Daily Dose: Antidepressant Discontinuation & Postpartum Psychiatric Outcomes

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On March 17, 2023, we reported on a study published in JAMA Psychiatry that examined the associations between longitudinal antidepressant fill trajectories during pregnancy and postpartum psychiatric outcomes.

The study

Investigators tapped population-based registers in Denmark and Norway including both prescription and medical birth registers. They identified 41 475 live-born singleton pregnancies in Denmark between 1997-2016 and 16 459 live-born singleton pregnancies in Norway between 2009-2018 for women who filled at least 1 antidepressant prescription within 6 months prior to pregnancy. Mean maternal age was 30.7 years in Denmark and 29.9 years in Norway, the authors report.

The team obtained data on antidepressant prescription fills from the Norwegian Prescription Database and the Danish National Prescription Register and in each country applied the k-means for longitudinal (KmL) data trajectory modeling method to antidepressant treatment from 6 months prior to pregnancy through gestational week 37 to cluster the cohort into groups. The researchers’ primary outcomes of interest were initiation of psycholeptics, psychiatric emergencies, or records of self-harm within 1-year post-partum.

The results

Using the 4 antidepressant fill trajectories identified (at right), researchers found the following distribution for included pregnancies in Denmark and Norway, respectively:

• Early discontinuers: 31.3% and 30.4%

• Late discontinuers (previously stable users) 21.5% and 27.8%

• Late discontinuers (short-term users) 15.9% and 18.4%

• Continuers: 31.3% and 23.4%

Overall, their analyses found a lower probability of initiating psycholeptics and having postpartum psychiatric emergencies in the early discontinuer and late discontinuer groups compared to the continuers.

The investigators observed a moderately increased probability of initiating psycholeptics among late discontinuers compared to continuers (hazard ratio [HR] 1.13, 95% CI, 1.03-1.24), which was more pronounced among participants with previous affective disorders (HR 1.28, 95% CI, 1.12-1.46).

Note from authors

"Based on pooled data from Denmark and Norway, a moderately elevated probability of initiation of psycholeptics in late discontinuers (previously stable users) vs continuers was found. These findings suggest that women with severe mental illness who are currently on stable treatment may benefit from continuing antidepressant treatment and personalized treatment counseling during pregnancy."

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