Antidepressant discontinuation worsens postpartum psychiatric outcomes: JAMA

A study published in the Journal of American Medical Association suggests that women with severe mental illness who are currently on stable treatment may benefit from continuing antidepressant treatment and personalized treatment counseling during pregnancy.

Approximately half of women with affective disorders discontinue antidepressant use during pregnancy, but discontinuation can increase the risk of postpartum relapse. This cohort study led by Nhung Trinh investigated the associations between longitudinal antidepressant fill trajectories during pregnancy and postpartum psychiatric outcomes.

The study included 57,934 pregnancies from Denmark and Norway, where the sample consisted of women who had filled at least one antidepressant prescription within 6 months before pregnancy. Antidepressant prescription fills were obtained from prescription registers, and antidepressant treatment during pregnancy was modeled using the k-means longitudinal method. The main outcomes measured were initiation of psycholeptics, psychiatric emergencies, or records of self-harm within one year postpartum.

The study identified four antidepressant fill trajectories: early discontinuers, late discontinuers (previously stable users), late discontinuers (short-term users), and continuers.

Early discontinuers and late discontinuers (short-term users) had a lower probability of initiating psycholeptics and having postpartum psychiatric emergencies compared to continuers. However, a moderately increased probability of initiation of psycholeptics was found among late discontinuers (previously stable users) compared to continuers.

This increase was more pronounced among women with previous affective disorders. No association between antidepressant fill trajectories and postpartum self-harm risk was found. However, the study's limitations include the lack of information on the specific antidepressants used and the possibility of unmeasured confounding factors. Overall, the study provides important insights into the management of affective disorders during pregnancy and postpartum.

Source: 

Trinh, N. T. H., Munk-Olsen, T., Wray, N. R., Bergink, V., Nordeng, H. M. E., Lupattelli, A., & Liu, X. (2023). Timing of Antidepressant Discontinuation During Pregnancy and Postpartum Psychiatric Outcomes in Denmark and Norway. In JAMA Psychiatry. American Medical Association (AMA). https://doi.org/10.1001/jamapsychiatry.2023.0041