Should women stop antidepressant treatment during pregnancy?

A re-evaluation of psychiatric treatment is needed for pregnant women treated with antidepressant, suggests a recent study, noting the necessity for focusing on obstetric complications for severely depressed women.

“Additionally, as relapse was associated with increased benzodiazepine use, it is important to carefully monitor all women who stop antidepressant treatment during pregnancy,” the authors said.

This cohort study sought to monitor the trajectories of antidepressant use during pregnancy and the postpartum period among women chronically treated with antidepressants prior to their pregnancy, as well as to examine the characteristics associated with each trajectory.

All pregnant women whose data were included in the General Sample of Beneficiaries (EGB) database affiliated with the French Health Insurance System from 2009 to 2014 were eligible for this study. Participants were followed until 6 months after childbirth.

Chronic treatment was defined as exposure over the 6-month period preceding pregnancy. The authors estimated a group-based trajectory model (GBTM) to identify distinctive longitudinal profiles of antidepressant use.

A total of 760 women were chronically treated with antidepressants before their pregnancy, of whom 55.8 percent discontinued therapy permanently in the first semester, 20.4 percent stopped for a minimum of 3 months and resumed postpartum, and 23.8 percent maintained treatment throughout pregnancy and postpartum.

No sociodemographic or medical characteristics correlated with any trajectory group. Obstetric complications and postpartum psychiatric disorders occurred more frequently among women who maintained treatment.

Among those who interrupted use of antidepressants, prescription of benzodiazepines and anxiolytics decreased at first but increased postpartum to a higher level than before pregnancy.