Patterns of antidepressant prescribing around pregnancy: a descriptive analysis in CPRD.

Background Antidepressant use is increasing during pregnancy but estimates of prevalence and patterns of prescribing are outdated. Aim To describe the prevalence and patterns of antidepressant prescribing in and around pregnancy. Design and setting Drug utilisation study in the UK's Clinical Practice Research Datalink (CPRD) GOLD Pregnancy Register. Methods Using primary care prescription records, we identified individuals who had been prescribed antidepressants in and around pregnancy between 1996-2018 and described prevalence of prescribing during pregnancy over time. We defined 'prevalent' or 'incident' antidepressant prescribed, where 'prevalent' individuals were prescribed antidepressants both before and during pregnancy, and 'incident' individuals were newly prescribed antidepressants during pregnancy, then qualitatively compared patterns of prescribing between these two groups. We also investigated post-pregnancy prescribing, as well as characteristics associated with antidepressant discontinuation anytime during pregnancy. Results A total of 1,033,783 pregnancies were eligible: 79,144 (7.7%) were prescribed antidepressants during pregnancy and 15,733 of these (19.9%) were 'incident'. Antidepressant prescribing during pregnancy increased from 3.2% in 1996 to 13.4% in 2018. Most women, both 'prevalent' and 'incident' prescribed, discontinued antidepressants anytime during pregnancy (54.8% and 59.9%, respectively). Over half of those who discontinued during pregnancy were prescribed antidepressants in the 12 months after pregnancy (53.0%). Younger age, previous stillbirth, and higher deprivation were associated with more frequent discontinuation anytime during pregnancy. Conclusions Antidepressant prescribing during pregnancy has been increasing in the UK. Over half of the sample discontinued antidepressants at some point before the end of pregnancy, but post-pregnancy resumption of antidepressants was common.