Impact of pregnancy on antidepressant treatment course: a population-based comparative cohort study in France

Bénard‐Laribière, Anne; Pambrun, Élodie; Sutter-Dallay, Anne-Laure; Gautier, Sophie; Hurault‐Delarue, Caroline; Damase‐Michel, Christine; Lacroix, Isabelle; Pariente, Alexandre

doi:10.1007/s00737-020-01033-z

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…This interruption pattern suggests a lack of compliance in pregnancy due to fear of teratogenic drug effects on the unborn child and/or a potential relapse due to discontinuation. 13 The interrupters in our population, however, started to resume their treatment after delivery potentially because reinitiating antidepressants in late pregnancy is not recommended. 4 Unlike non-pregnant women, pregnant women might also consult with their obstetricians and gynaecologists for depression/anxiety, which potentially explains the decrease in the consultations with GPs and psychiatric specialists for these conditions.…”

Section: Discussionmentioning

confidence: 93%

“…[6][7][8] Antidepressant treatment discontinuation is highly prevalent (approximately 50%) in pregnant women, especially before the time of conception. [9][10][11][12][13] The discontinuation of antidepressant medications in pregnant women with major depression is associated with risk of relapse and postpartum depression for the mothers and several adverse consequences for the developing neonates. [14][15][16] A recent study using interrupted time-series analysis (ITSA) visualized a sudden decline in prescription fills for antidepressants (from 1500 to 500 prescription fills per week) starting two to five weeks into pregnancy among prevalent users in Norway.…”

Section: Introductionmentioning

confidence: 99%

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Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: an interrupted time-series analysis

Trinh

Nordeng

Bandoli

et al. 2021

Preprint

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Objectives To assess mental health care utilization patterns during and after pregnancy in women with depression and/or anxiety in Norway according to antidepressant fill trajectories in pregnancy. Method We conducted a registry-linkage cohort study of pregnancies within women having outpatient visit for depression and/or anxiety and antidepressant fills in the six months prior to pregnancy identified from four national registries of Norway (2009-2018). Number of consultations for depression/anxiety per 100 pregnancies as proxy of mental health care utilization were modelled using interrupted time-series analysis with first month into pregnancy and first month after delivery as interruption points. We investigated the time window including six months prior to pregnancy, eight months into pregnancy and one year postpartum. Antidepressant fill trajectories in the corresponding time window were identified using longitudinal k-means trajectory modelling. Results The cohort included 8,460 pregnancies within 8,062 women with depression/anxiety. We observed reduced mental health care utilization when pregnant women entered the course of pregnancy (negative slopes during pregnancy for all psychiatric specialists and psychologists). The declines were observed for all antidepressant fill trajectories (i.e., discontinuers and continuers) except interrupters (i.e., discontinued then resumed treatment). We found increased mental health care utilization in the postpartum year, notably in interrupters (positive slopes in consultation rates with specialists of outpatient clinics and public-contracted psychiatrists).. Conclusions Pregnancy was associated with reduced mental health care utilization regardless of whether antidepressant treatment was maintained during pregnancy or not. Increases in mental health care utilization were observed in the postpartum year, especially in interrupters.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: an interrupted time-series analysis

Trinh

Nordeng

Bandoli

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…It can adversely impact the critical period of fetus' early brain development [5][6][7] and is associated with poor cognitive and emotional development and behavioral problems in later life [1,8,9]. Yet, women who are depressed are less likely to seek help and the majority do not receive treatment [10,11]. Turkey has attained significant improvements in provision of mental health care services, through their Mental Health Action Plan, initiated in 2006 and later updated for 2020-2023 [12].…”

Section: Introductionmentioning

confidence: 99%

Delivering the Thinking Healthy Programme as a universal group intervention integrated into routine antenatal care: a randomized-controlled pilot study

et al. 2023

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Background Women with perinatal depression and their children are at increased risk of poor health outcomes. There is a need to implement non-stigmatizing interventions into existing health systems which reduce psychosocial distress during pregnancy and prevent perinatal depression. We adapted the WHO-endorsed Thinking Healthy Programme (THP) to be delivered universally to all women attending routine online pregnancy schools in Istanbul, Turkey. This study aimed to evaluate the feasibility and acceptability of this intervention. Methods This mixed-methods study incorporated a two-arm pilot randomized controlled trial and qualitative evaluation of the feasibility and acceptability of the adapted THP – Brief Group version (THP-BGV) to a range of stakeholders. We recruited pregnant women at 12-30 weeks’ gestation through pregnancy schools within the University Hospital’s catchment area. Women in the intervention arm received five online sessions of the THP-BGV delivered by antenatal nurses. The intervention employed principles of cognitive behaviour therapy to provide psychoeducation, behaviour activation, problem-solving strategies and group support to participants. In the control arm, women received usual care consisting of routine online educational pregnancy classes aided by the antenatal nurses. The women were assessed for depressive symptoms with the Edinburgh Postnatal Depression Scale at baseline and 4-6 weeks post-intervention and also evaluated for anxiety, perceived social support, partner relationship, level of disability and sleep quality. In-depth interviews were conducted with women and other key stakeholders. Results Of the 99 consecutive women referred to the pregnancy schools, 91 (91.9%) were eligible and 88 (88.8%) consented to participate in the study and were randomized. Eighty-two (83%) completed the final assessments. Our main findings were that this preventive group intervention was feasible to be integrated into routine antenatal educational classes and it was valued by the women and delivery-agents. While the study was not powered to detect differences between intervention and control conditions, we found small trends towards reduction in anxiety and depressive symptoms favoring the intervention arm. No serious adverse events were reported. Conclusions Given the paucity of preventive interventions for perinatal depression in low and middle-income countries, a fully powered definitive randomized controlled trial of this feasible and acceptable intervention should be conducted. Trial registration The study was registered at Clinical Trails.gov (NCT04819711) (Registration Date: 29/03/2021).

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“…It can adversely impact the critical period of fetus' early brain development [5,6,7] and is associated with poor cognitive and emotional development and behavioral problems in later life [8,9,10]. Yet, women who are depressed are less likely to seek help and the majority do not receive treatment [11,12]. Turkey has attained signi cant improvements in provision of mental health care services, through their Mental Health Action Plan, initiated in 2006 and later updated for 2020-2023 [13].…”

Section: Introductionmentioning

confidence: 99%

Delivering the Thinking Healthy Programme as a universal group intervention integrated into routine antenatal care: a randomized-controlled pilot study

Boran

Dönmez

Baris

et al. 2022

Preprint

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Background Women with perinatal depression and their children are at increased risk of poor health outcomes. There is a need to implement non-stigmatizing interventions into existing health systems which reduce psychosocial distress during pregnancy and prevent perinatal depression. We adapted the WHO-endorsed Thinking Healthy Programme (THP) to be delivered universally to all women attending routine online pregnancy schools in Istanbul, Turkey. This study aimed to evaluate the feasibility and acceptability of this intervention. Methods This mixed-methods study incorporated a two-arm pilot randomized controlled trial and qualitative evaluation of the feasibility and acceptability of the adapted THP – Brief Group version (THP-BGV) to a range of stakeholders. We recruited pregnant women at 12-30 weeks’ gestation through pregnancy schools within the University Hospital’s catchment area. Women in the intervention arm received five online sessions of the THP-BGV delivered by antenatal nurses. The intervention employed principles of cognitive behaviour therapy to provide psychoeducation, behaviour activation, problem-solving strategies and group support to participants. In the control arm, women received usual care consisting of routine online educational pregnancy classes aided by the antenatal nurses. The women were assessed for depressive symptoms with the Edinburgh Postnatal Depression Scale at baseline and 4-6 weeks post-intervention and also evaluated for anxiety, perceived social support, partner relationship, level of disability and sleep quality. In-depth interviews were conducted with women and other key stakeholders. Results Of the 99 consecutive women referred to the pregnancy schools, 91 (91.9%) were eligible and 88 (88.8%) consented to participate in the study and were randomized. Eighty-two (83%) completed the final assessments. Our main findings were that this preventive group intervention was feasible to be integrated into routine antenatal educational classes and it was valued by the women and delivery-agents. While the study was not powered to detect differences between intervention and control conditions, we found small trends towards reduction in anxiety and depressive symptoms favoring the intervention arm. No serious adverse events were reported. Conclusions: Given the paucity of preventive interventions for perinatal depression in low and middle-income countries, a fully powered definitive randomized controlled trial of this feasible and acceptable intervention should be conducted. Trial registration: The study was registered at Clinical Trails.gov (NCT04819711) (Registration Date: 29/03/2021).

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Impact of pregnancy on antidepressant treatment course: a population-based comparative cohort study in France

Cited by 5 publications

References 17 publications

Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: an interrupted time-series analysis

Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: an interrupted time-series analysis

Delivering the Thinking Healthy Programme as a universal group intervention integrated into routine antenatal care: a randomized-controlled pilot study

Delivering the Thinking Healthy Programme as a universal group intervention integrated into routine antenatal care: a randomized-controlled pilot study

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