re-initiate antidepressants following discontinuation of treatment during pregnancy. A register-based cohort study was carried out including 38,595 women who gave birth between the 1st of January 2007 and the 31st of December 2014, who had filled a prescription for an antidepressant medication in the year prior to conception. Logistic regressions were used to explore associations between maternal characteristics and antidepressant treatment discontinuation or re-initiation during pregnancy. Most women discontinued antidepressant treatment during pregnancy (n = 29,095, 75.4%), of whom nearly 12% (n = 3434, 11.8%) re-initiated treatment during pregnancy. In adjusted analyses, parous women (aOR 1.22, 95% CI 1.12–1.33), with high educational level (aOR 1.21, 95% CI 1.08–1.36); born within the EU (excluding Nordic countries, aOR 1.41, 95% CI 1.03–1.92) or a Nordic country (aOR 1.42, 95% CI 1.22–1.65); who more often reported prior hospitalizations due to psychiatric disorders (aOR 1.50, 95% CI 1.10–2.03, for three or more episodes); and had longer duration of pre-pregnancy antidepressant use (aOR 6.10, 95% CI 5.48–6.77, for >2 years antidepressant use), were more likely to re-initiate antidepressants than were women who remained off treatment. Women with a greater burden of pre-pregnancy psychiatric illness were more likely to re-initiate antidepressants. Thus, pre-pregnancy psychiatric history may be particularly important for weighing the risks and benefits of discontinuing antidepressants during pregnancy.

Antidepressant utilization patterns and predictors of treatment continuation in pregnant women: A 16-year population-based cohort

“…Another study examined pregnant women with depression diagnosis and receipt of antidepressant within 6 months pre-conception in Korea, and revealed that 95% of the cohort terminated treatment during pregnancy (Noh et al, 2022). Consistent with several previous studies investigating the relationship between maternal characteristics and prenatal antidepressant continuation (Donald et al, 2021; Hurault-Delarue et al, 2019; Molenaar et al, 2020b; Noh et al, 2022; Petersen et al, 2011; Wikman et al, 2020), our findings demonstrated that older age at conception (⩾35 years), more recent calendar year of delivery and proxies for greater illness severity were significantly associated with antidepressant continuation. In fact, some recent reports also noticed a change in prescribing practice toward continuation of antidepressant during pregnancy over the years (Molenaar et al, 2020b; Wikman et al, 2020).…”

“…To determine factors associated with continuation of antidepressants into the second trimester, an array of maternal variables was selected a priori for analysis based on findings of prior literature suggesting that age (Donald et al, 2021; Hurault-Delarue et al, 2019; Petersen et al, 2011), year of delivery (Molenaar et al, 2020b; Wikman et al, 2020), parity (Molenaar et al, 2020b), chronic physical diseases (Hurault-Delarue et al, 2019) and proxies of psychiatric illness severity (Hurault-Delarue et al, 2019; Molenaar et al, 2020b; Noh et al, 2022; Petersen et al, 2011; Wikman et al, 2020) may predict continued treatment during pregnancy. The selected variables included age at conception, calendar year of delivery, parity, physical diseases as measured by Charlson Comorbidity Index (CCI; Charlson et al, 1987; Deyo et al, 1992), pre-existing depression and anxiety disorders, other pre-existing psychiatric disorders, substance and alcohol use disorders, history of psychiatric admission within 24 months before pregnancy, cumulative antidepressant use ⩾90 days within 12–3 months pre-pregnancy, use of antipsychotics, use of mood stabilizers, and use of sedatives and hypnotics (see Supplementary Material Table S1) in 12 months pre-pregnancy, as defined by having at least one prescription of the specified psychotropics during that period.…”

“…Until now, only two studies were conducted in Asia in this respect (Ishikawa et al, 2020; Noh et al, 2022) and none in the Chinese populations. Importantly, despite complexity in weighing between the risks and benefits of prenatal antidepressant use, there is limited research assessing the patterns and predictors of antidepressant continuation versus discontinuation during pregnancy (Donald et al, 2021; Hurault-Delarue et al, 2019; Molenaar et al, 2020b; Noh et al, 2022; Wikman et al, 2020). In addition, factors associated with prenatal reinitiation of antidepressants after treatment discontinuation have rarely been investigated (Noh et al, 2022; Wikman et al, 2020).…”

Drug use during pregnancy with focus on antidepressants

“…Factors associated with treatment resumption for pregnant women in Sweden are: a greater burden of pre-pregnancy psychiatric illnesses, multipara, higher educational level and have been born in the Nordic countries or the EU. Difference in severity of the psychiatric illness prior to pregnancy could explain the divergent results in the studies above (85). Among those continuing with antidepressants, however studies have shown that the overall rate of adherence to the medication varies between 60 and 86% (86,87).…”

“…The women who discontinue their medication have a higher risk of relapsing during pregnancy compared with women who maintained their antidepressant medication (4,78,82). Discontinuation of antidepressant medication during pregnancy leads to treatment resumption in 12-57% of the cases before childbirth (75,(83)(84)(85). Factors associated with treatment resumption for pregnant women in Sweden are: a greater burden of pre-pregnancy psychiatric illnesses, multipara, higher educational level and have been born in the Nordic countries or the EU.…”