Oslo, Norway—Continuing antidepressants during pregnancy instead of short-term use appears to be the better course of action for pregnant women with severe mental illnesses and currently receiving stable treatment.
That is according to a report in the Journal of the American Medical Association Psychiatry, which explains that discontinuation could lead to postpartum relapse. University of Oslo–led researchers noted that about one-half of women treated for affective disorders currently discontinue antidepressant use during pregnancy.
The study team sought to investigate the associations between longitudinal antidepressant fill trajectories during pregnancy and postpartum psychiatric outcomes. To do that, researchers conducted a cohort study using nationwide registers in Denmark and Norway. Their sample included 41,475 live-born singleton pregnancies in Denmark from 1997 to 2016 and 16,459 in Norway from 2009 to 2018 for women who filled at least one antidepressant prescription within 6 months before pregnancy.
The authors were focused on the initiation of psycholeptics, psychiatric emergencies, or records of self-harm within 1 year postpartum. The study identified:
• 31.3% of participants in Denmark and 30.4% of those in Norway as early discontinuers
• 21.5% and 27.8%, respectively, as late discontinuers (previously stable users)
• 15.9% and 18.4%, respectively, as late discontinuers (short-term users)
• 31.3% and 23.4%, respectively, as continuers.
“Early discontinuers and late discontinuers (short-term users) had a lower probability of initiating psycholeptics and having postpartum psychiatric emergencies vs. continuers,” the researchers explained. “A moderately increased probability of initiation of psycholeptics was found among late discontinuers (previously stable users) vs. continuers (HR, 1.13; 95% CI, 1.03-1.24). This increase in late discontinuers (previously stable users) was more pronounced among women with previous affective disorders (HR, 1.28; 95% CI, 1.12-1.46).” They added that no association between antidepressant fill trajectories and postpartum self-harm risk was found.
The authors pointed out that a moderately elevated probability of initiation of psycholeptics in late discontinuers (previously stable users) versus continuers was identified, adding, “These findings suggest that women with severe mental illness who are currently on stable treatment may benefit from continuing antidepressant treatment and personalized treatment counseling during pregnancy.”
Background information in the article noted that affective disorders are among the most common morbidities of pregnancy, with antidepressants being “the mainstay of treatment for moderate to severe affective disorders for adults, including women of childbearing age. For individuals who respond to pharmaceutical treatment, long-term maintenance treatment with antidepressants is often needed to prevent recurrence.”
The authors advised that the treatment of pregnant women with antidepressants is a balancing act between possible risks of untreated mental disorders versus fetal drug exposure.
The current study assessed three psychiatric outcomes during the first year after delivery from moderate-to-severe forms and included the initiation of psycholeptics, inpatient or emergency department visits for psychiatric disorders, and self-harm.
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Published March 14, 2023