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Use of antidepressants decreases among pregnant women without a corresponding increase in psychotherapy, according to results of a cohort study published as a Research Letter in JAMA Network Open.
Risk for depression throughout a woman’s life peaks during and after pregnancy, particularly among women with a history of depression. While there are certain safety risks to taking antidepressants during pregnancy, untreated depression can also have lasting consequences for mother and child.
Researchers from McGill University in Canada and the University of Chicago Booth School of Business in the United States (US) sourced data for this study from the Merative MarketScan Research Databases, which houses medical data from individuals with private insurance in the US. Women who gave birth between 2011 and 2017 and their spouses were evaluated for use of antidepressant medications and psychotherapy 2 years before and 2 years after delivery. Spouses were included if the spouse was on the same insurance. The primary outcome was whether women received current guideline recommended treatment for depression in pregnancy, which is to substitute antidepressant medication with psychotherapy.
The final study included 385,731 women and 217,877 spouses. The women were aged mean (SD) 31.8 (5.4) years at delivery, 74.8% were employed, and they had a mean (SD) income of $84,577 ($39,676).
A total of 4.3% of women filled a prescription for an antidepressant in the year before their pregnancy and 2.2% filled an antidepressant prescription during their pregnancy, equating to a 48.8% reduction in antidepressant use during pregnancy. No corresponding reduction in antidepressant use during pregnancy was observed among their spouses, suggesting that antidepressant discontinuation was not related with home life. Furthermore, antidepressant prescription fills returned to pre-pregnancy rates among women within 1 month of delivery. However, the researchers noted that, given the time delay in antidepressant functioning, this may leave many women essentially untreated during a high-risk period.
No increase in psychotherapy was observed during the period of antidepressant discontinuation during pregnancy. Instead, a slight decrease in psychotherapy use was also observed during pregnancy.
The study authors concluded, “[W]e documented a large decrease in antidepressant use without an accompanying increase in psychotherapy during pregnancy. These findings, coupled with evidence of mental health challenges during and after pregnancy, suggest the need for increased focus on and discussion about mental health treatments by pregnant women and their clinicians.”
This study was limited by not having access to data about medication adherence or motivation for discontinuing antidepressant use during pregnancy.
This article originally appeared on Psychiatry Advisor
