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More research necessary on safety of antidepressants in reproductive-aged women

Antidepressant prescriptions among reproductive-aged women are common, highlighting the importance for more studies on antidepressant safety to identify potential risks of exposure before, during and between pregnancies, according to data published in Morbidity and Mortality Weekly Report.

“Many women require antidepressants on an ongoing basis, and a clear consensus on the safest medication options for both the mother and her fetus does not exist,” April Dawson, MPH, of the CDC National Center on Birth Defects and Developmental Disabilities, and colleagues wrote. “Given that half of all U.S. pregnancies are unplanned, antidepressant use will occur during the first weeks of pregnancy, a critical period for fetal development.”

To examine antidepressant use among women of reproductive age, the CDC researchers reviewed Truven Health’s 2008-2013 MarketScan Commercial Claims and Encounters database, a large convenience sample of employed persons and their dependents with private, employer-sponsored health insurance. The researchers analyzed data on women aged 15 to 44 years who had been enrolled in a private health insurance plan that included prescription drug coverage for 11 months or more per calendar year. An average of 5.8 million women were included in the analytic sample each year during 2008 to 2013.

The researchers searched outpatient pharmacy claims for antidepressant medications using national drug codes to determine whether women filled their prescription during a given calendar year. The annual number, proportion and average proportion of reproductive-aged women who filled an antidepressant prescription at an outpatient pharmacy were analyzed by specific medication, drug class, age group and geographic region.

According to the researchers, an average of 15.4% of women aged 15 to 44 years filled a prescription for an antidepressant at an outpatient pharmacy each year during 2008 to 2013. Of those, 76% filled prescriptions for only one type of antidepressant. The most commonly-filled medications among the sample were sertraline, bupropion, citalopram, escitalopram and fluoxetine. The percentage of women who filled an antidepressant prescription varied by age group, from an average of 8.3% among those aged 15 to 19 years, to 20.9% among those aged 40 to 44 years.

“This relative frequency of dispensing of antidepressant prescriptions to this population raises public health concerns, given the high proportion of unplanned pregnancies, the lack of adequate information on the safety or risk of antidepressant use during pregnancy and the reported possible association between the use of some antidepressants during early pregnancy and the occurrence of some major birth defects,” Dawson and colleagues wrote. “… The high prevalence of antidepressant claims in this population highlights the need for more research to support development of evidence-based guidance for informed decision making by health care providers and reproductive-aged women.” – by Jason Laday

Disclosure: The authors report no relevant financial disclosures.