Pregnant Women With Severe Mental Illness Benefit From Continued Antidepressant Use

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There was a lower probability of initiating psycholeptics and having postpartum psychiatric emergencies in the early discontinuer and late discontinuer groups compared to the continuers.

Pregnant Women With Severe Mental Illness Benefit From Continued Antidepressant Use

Credit: Amina Filkins

New research from Scandinavia suggest pregnant women treated with antidepressants do benefit more from the continued use of the treatment.1

A team, led by Nhung T. H. Trinh, PhD, PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, investigated the associations between longitudinal antidepressant fill trajectories during pregnancy and postpartum psychiatric outcomes.

The Problem

Approximately half of women treated for affective disorders discontinue antidepressant use during pregnancy, but this discontinuation treatment during pregnancy could be beneficial.

“The treatment of pregnant women with antidepressants must balance possible risks of untreated mental disorders against fetal drug exposure,” the authors wrote. “While psychiatric disorders before and during pregnancy are known to be associated with postpartum mental health, few studies have addressed how antidepressant use before and during pregnancy influences postpartum psychiatric outcomes.”

Denmark and Norway

In the cohort study, the investigators nationwide registers in Denmark and Norway involving 41,475 live-born singleton pregnancies in Denmark between 1997-2016 and 16,459 live-born singleton pregnancies in Norway between 2009-2018 for women who filled at least 1 antidepressant prescription within 6 months prior to pregnancy.

The team obtained data on antidepressant prescription fills from the prescription registers and modeled antidepressant treatment during pregnancy using the k-means longitudinal method.

The investigators sought main outcomes of the initiation of psycholeptics, psychiatric emergencies, or records of self-harm within 1 year post-partum.

The maternal age was 30.7 years in Denmark and 29.9 years in Norway.

Antidepressant Trajectories

The results identified 4 clear antidepressant trajectories. There were early discontinuers (31.3% and 30.4% of the included pregnancies in Denmark and Norway, respectively), late discontinuers (previously stable users) (21.5% and 27.8%), late discontinuers (short-term users) (15.9% and 18.4%), and continuers (31.3% and 23.4%).

There was a lower probability of initiating psycholeptics and having postpartum psychiatric emergencies in the early discontinuer and late discontinuer groups compared to the continuers.

There was also an increase, albeit moderate, in the probability of initiating of psycholeptics in the group of late discontinuers compared to continuers (hazard ratios [HR], 1.13; 95% confidence interval [CI], 1.03-1.24), which was more pronounced among women with previous affective disorders (HR, 1.28; 95% CI, 1.12-1.46).

Finally, no association was found between antidepressant fill trajectories and postpartum self-harm.

“Based on pooled data from Denmark and Norway, a moderately elevated probability of initiation of psycholeptics in late discontinuers (previously stable users) vs continuers was found,” the authors wrote. “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.”

References:

Trinh NTH, Munk-Olsen T, Wray NR, et al. Timing of Antidepressant Discontinuation During Pregnancy and Postpartum Psychiatric Outcomes in Denmark and Norway. JAMA Psychiatry. Published online March 08, 2023. doi:10.1001/jamapsychiatry.2023.0041

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