Continuation and discontinuation of antidepressant treatment before, during and after pregnancy: a cohort study.

OBJECTIVE

To assess the relationship between antidepressant treatment before, during and after childbirth.

DESIGN

Cohort study.

SETTING

Primary care in the United Kingdom (UK).

PARTICIPANTS

Women aged 15–49 with a single live birth (2006–2015), stratified by antidepressant history: Cohort A: Prescribed antidepressants ≥ 2 years before childbirth. Cohort B: Prescribed 1–2 years before childbirth. Cohort C: Prescribed within 1 year before childbirth. Cohort D: No antidepressants prescribed before childbirth. OUTCOME MEASURES: Changes in antidepressant treatment during the perinatal period.

RESULTS

Of 202,303 women, 46,479 (23%) had pre-childbirth antidepressant prescriptions (Cohorts A: 37,161; B: 19,627; C: 14,363), while 155,824 (77%) did not (Cohort D). In cohort A, 76% discontinued treatment in the year before childbirth, compared to 48% in cohort B. Postpartum, 22% of those in cohort A and 33% in cohort B restarted treatment. Overall, 26,835/202,303 (13%) received antidepressants in the year after childbirth. Among women without prior treatment, 10,258/155,824 (7%) started antidepressants postpartum, compared to 16,577/46,479 (36%) of those with prior use. Cohort C had the highest postpartum prescription rate (9,232/14,363, 64%).

CONCLUSIONS

Antidepressant treatment after childbirth is common, particularly among women who have received treatment before childbirth. Many women discontinue antidepressants before or during pregnancy. The study highlights the importance of considering history of antidepressant treatment when planning postnatal care and counselling women on continuing or stopping antidepressants during pregnancy. This information can aid healthcare professionals in advising women about antidepressant use before, during, and after pregnancy, considering individual circumstances and risks.