Drop in antidepressant use seen during pregnancy
A marked fall in antidepressant use occurs when women first learn that they are pregnant, according to a report.
“It is alarming to see that there is still a fear regarding antidepressant use during pregnancy. We knew that some women were going to discontinue using their antidepressants during pregnancy but we didn’t think it would be so prevalent and inappropriately used (amongst those who remain on it),” senior author Dr. Anick Berard told Reuters Health.
“The risks of untreated depression during pregnancy are significant,” Berard, from the CHU Sainte-Justine Hospital in Montreal, said. “Given the safety of most antidepressants during pregnancy, a careful evaluation of the risk/benefit ratio should be done before deciding to discontinue their use. Although physicians and women think they are protecting their unborn child, they might be doing just the contrary.”
The study included 97,680 women in Quebec who were pregnant between 1998 and 2002. Of these women, 6427 (6.6 percent) were antidepressant users in the 12 months prior to the first day of gestation. In the 12 months after the end of pregnancy, however, the prevalence climbed to 7.0 percent, significantly higher than the prepregnancy rate.
During the first trimester of pregnancy, the prevalence of antidepressant use fell to 3.7 percent. Moreover, antidepressant doses below those recommended were used 7.7 percent of the time and 4.7 percent of patients switched to a different class of antidepressants.
Some of the predictors of antidepressant use during pregnancy included older age of the mom-to-be, living on welfare, having at least two different prescribers, and having at least one diagnosis of depression in the year before pregnancy.
In a related editorial, Dr. V. O’Keane and Dr. M. S. Marsh, from King’s College Hospital in London, comment that “the new evidence…suggests that depression is probably seriously under treated during pregnancy is alarming in terms not only of the costs that the mother will pay as she enters the challenges of motherhood in a compromised manner but also the costs that the baby may have to carry for the rest of its life.”
SOURCE: BJOG: An International Journal of Obstetrics and Gynecology, Sept. 2007.
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