Abstract
The prevention of relapses and the treatment of depression during pregnancy are difficult challenges. The maintenance of antidepressants in pregnancy with its concomitant risks to mother and child needs to be weighed against those associated with not treating the disease. This study aimed at quantifying the impact of the occurrence of pregnancy on the course of antidepressant treatment among newly treated women (< 6 months). We performed a comparative observational cohort study using the nationwide French reimbursement healthcare system database. Women who conceived in 2014 and initiated an antidepressant at any time in the 6 months before pregnancy were compared with nonpregnant women newly exposed to antidepressants with matching on age, antidepressant exposure, history of psychiatric disorders, and area of residence. The primary outcome was a composite of antidepressant discontinuation, switch to another antidepressant, and concomitant use of antidepressants. The secondary outcome was the resumption of antidepressant during follow-up. We used Cox marginal proportional hazards models to compare time to outcomes between pregnant and nonpregnant women. The pregnant cohort included 6593 women, and the comparison cohort 29,347 nonpregnant women. In the period following the first month of treatment, pregnant women were more likely to experience treatment modification, and especially to stop receiving it, compared with nonpregnant women (adjusted hazard ratio (aHR) 1.58; 95%CI, 1.51–1.62). Pregnant women who discontinued treatment had a 41% decreased incidence of antidepressant resumption compared with nonpregnant women (aHR 0.59; 95%CI, 0.56–0.62). Pregnancy was a determinant of antidepressant treatment modification, and especially of discontinuation.
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Funding
This work was supported by the French Medicines Agency (Agence Nationale de Sécurité du Médicament et des Produits de Santé, ANSM) (grant number 2014S029). The present study is part of the Drugs Systematized Assessment in real-liFe Environment (DRUGS-SAFE) research program. This program aims at providing an integrated system allowing the concomitant monitoring of drug use and safety in France. The potential impact of drugs, frailty of populations, and seriousness of risks drive the research program. This publication represents the views of the authors and does not necessarily represent the opinion of the French Medicines Agency.
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ABL, ALSD, SG, CHD, CDM, IL, and AP conceptualized and designed the work.
EP collected the data and carried out the analysis.
ABL, ALSD, SG, CHD, CDM, IL, and AP interpreted the data.
ABL wrote the first draft, and all the authors critically revised and approved the final manuscript.
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Neither ethics committee approval nor informed consent was required for this observational study based on French medico-administrative databases because of the anonymous nature of the data, by agreement of the French Data Protection Supervisory Authority (Commission nationale de l’informatique et des libertés).
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Bénard-Laribière, A., Pambrun, E., Sutter-Dallay, AL. et al. Impact of pregnancy on antidepressant treatment course: a population-based comparative cohort study in France. Arch Womens Ment Health 23, 699–707 (2020). https://doi.org/10.1007/s00737-020-01033-z
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DOI: https://doi.org/10.1007/s00737-020-01033-z