Stopping SSRIs, SNRIs During Pregnancy Not Linked to Adverse Psychiatric Outcomes
Discontinuing SSRIs or SNRIs during pregnancy did not lead to an increase in hospitalizations, outpatient visits, suicidal behavior, or sick leave use.
For pregnant women taking selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), discontinuing use during pregnancy is not associated with adverse psychiatric outcomes, according to a study published in JAMA Network Open.1
Stopping SSRIs, SNRIs During Pregnancy Not Linked to Adverse Psychiatric Outcomes / emiliau - stock.adobe.com
In the past few decades, antidepressant use in reproductive-aged women has increased but there is little data to guide treatment management for women who become pregnant. Previous studies of SSRI/SNRI discontinuation in pregnancy have included all pregnant women, regardless of indication. However, data suggests that adverse psychiatric outcomes are linked to the severity of maternal psychiatric burden rather than discontinuation of SSRI/SNRI treatment.
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In the study, researchers sought to compare psychiatric outcomes for women with mild-to-moderate depression and anxiety who discontinued SSRI/SNRI use during pregnancy to those who continued use. This more homogenous population excluded women with severe diagnoses or those with comorbid psychiatric conditions like insomnia, obsessive-compulsive disorder, eating disorders, bipolar disorder, and psychotic disorders.
The study included data from Swedish population-based registers from 2006 to 2019. Participants included pregnant women with mild-to-moderate depression or anxiety who filled a prescription for an SSRI or SNRI in the 90 days before pregnancy and did not have recorded comorbid or severe psychiatric conditions. The primary outcome was psychiatric-related hospitalizations in the 90 days after childbirth. Secondary outcomes included psychiatric-related outpatient visits, self-harm, suicide, any-cause mortality in the 90 days after childbirth, and sick leave absence 1.5 years after childbirth.
Out of 27773 pregnant women, 13184 (47.5%) discontinued SSRI or SNRI use during pregnancy while 14589 (52.5%) reported continued use. Participants who discontinued SSRIs or SNRIs were younger, less educated, and more likely to have smoked during early pregnancy compared with those who continued use. Those who discontinued use were also more likely to have used anxiolytics as well as hypnotics and sedatives. After childbirth, 6128 (46.5%) of women who had discontinued SSRIs or SNRIs during pregnancy reported reinitiating treatment.
In the discontinued group, there were 49 participants (0.4%) who had psychiatric-related hospitalizations compared with 59 (0.5%) in the continued use group in the 90 days after childbirth. While this initially represented a higher hazard rate (1.28) for those in the discontinued group, the hazard rate dropped to 0.81 in the 1.5 years after childbirth.
The researchers found that, compared with the continued use group, the discontinued group had lower hazard rates of outpatient psychiatric visits at both 90 days after childbirth (0.59) and 1.5 years after (0.60). They did not find any association between SSRI or SNRI discontinuation and self-harm or suicide. Participants who discontinued use reported fewer days of sick leave in the 1.5 years after childbirth compared with those who continued use (mean 44.6 vs. 53.1 days). However, the researchers did not find any difference in sick leave absence between the discontinued and continued use groups.
The researchers noted that women who discontinue SSRI/SNRI use during pregnancy may likely have less severe symptoms of depression and anxiety, which may explain the lower hazard rates for outpatient visits. Women who continue SSRI/SNRI treatment may have planned follow-up visits during the postpartum period.
READ MORE: Women's Health Resource Center
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