Exploring the prevalence of antidepressant medication discontinuation among pregnant veterans.
Antidepressant medication
Comorbidities
Perinatal health
Veterans
Journal
Archives of women's mental health
ISSN: 1435-1102
Titre abrégé: Arch Womens Ment Health
Pays: Austria
ID NLM: 9815663
Informations de publication
Date de publication:
23 Sep 2023
23 Sep 2023
Historique:
received:
21
04
2023
accepted:
12
09
2023
medline:
23
9
2023
pubmed:
23
9
2023
entrez:
22
9
2023
Statut:
aheadofprint
Résumé
US female veterans have higher rates of mental health (MH) disorders compared to US civilian females and, consequently, are at risk for poor MH outcomes during pregnancy. This study evaluated the MH burden and identified the prevalence of antidepressant prescription and discontinuation among pregnant veterans (PGVets). The electronic health records (EHR) of PGVets using the US Veterans Administration's (VA) maternity care benefits over a two-year period were retrospectively reviewed. Inclusion criteria for this study were a current MH diagnosis of depression, anxiety, or posttraumatic stress disorder (PTSD) at the onset of pregnancy (n=351). Outcomes examined included antidepressant use prior to pregnancy, the use and discontinuation of antidepressants during pregnancy, and risk factors for discontinuation. PGVets had a high MH burden, as indicated by multiple comorbid diagnoses of unipolar depression, anxiety, and PTSD in 67% of the sample. At the onset of pregnancy, 163 (46%) were treated with an antidepressant. Only 56 (34%) continued using antidepressants through the pregnancy. Self-discontinuation (34%) and VA provider discontinuation (31%) of antidepressants were found. Among PGVets with documented past suicidal behaviors, 90% discontinued their active antidepressants. PGVets with indicators for more severe MH diagnoses were most likely to discontinue. The MH burden of PGVets and high rates of antidepressant discontinuation have implications for engaging this population in a higher level of perinatal monitoring and intervention. The findings suggest that VA providers and veterans would benefit from risks and benefits education regarding antidepressant use during pregnancy as well as the provision of alternative therapies.
Identifiants
pubmed: 37740096
doi: 10.1007/s00737-023-01372-7
pii: 10.1007/s00737-023-01372-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
Références
Bayrampour H, Kapoor A, Bunka M, Ryan D (2020) The risk of relapse of depression during pregnancy after discontinuation of antidepressants: a systematic review and meta-analysis. J Clin Psychiatry 81(4). https://doi.org/10.4088/JCP.19r13134
Bonari L, Koren G, Einarson TR, Jasper JD, Taddio A, Einarson A (2005) Use of antidepressants by pregnant women: evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making. Arch Womens Ment Health 8(4):214–220. https://doi.org/10.1007/s00737-005-0094-8
doi: 10.1007/s00737-005-0094-8
pubmed: 15959622
Callegari L, Edmonds S, Borrero S, Ryan G, Cusack C, Zephyrin L (2018) Preconception care in the Veterans Health Administration. Semin Reprod Med 36(06):327–339. https://doi.org/10.1055/s-0039-1678753
doi: 10.1055/s-0039-1678753
pubmed: 31003248
Einarson A, Selby P, Koren G (2001) Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling. J Psychiatry Neurosci 26(1):44–48
pubmed: 11212593
pmcid: 1408034
Frayne SM, Phibbs CS, Saechao F, Friedman SA, Shaw JG, Romodan Y, Berg E, Lee J, Ananth L, Iqbal S, Hayes PM, Haskell S (2018) Sourcebook: women veterans in the veterans health administration, vol 4: Longitudinal trends in sociodemographics, utilization, health profile, and geographic distribution. Women’s Health Evaluation Initiative, Women’s Health Services, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
Gawron L, Mohanty A, Kaiser J, Gundlapalli A (2018) Impact of deployment on reproductive health in U.S. active-duty servicewomen and veterans. Semin Reprod Med 36(06):361–370. https://doi.org/10.1055/s-0039-1678749
doi: 10.1055/s-0039-1678749
pubmed: 31003251
Goldman-Mellor S, Margerison CE (2019) Maternal drug-related death and suicide are leading causes of postpartum death in California. Am J Obstet Gynecol 221(5):489.e1–489.e9. https://doi.org/10.1016/j.ajog.2019.05.045
doi: 10.1016/j.ajog.2019.05.045
pubmed: 31173749
Grigoriadis S, VonderPorten EH, Mamisashvili L, Tomlinson G, Dennis C-L, Koren G, Steiner M, Mousmanis P, Cheung A, Radford K, Martinovic J, Ross LE (2013) The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry 74(04):e321–e341. https://doi.org/10.4088/JCP.12r07968
doi: 10.4088/JCP.12r07968
pubmed: 23656857
Kroll-Desrosiers AR, Crawford SL, Moore Simas TA, Clark MA, Bastian LA, Mattocks KM (2019) Rates and correlates of depression symptoms in a sample of pregnant veterans receiving Veterans Health Administration care. J Women's Health 29(4):333–340. https://doi.org/10.1016/j.whi.2019.04.008
doi: 10.1016/j.whi.2019.04.008
Kroll-Desrosiers AR, Crawford SL, Moore Simas TA, Clark MA, Mattocks KM (2020) Treatment and management of depression symptoms in pregnant veterans: varying experiences of mental health care in the prenatal period. Psychiatry Q 91(2):475–493. https://doi.org/10.1007/s11126-019-09676-7
doi: 10.1007/s11126-019-09676-7
Mattocks KM, Skanderson M, Goulet JL, Brandt C, Womack J, Krebs E, Desai R, Justice A, Yano E, Haskell S (2010) Pregnancy and mental health among women veterans returning from Iraq and Afghanistan. J Women's Health 19(12):2159–2166. https://doi.org/10.1089/jwh.2009.1892
doi: 10.1089/jwh.2009.1892
McHugh ML (2012) Interrater reliability: the kappa statistic. Biochem Med 22(3):276–282
doi: 10.11613/BM.2012.031
Molenaar NM, Kamperman AM, Boyce P, Bergink V (2018) Guidelines on treatment of perinatal depression with antidepressants: an international review. Aust N Z J Psychiatry 52(4):320–327. https://doi.org/10.1177/0004867418762057
doi: 10.1177/0004867418762057
pubmed: 29506399
pmcid: 5871019
Protecting Moms Who Served Act, Pub. L. No. 117–69, 1496 135 STAT. (2021). https://www.congress.gov/117/plaws/publ69/PLAW-117publ69.pdf
Roca A, Imaz ML, Torres A, Plaza A, Subirà S, Valdés M, Martin-Santos R, Garcia-Esteve L (2013) Unplanned pregnancy and discontinuation of SSRIs in pregnant women with previously treated affective disorder. J Affect Disord 150(3):807–813. https://doi.org/10.1016/j.jad.2013.02.040
doi: 10.1016/j.jad.2013.02.040
pubmed: 23566335
Shivakumar G, Kroll-Desrosiers AR, Copeland L, Anderson EH, Maydon A, Mattocks K (2021) Patterns of treatment utilization across the perinatal period in the Center for Maternal and Infant Outcomes and Research in Translation (COMFORT) veterans study. J Womens Health (Larchmt) 30(6):882–890. https://doi.org/10.1089/jwh.2020.8435
doi: 10.1089/jwh.2020.8435
pubmed: 33211614
Suzuki S, Kato M (2017) Deterioration/relapse of depression during pregnancy in Japanese women associated with interruption of antidepressant medications. J Matern Fetal Neonatal Med 30(10):1129–1132. https://doi.org/10.1080/14767058.2016.1205026
doi: 10.1080/14767058.2016.1205026
pubmed: 27334426
Verreault N, Da Costa D, Marchand A, Ireland K, Dritsa M, Khalifé S (2014) Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset. J Psychosom Obstet Gynecol 35(3):84–91. https://doi.org/10.3109/0167482X.2014.947953
doi: 10.3109/0167482X.2014.947953
Vigod SN, Wilson CA, Howard LM (2016) Depression in pregnancy. BMJ i1547. https://doi.org/10.1136/bmj.i1547
Wikman A, Skalkidou A, Wikström A-K, Lampa E, Kramer MS, Yong E-L, Skoglund C, Epperson N, Sundström-Poromaa I (2020) Factors associated with re-initiation of antidepressant treatment following discontinuation during pregnancy: a register-based cohort study. Arch Womens Ment Health 23(5):709–717. https://doi.org/10.1007/s00737-020-01050-y
doi: 10.1007/s00737-020-01050-y
pubmed: 32632522
pmcid: 7497307