Unplanned pregnancy and discontinuation of SSRIs in pregnant women with previously treated affective disorder

Roca, A.; Imaz, M.L.; Torres, Anna; Plaza, A.; Subirà, Susana; Valdés, Manuel; Martín‐Santos, Rocío; García-Esteve, Luisa

doi:10.1016/j.jad.2013.02.040

Cited by 41 publications

(30 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The dominance of questions about chronic medication use, for example antidepressants, together with fertility as a strong driver for concern, suggests a need for counselling women on the risk‐benefit of their chronic medication during their childbearing years. As many pregnancies are unplanned, discussing the importance of continuing medication to all women of childbearing age can avoid abrupt discontinuation of treatment when a woman first learns that she is pregnant …”

Section: Discussionmentioning

confidence: 99%

Women's questions about medicines in pregnancy – An analysis of calls to an Australian national medicines call centre

Pijpers

Kreijkamp-Kaspers

McGuire

et al. 2016

Aust NZ J Obst Gynaeco

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Women's questions about medicines in pregnancy – An analysis of calls to an Australian national medicines call centre

Pijpers

Kreijkamp-Kaspers

McGuire

et al. 2016

Aust NZ J Obst Gynaeco

View full text Add to dashboard Cite

show abstract

“…Another study followed 70 women who discontinued antidepressants, and of these, 40 (57%) restarted treatment, almost half in the first trimester of pregnancy. 43 The major determinant of treatment reintroduction was relapse of the disorder, as noted from women who scored higher on depression and anxiety measures in cases where treatment was reintroduced. 39 Lithium and other mood stabilisers may on the other hand be introduced for preventative measures rather than to treat relapse.…”

Section: Introductionmentioning

confidence: 99%

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

133

View full text Add to dashboard Cite

BackgroundAlthough many women treated with psychotropic medication become pregnant, no psychotropic medication has been licensed for use in pregnancy. This leaves women and their health-care professionals in a treatment dilemma, as they need to balance the health of the woman with that of the unborn child. The aim of this project was to investigate the risks and benefits of psychotropic medication in women treated for psychosis who become pregnant.Objective(s)(1) To provide a descriptive account of psychotropic medication prescribed before pregnancy, during pregnancy and up to 15 months after delivery in UK primary care from 1995 to 2012; (2) to identify risk factors predictive of discontinuation and restarting of lithium (multiple manufacturers), anticonvulsant mood stabilisers and antipsychotic medication; (3) to examine the extent to which pregnancy is a determinant for discontinuation of psychotropic medication; (4) to examine prevalence of records suggestive of adverse mental health, deterioration or relapse 18 months before and during pregnancy, and up to 15 months after delivery; and (5) to estimate absolute and relative risks of adverse maternal and child outcomes of psychotropic treatment in pregnancy.DesignRetrospective cohort studies.SettingPrimary care.ParticipantsWomen treated for psychosis who became pregnant, and their children.InterventionsTreatment with antipsychotics, lithium or anticonvulsant mood stabilisers.Main outcome measuresDiscontinuation and restarting of treatment; worsening of mental health; acute pre-eclampsia/gestational hypertension; gestational diabetes; caesarean section; perinatal death; major congenital malformations; poor birth outcome (low birthweight, preterm birth, small for gestational age, low Apgar score); transient poor birth outcomes (tremor, agitation, breathing and muscle tone problems); and neurodevelopmental and behavioural disorders.Data sourcesClinical Practice Research Datalink database and The Health Improvement Network primary care database.ResultsPrescribing of psychotropic medication was relatively constant before pregnancy, decreased sharply in early pregnancy and peaked after delivery. Antipsychotic and anticonvulsant treatment increased over the study period. The recording of markers of worsening mental health peaked after delivery. Pregnancy was a strong determinant for discontinuation of psychotropic medication. However, between 40% and 76% of women who discontinued psychotropic medication before or in early pregnancy restarted treatment by 15 months after delivery. The risk of major congenital malformations, and neurodevelopmental and behavioural outcomes in valproate (multiple manufacturers) users was twice that in users of other anticonvulsants. The risks of adverse maternal and child outcomes in women who continued antipsychotic use in pregnancy were not greater than in those who discontinued treatment before pregnancy.LimitationsA few women would have received parts of their care outside primary care, which may not be captured in this analysis. Likewise, the analyses were based on prescribing data, which may differ from usage.ConclusionsPsychotropic medication is prescribed before, during and after pregnancy. Many women discontinue treatment before or during early pregnancy and then restart again in late pregnancy or after delivery. Our results support previous associations between valproate and adverse child outcomes but we found no evidence of such an association for antipsychotics.Future workFuture research should focus on (1) curtailing the use of sodium valproate; (2) estimating the benefits of psychotropic drug use in pregnancy; and (3) investigating the risks associated with lifestyle choices that are more prevalent among women using psychotropic drugs.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

show abstract

“…Among women treated with antidepressants, rates of discontinuation during pregnancy and subsequent relapse/recurrence are high, with over 50% discontinuing and nearly 70% relapsing following discontinuation (Cohen et al, 2006; Roca et al, 2013). Such findings are consistent with survey research indicating that pregnant women prefer non-pharmacological approaches to prevention if provided the option (Dimidjian & Goodman, 2014).…”

mentioning

confidence: 99%

Staying well during pregnancy and the postpartum: A pilot randomized trial of mindfulness-based cognitive therapy for the prevention of depressive relapse/recurrence.

Dimidjian

Goodman

Felder

et al. 2016

Journal of Consulting and Clinical Psychology

167

138

View full text Add to dashboard Cite

Objective Clinical decision-making regarding the prevention of depression is complex for pregnant women with histories of depression and their healthcare providers. Pregnant women with histories of depression report preference for non-pharmacological care, but few evidence-based options exist. Mindfulness-based cognitive therapy has strong evidence in the prevention of depressive relapse/recurrence among general populations and indications of promise as adapted for perinatal depression (MBCT-PD). With a pilot randomized clinical trial, our aim was to evaluate treatment acceptability and efficacy of MBCT-PD relative to treatment as usual (TAU). Methods Pregnant adult women with depression histories were recruited from obstetrics clinics at two sites and randomized to MBCT-PD (N= 43) or TAU (N=43). Treatment acceptability was measured by assessing completion of sessions, at-home practice, and satisfaction. Clinical outcomes were interview-based depression relapse/recurrence status and self-reported depressive symptoms through 6-months postpartum. Results Consistent with predictions, MBCT-PD for at-risk pregnant women was acceptable based on rates of completion of sessions and at-home practice assignments, and satisfaction with services was significantly higher for MBCT-PD than TAU. Moreover, at-risk women randomly assigned to MBCT-PD reported significantly improved depressive outcomes compared to participants receiving TAU, including significantly lower rates of depressive relapse/recurrence and lower depressive symptom severity during the course of the study. Conclusions MBCT-PD is an acceptable and clinically beneficial program for pregnant women with histories of depression; teaching the skills and practices of mindfulness meditation and cognitive behavioral therapy during pregnancy may help to reduce the risk of depression during an important transition in women’s lives. Public Health Significance Statement This study’s findings support MBCT-PD as a viable non-pharmacological approach to preventing depressive relapse/recurrence among pregnant women with histories of depression.

show abstract

Unplanned pregnancy and discontinuation of SSRIs in pregnant women with previously treated affective disorder

Cited by 41 publications

References 48 publications

Women's questions about medicines in pregnancy – An analysis of calls to an Australian national medicines call centre

Women's questions about medicines in pregnancy – An analysis of calls to an Australian national medicines call centre

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Staying well during pregnancy and the postpartum: A pilot randomized trial of mindfulness-based cognitive therapy for the prevention of depressive relapse/recurrence.

Contact Info

Product

Resources

About