New research from Scandinavia suggests that women suffering from severe mental illness may be able continue their pharmacotherapy even if they are already on antidepressant therapy.
Inputting JAMA Psychiatry, Nhung Trinh, PhD, of the PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, at the University of Oslo and colleagues note that approximately one-half of women who are being treated for an affective disorder elect to stop antidepressant therapy during pregnancy, a decision that may have benefits but that also poses the risk for relapse after giving birth.
“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.” The small number of studies that have been conducted have yielded conflicting results, they add.
“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.”
Trinh, Australia, New York, Denmark and the Netherlands collaborated further to analyze the relationships between longitudinal antidepressant prescription-fill trajectories during pregnancy, and postpartum psychoiatric outcomes in large Scandinavian cohorts.
Investigators used population-based records in Denmark and Norway to obtain the data. These registers included both medical and prescription birth registers. The study identified 41 475 singleton live-born pregnancies between 1997 and 2016, in Denmark, and 16 459 singleton live-born pregnancies between 2009-2018 in Norway for women who had filled at least one antidepressant prescription in the 6 months preceding pregnancy. According to the authors, the average maternal age was 30.7 in Denmark and 29.9 in Norway.
The team obtained data from the Danish National Prescription Register, Norwegian Prescription Database, and the Danish National Prescription Register on antidepressant prescription fills. In each country, they used the k-means longitudinal (KmL), data trajectory modeling method to antidepressant treatment starting at 6 months before pregnancy and ending at 37 weeks gestational.
The researchers’ primary outcomes of interest were initiation of psycholeptics, psychiatric emergencies, or records of self-harm within 1-year post-partum.
Trinh and colleagues used the four antidepressant fill routes identified (at right) to find the following distribution for pregnancies in Denmark, Norway, and Sweden.
- Early discontinuers: 31.3% & 30.4%
- Late discontinuers (previously stable user) 21.5% & 27.8%
- Late discontinuers (short-term user) 15.9% and 18.4%
- Continue reading: 31.3%, 23.4%
Their analysis revealed that the probability of initiating psycholeptics or having postpartum mental emergencies in the early and late discontinuer groups was lower than the continuers.
The investigators noticed a moderately higher probability of initiating psycholeptics in late discontinuers than among continuers (hazard rate). [HR] 1.13, 95%CI. 1.03-1.24). This difference was more prominent among participants with past affective disorders (HR. 1.28, 95%CI. 1.12-1.46).
They also stated that there was no association between antidepressant fill tracks and postpartum depression.
The authors point out that because the analysis of self-harm risk relied only on Danish data, it was difficult to draw accurate conclusions due to the small sample size. Even though several variables were included as proxies of disease severity, there may be residual confounding from treatment indications.
“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.”
Reference: Trinh NTH, Munk-Olsen T, Wray NR, et al. The timing of antidepressant discontinuation in pregnancy and postpartum mental outcomes in Denmark/Norway JAMA Psychiatry. Published online March 08, 2023. doi:10.1001/jamapsychiatry.2023.0041
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