School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do 16419, Republic of Korea.
Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
J Affect Disord. 2022 Feb 1;298(Pt A):500-507. doi: 10.1016/j.jad.2021.10.069. Epub 2021 Oct 30.
Women tend to discontinue antidepressants during pregnancy. We examined the rate of and factors associated with antidepressant discontinuation and re-initiation during pregnancy.
We conducted a nationwide cohort study using Korea's healthcare database. The study cohort included women who were aged 15-50 years, gave birth during 2013-2017, had ≥1 depression diagnosis, ≥2 antidepressant prescriptions within 6 months (one within one month of preconception). Cox proportional hazards model was used to evaluate factors associated with antidepressant discontinuation and re-initiation during pregnancy.
Among 5207 pregnancies, 4954 (95.1%) discontinued antidepressants during pregnancy, which included 4657 (89.4%) in the first trimester, 1810 (38.9%) of whom re-initiated them during pregnancy or postpartum period. The risk of antidepressant discontinuation increased in women with substance-related disorders (HR 1.17, 95% CI 1.01-1.35), but decreased in women receiving medical aid (0.53, 0.46-0.62) and patients suggestive of severe depression, such as psychiatric comorbidities and long-term antidepressant use before pregnancy. Antidepressant re-initiation occurred frequently in medical aid recipients (1.25, 1.06-1.47), nulliparous women (1.11, 1.01-1.22), and women with severe symptoms.
We found high rates of antidepressant discontinuation and re-initiation during pregnancy. Although women suggestive of severe symptoms were less likely to discontinue antidepressants during pregnancy, they were more likely to re-initiate them during their perinatal period, which warrants more detailed guidelines on perinatal depression.
女性在怀孕期间往往会停止服用抗抑郁药。我们研究了怀孕期间停止和重新开始服用抗抑郁药的比率和相关因素。
我们使用韩国的医疗保健数据库进行了一项全国性队列研究。研究队列包括年龄在 15-50 岁之间、2013-2017 年期间分娩、至少有 1 次抑郁症诊断、6 个月内至少有 2 次抗抑郁药处方（一次在受孕前 1 个月内）的女性。使用 Cox 比例风险模型评估与怀孕期间停止和重新开始使用抗抑郁药相关的因素。
在 5207 例妊娠中，有 4954 例（95.1%）在怀孕期间停止使用抗抑郁药，其中 4657 例（89.4%）在孕早期，1810 例（38.9%）在怀孕期间或产后重新开始使用。有物质相关障碍的女性（HR 1.17，95%CI 1.01-1.35）停止使用抗抑郁药的风险增加，但接受医疗补助的女性（0.53，0.46-0.62）和有精神科合并症和怀孕前长期使用抗抑郁药等严重抑郁症状的女性则减少。抗抑郁药重新开始使用在接受医疗补助的人群中较为常见（1.25，1.06-1.47）、初产妇（1.11，1.01-1.22）和症状严重的女性。
我们发现怀孕期间抗抑郁药停药和重新开始使用的比率较高。虽然有严重症状的女性在怀孕期间停止使用抗抑郁药的可能性较低，但她们在围产期重新开始使用抗抑郁药的可能性较高，这需要更详细的围产期抑郁症指南。
