Unplanned pregnancy and discontinuation of SSRIs in pregnant women with previously treated affective disorder

Abstract

Objective: To identify the factors associated with discontinuation of selective serotonin reuptake inhibitors (SSRIs) in pregnant women and to determine the rates of SSRI reintroduction during pregnancy.

Method: A prospective study was conducted in the Perinatal Psychiatry Service of the Hospital Clínic in Barcelona. The total sample comprised 132 consecutive pregnant women with depressive or anxiety disorder (DSM-IV criteria), seen between January 2005 and December 2008 and who were receiving SSRIs at the time of conception. Clinical, psychometric and socio-demographic variables were collected at the first visit. All women were assessed during treatment with the Edinburgh Perinatal Depression Scale (EPDS) and the Spielberger State-Trait Anxiety Inventory (STAI). Dose and type of antidepressant were recorded at each visit during pregnancy.

Results: Seventy women (53%) discontinued SSRI treatment upon confirmation of pregnancy. Socio-demographic, obstetric and psychiatric variables did not differ significantly between women who maintained and women who discontinued treatment. Only unplanned pregnancy was associated with a greater risk of discontinuation (OR=2.7, 95% CI=1.34-5.52). Women who discontinued treatment also had higher EPDS and STAI scores in the first visit and prenatal visit (34-36 weeks) (p<.05). Of the 70 women who discontinued treatment, 57.1% (N=40) reintroduced treatment, almost half of these in the first trimester of pregnancy.

Conclusions: Unplanned pregnancy was a risk factor for abrupt discontinuation of SSRIs upon confirmation of pregnancy in women with depressive or anxiety disorder. More than half the pregnant women who discontinued SSRIs reintroduced antidepressant therapy during pregnancy.

Keywords: Antidepressant; Discontinuation; Pregnancy; Relapse; SSRI; Unplanned pregnancy.