The easy misuse of antidepressants during pregnancy is depressing

Abstract

Bénard-Laribière et al. must be commended for their detailed monitoring of antidepressant prescriptions during pregnancy [1], in a Journal that has previous creditable pieces including warnings about malformations with paroxetine and fluoxetine [2]. However, we disagree with their views on potential undertreatment and the over-reassuring conclusion that treatment has been especially adapted in accordance with existing recommendations in a 'large proportion' of pregnant women.Firstly, all prescribers should always prioritize pregnancy and drug safety. However, data to ascertain the benefit:harm ratio or guide dosing are scarce. Even when available, such data are often overlooked by prescribers [3]. Very few drug registries exist to report postmarketing harms. The European Registry of Antiepileptic Drugs and Pregnancy (EURAP) is among notable exceptions.Secondly, in contrast to the authors' beliefs [1], first-line treatment should always be cognitive behavioural therapy (CBT)even for severe depression [4]. The most serious adverse effects of antidepressants, such as malformations [2] and postpartum haemorrhage [5], cannot be overlooked. Almost all antidepressant prescriptions in this particular observational series may be first-line treatments as psychotherapies are not reimbursed by the mandatory and affluent French health care system. France has overlooked evidence underpinning the Improving Access to Psychological Therapies programme launched in 2008 in England. This beacon, offering largely CBT approaches to people with anxiety or depressive diagnoses, has also been implemented in Quebec and Belgium. Limiting prescriptions to medicines only ties doctors' hands to the patients' detriment.

Reply to ‘The easy misuse of antidepressants during pregnancy is depressing’

“…We thank Braillon and Bewley [1] for their thorough reading of our article on 'Patterns of antidepressant use during pregnancy: a nationwide population-based cohort study' [2]. Aside of the important discussion they have on antiepileptic drugs that was not the subject of our research, the main comment they emitted concerned our discussion on a 'potential undertreatment and the over-reassuring conclusion that treatment has been especially adapted'.…”