Women with mild to moderate depression or anxiety and no other mental illnesses who discontinue antidepressants during pregnancy do not appear to experience adverse psychiatric outcomes postpartum, according to a study issued today by JAMA Network Open.
“(E)vidence suggests that the severity of the maternal psychiatric burden rather than the discontinuation of antidepressants per se is associated with the risk of adverse psychiatric events,” wrote Carolyn E. Cesta, Ph.D., of the Karolinska Institutet in Stockholm, Sweden, and colleagues. Their study aimed to investigate that possibility.
Cesta and colleagues analyzed health records of 27,773 individuals in Sweden with singleton pregnancies between 2006 and 2019 who had taken at least one selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) within 90 days of their pregnancy. Individuals with any recorded psychiatric diagnosis from a specialist in the year before pregnancy—beyond outpatient diagnoses of mild or moderate unipolar depression and anxiety—or any prescription fill in the 90 days prior for other antidepressants, antipsychotics, or antiepileptics were excluded.
Overall, 47.5% of the individuals discontinued their SSRIs/SNRIs during pregnancy while 52.5% continued taking them. The researchers assessed psychiatric-related hospitalizations as well as outpatient visits, self-harm and suicide, and any cause mortality at 90 days and 1.5 years after childbirth in both groups; they also examined sick leave usage in the 1.5 years after childbirth.
The researchers found no association between antidepressant discontinuation and adverse psychiatric-related outcomes, including outpatient visits, hospitalizations, or suicidal behavior during the 90 days or 1.5 years after childbirth. Individuals who discontinued their antidepressants during pregnancy also used fewer days of sick leave 1.5 years after childbirth compared with those in the continued use group (45 days vs. 53 days).
“Reasons for discontinuing SSRIs or SNRIs during pregnancy can include wishing to avoid fetal exposure, resolution of symptoms of depression or anxiety, or worsening of symptoms, resulting in a possible switch to other psychotropic medications,” the researchers noted. “Notably, 69.9% of individuals taking SSRIs or SNRIs before pregnancy were included in the study cohort, highlighting that this is an important patient group for which evidence on risks and benefits of SSRI or SNRI use or discontinuation in pregnancy is needed.”
For related information, see the Psychiatric News article “Neurodevelopmental Problems Not Linked to Antidepressant Exposure In Utero.”
(Image: Getty Images/iStock/shironosov)
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