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Discontinuation and re-initiation of antidepressants during pregnancy: A nationwide cohort study

Authors
Noh, YunhaChoe, Seung-AhKim, Woo JungShin, Ju-Young
Issue Date
1-2월-2022
Publisher
ELSEVIER
Keywords
Pregnancy; Depression; Mental health; Antidepressive agents; Pharmacoepidemiology
Citation
JOURNAL OF AFFECTIVE DISORDERS, v.298, pp.500 - 507
Indexed
SCIE
SSCI
SCOPUS
Journal Title
JOURNAL OF AFFECTIVE DISORDERS
Volume
298
Start Page
500
End Page
507
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/139382
DOI
10.1016/j.jad.2021.10.069
ISSN
0165-0327
Abstract
Background: Women tend to discontinue antidepressants during pregnancy. We examined the rate of and factors associated with antidepressant discontinuation and re-initiation during pregnancy. Methods: We conducted a nationwide cohort study using Korea's healthcare database. The study cohort included women who were aged 15-50 years, gave birth during 2013-2017, had >1 depression diagnosis, >2 antidepressant prescriptions within 6 months (one within one month of preconception). Cox proportional hazards model was used to evaluate factors associated with antidepressant discontinuation and re-initiation during pregnancy. Results: Among 5207 pregnancies, 4954 (95.1%) discontinued antidepressants during pregnancy, which included 4657 (89.4%) in the first trimester, 1810 (38.9%) of whom re-initiated them during pregnancy or postpartum period. The risk of antidepressant discontinuation increased in women with substance-related disorders (HR 1.17, 95% CI 1.01-1.35), but decreased in women receiving medical aid (0.53, 0.46-0.62) and patients suggestive of severe depression, such as psychiatric comorbidities and long-term antidepressant use before pregnancy. Antidepressant re-initiation occurred frequently in medical aid recipients (1.25, 1.06-1.47), nulliparous women (1.11, 1.01-1.22), and women with severe symptoms. Conclusions: We found high rates of antidepressant discontinuation and re-initiation during pregnancy. Although women suggestive of severe symptoms were less likely to discontinue antidepressants during pregnancy, they were more likely to re-initiate them during their perinatal period, which warrants more detailed guidelines on perinatal depression.
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