Factors associated with re-initiation of antidepressant treatment following discontinuation during pregnancy: a register
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ORIGINAL ARTICLE
Factors associated with re-initiation of antidepressant treatment following discontinuation during pregnancy: a register-based cohort study Anna Wikman 1 & Alkistis Skalkidou 1 & Anna-Karin Wikström 1 & Erik Lampa 2 & Michael S. Kramer 3,4 & Eu-Leong Yong 4 & Charlotte Skoglund 5 & Neill Epperson 6 & Inger Sundström-Poromaa 1 Received: 8 April 2020 / Accepted: 23 June 2020 # The Author(s) 2020
Abstract Antidepressant treatment when facing a pregnancy is an important issue for many women and their physicians. We hypothesized that women with a greater burden of pre-pregnancy psychiatric illness would be more likely to re-initiate antidepressants following discontinuation of treatment during pregnancy. A register-based cohort study was carried out including 38,595 women who gave birth between the 1st of January 2007 and the 31st of December 2014, who had filled a prescription for an antidepressant medication in the year prior to conception. Logistic regressions were used to explore associations between maternal characteristics and antidepressant treatment discontinuation or re-initiation during pregnancy. Most women discontinued antidepressant treatment during pregnancy (n = 29,095, 75.4%), of whom nearly 12% (n = 3434, 11.8%) re-initiated treatment during pregnancy. In adjusted analyses, parous women (aOR 1.22, 95% CI 1.12–1.33), with high educational level (aOR 1.21, 95% CI 1.08–1.36); born within the EU (excluding Nordic countries, aOR 1.41, 95% CI 1.03–1.92) or a Nordic country (aOR 1.42, 95% CI 1.22–1.65); who more often reported prior hospitalizations due to psychiatric disorders (aOR 1.50, 95% CI 1.10–2.03, for three or more episodes); and had longer duration of pre-pregnancy antidepressant use (aOR 6.10, 95% CI 5.48–6.77, for >2 years antidepressant use), were more likely to re-initiate antidepressants than were women who remained off treatment. Women with a greater burden of pre-pregnancy psychiatric illness were more likely to re-initiate antidepressants. Thus, pre-pregnancy psychiatric history may be particularly important for weighing the risks and benefits of discontinuing antidepressants during pregnancy. Keywords Mental health . Peripartum depression . Pregnancy . Antidepressants
Introduction * Anna Wikman [email protected] 1
Department of Women’ and Children’s Health, Uppsala University, Uppsala, Sweden
2
Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
3
Departments of Epidemiology, Biostatistics & Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
4
Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, Singapore
5
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
6
Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
Psychiatric disorders in the perinatal period are common (Howard et al. 2014; Vesga-Lopez et al. 2008), and approximately 12% of pregnant women experience perinata
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