Nearly half of women using antidepressants stopped treatment during pregnancy

Key takeaways:

• Almost half of women using antidepressants stopped treatment during pregnancy without substituting psychotherapy.
• Prescription fills returned to prepregnancy levels within 1 month postpartum.

Nearly 50% of women who utilized antidepressant prescriptions before conception discontinued use after pregnancy without substitution of psychotherapy treatment, according to results of a cohort study published in JAMA Network Open.

“Our data show that almost half of women stop taking antidepressants while pregnant, and they largely do not substitute with psychotherapy,” Claire Boone, PhD, assistant professor in the department of economics and the department of equity, ethics and policy at McGill University in Montreal, told Healio. “This suggests a gap in mental health care during pregnancy that could leave many women effectively untreated during a critical period.”

Boone and colleagues conducted a cohort study using data from 385,731 women (mean age at delivery, 31.8 years) who gave birth between 2011 and 2017 and had prescription drug coverage 24 months before and after delivery, using Merative MarketScan Research Databases. Researchers measured antidepressant medication fills and psychotherapy claims from women and their spouses for 24 months before and after delivery.

Overall, researchers observed a 48.8% reduction in antidepressant prescription fills, with 4.3% of women filling a prescription in the year before conception and 2.2% during pregnancy. There was no similar change in antidepressant use among spouses, which suggested that this behavior was not linked to other, co-occurring changes in the couple’s life, according to the researchers.

Women who stopped using antidepressants did not substitute treatment with psychotherapy. In addition, researchers noted a slight decrease in psychotherapy claims during pregnancy.

Within 1 month postpartum, women’s mean antidepressant prescription fills returned to what was observed before conception. The researchers suggested that women valued depression treatments, but chose to avoid antidepressant use during pregnancy.

According to the researchers, many women may be left effectively untreated by this behavior during the high-risk postpartum period given the time delay for antidepressants to work.

“Our findings suggest that clinicians should do more to proactively discuss mental health treatment options with pregnant patients, emphasizing the risks of both continuing and discontinuing medication and ensuring they receive appropriate support, whether through medication or psychotherapy,” Boone told Healio. “It’s important to continue research into how to reduce this gap in mental health care during pregnancy.”

For more information:

Claire Boone, PhD, can be reached at claire.boone@mcgill.ca; Bluesky: @claireboone.bsky.social.