Trajectories of antidepressant drugs during pregnancy: A cohort study from a community‐based sample

Abstract

The aim of this study was to monitor the trajectories of antidepressant use during pregnancy and the postpartum period among women chronically treated with antidepressants before their pregnancy, and to assess characteristics associated with each trajectory. Methods: This cohort study included all pregnant women whose data were included in the General Sample of Beneficiaries (EGB) database affiliated with the French Health Insurance System, from 2009 to 2014. Women were followed up until 6 months after childbirth. Chronic treatment was defined as exposure over the 6-month period preceding pregnancy. A group-based trajectory model (GBMT) was estimated to identify distinctive longitudinal profiles of antidepressant use. Results: Among 760 women chronically treated with antidepressants before their pregnancy, 55.8% stopped their treatment permanently in the first trimester, 20.4% discontinued it for a minimum of 3 months and resumed it postpartum, and 23.8% maintained it throughout pregnancy and postpartum. No sociodemographic or medical characteristics were associated with any trajectory group. Women who maintained treatment presented more frequent obstetric complications and postpartum psychiatric disorders. Among women who interrupted treatment, prescription of benzodiazepines and anxiolytics decreased initially but rose postpartum to a higher level than before pregnancy. Conclusions: Pregnant women treated with antidepressant require a re-evaluation of psychiatric treatment. It is necessary to pay attention to obstetric complications for severely depressed women. Additionally, as relapse was associated with increased benzodiazepine use, it is important to carefully monitor all women who stop antidepressant treatment during pregnancy.

Antidepressants are not safe during pregnancy and in women of child bearing age.

“…Cabaillot and colleagues' pharmaco-epidemiological study of antidepressants use during pregnancy in France raises a number of questions about the validity of their conclusions. (1) Firstly, what is their basis for making the claim that "[selective serotonin-norepinephrine reuptake inhibitors] appear to be safe in pregnant women"? (1) This claim ignores significant evidence to the contrary: a) the odds ratio for maternal use of serotonin reuptake inhibitor antidepressants (SRIs) (we use SRI to refer to both serotonin-norepinephrine reuptake inhibitors and so-called 'selective' serotonin reuptake inhibitors as selectivity is restricted to the experimental setting) during the first trimester of pregnancy and the presence of congenital heart defects is 1.57 (95% CI 1.25-1.97) for paroxetine, 1.36 (95% CI 1.08-1.72) for fluoxetine and 1.29 (95% CI 1.14-1.45) for sertraline.…”

Drug use during pregnancy with focus on antidepressants

“…Sertraline was the most commonly used SSRI during pregnancy, with a prevalence rate of 1.1% followed by citalopram (0.77%), fluoxetine (0.76%), paroxetine (0.56%), escitalopram (0.47%) and fluvoxamine (0.01%) (72). Many women discontinue their antidepressant drug treatment during pregnancy (78)(79)(80) most commonly due to apprehension of potential negative side effects to the foetus, health professional advice and/or symptomatology that was under control (81). 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).…”

“…Many women discontinue their antidepressant drug treatment during pregnancy (78)(79)(80) most commonly due to apprehension of potential negative side effects to the foetus, health professional advice and/or symptomatology that was under control (81). 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).…”

Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: an interrupted time-series analysis

“…[6][7][8] Antidepressant treatment discontinuation is highly prevalent (approximately 50%) in pregnant women, especially before the time of conception. [9][10][11][12][13] The discontinuation of antidepressant medications in pregnant women with major depression is associated with risk of relapse and postpartum depression for the mothers and several adverse consequences for the developing neonates. [14][15][16] A recent study using interrupted time-series analysis (ITSA) visualized a sudden decline in prescription fills for antidepressants (from 1500 to 500 prescription fills per week) starting two to five weeks into pregnancy among prevalent users in Norway.…”