Prenatal SSRI or SNRI discontinuation not linked to adverse psychiatric outcomes

Prenatal SSRI or SNRI discontinuation not linked to adverse psychiatric outcomes | Image Credit: © Hazal - © Hazal - stock.adobe.com.

Discontinuation of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) is not linked to adverse psychiatric-related outcomes, according to a recent study published in JAMA Network Open.

Despite the rise in antidepression use among reproductive-aged women in recent decades, guidelines for treatment among pregnant women remain lacking. Of antidepressants, SSRIs and SNRIs are the most common among pregnant women, but approximately half discontinue use before or during pregnancy.

Alongside depression and anxiety, SSRIs and SNRIs may be used to treat insomnia, eating disorders, obsessive-compulsive disorder, and bipolar or psychiatric disorders. These conditions are associated with increased risks of adverse postpartum psychiatric outcomes, making it vital to evaluate the impacts of SSRI and SNRI discontinuation during pregnancy.

To evaluate the association between discontinuation of SSRIs and SNRIs with psychiatric-related outcomes, investigators conducted a population register-based cohort study. Data from 2006 to 2019 was obtained from Swedish national demographic and health registers.

Participants included pregnant women with 1 or more SSRI or SNRI prescription fill within 90 days before the first day of the last menstrual period. These patients completed live birth or still birth after 22 weeks’ gestation between July 31, 2006, and June 30, 2017.

Available data from at least 1 year before the LMP to 1.5 years after childbirth was necessary for inclusion. Exclusion criteria included recorded psychiatric diagnosis in the year before LMP and any prescription fill in the 90 days before the LMP of non-SSRI or SNRI antidepressants.

The number of days covered by prescription fills was reported to determine SSRI and SNRI use during pregnancy. Pregnancies were divided into 9 30-day periods, starting at LMP and ending at day 270 of gestation. The number of gestational days in each of these periods with medication coverage was reported.

If a pregnancy ended before day 270 of gestation, the remaining days of the 9 periods were considered missing. A k-means clustering algorithm was used to identify SSRI or SNRI patterns of use during pregnancy.

Exposure groups included an SSRI or SNRI continued use group with a higher mean number of days covered during pregnancy and an SSRI and SNRI discontinued use group with a lower mean number of days covered during pregnancy. Psychiatric-related hospitalizations within 90 days after childbirth was the primary outcome of the analysis.

Secondary outcomes included psychiatric-related hospitalization within 1.5 years after childbirth, self-harm and suicide, and any cause mortality within 90 days and 1.5 years after childbirth. Sick leave outcomes within 1.5 years after childbirth were also evaluated.

There were 27,773 pregnant women included in the final analysis, 62.1% of whom were aged over 30 years at childbirth. Of patients, 52.5% were in the SSRI or SNRI continued use group while 47.5% were in the discontinued use group.

A younger age, lower education, and increased rates of smoking in pregnancy were reported among patients who discontinued SSRI or SNRI use. Reinitiation of SSRIs or SNRIs after childbirth was reported in 46.5% of the discontinued use group.

Psychiatric-related hospitalizations within 90 days after childbirth were reported in 0.4% of the discontinued use group and 0.5% of the continued use group. This indicated an adjusted hazard ratio (aHR) of 1.28, but this decreased to 0.81 at 1.5 years after childbirth.

The aHR for psychiatric-related outpatient visits for discontinued use vs continued use at 90 days was 0.59, indicating a reduced hazard rate. At 1.5 years, this aHR was 0.60. Additionally, discontinuation of SSRIs and SNRIs was not linked to self-harm or suicide, nor were associations reported for other outcomes.

SSRI or SNRI discontinuation was not linked to sick leave absence. However, the number of sick leave days at 1.5 years was reduced in the discontinued use group vs the continued use group, with means of 44.6 days and 53.1 days, respectively.

These results indicated no associations between SSRI or SNRI discontinuation and adverse psychiatric-related outcomes among pregnant women with anxiety or depression. These outcomes included psychiatric-relates hospitalizations or outpatient visits, suicidal behavior, and sick leave absence.

References

Cesta CE, Reutfors J, Cohen JM. Postpartum psychiatric outcomes and sick leave after discontinuing SSRI or SNRI in pregnancy. JAMA Netw Open. 2024;7(10):e2438269. doi:10.1001/jamanetworkopen.2024.38269