Significantly fewer pregnant women take antidepressants
October 29, 2019
Science Daily/Aarhus University
A pregnancy is not always a happy event and as many as 10-15% of pregnant women in Denmark have depressive symptoms. A new study now shows a significant decrease in the use of antidepressants by pregnant women -- with consumption falling by more than 33% since 2011.
A new study carried out by the National Centre for Register-based Research and the Department of Clinical Medicine at Aarhus University now shows a significant decrease in the use of antidepressants by pregnant women -- with consumption falling by more than 33 per cent since 2011. The decrease in the use of ADs after 2011 was mainly driven by a decrease in the prescribing of serotonin reuptake inhibitors (SSRIs) and in particular citalopram, the main type of SSRI used in Denmark, explains Postdoc Julie Werenberg Dreier from the National Centre for Register-based Research at Aarhus University.
"Research from Denmark and other countries has documented a striking increase in the use of antidepressants over the past two decades. Now, for the first time, we can see a significant decline in the use of antidepressants by pregnant women," says Julie Werenberg Dreier. She is behind the study together with Yuelian Sun, who is the first author of this study and an associate professor at the Department of Clinical Medicine at Aarhus University and Jakob Christensen, who is clinical associate professor at the Department of Clinical Medicine at Aarhus University and consultant at the Department of Neurology at Aarhus University Hospital.
Both emphasise that it is important to find an explanation for the sharp decline. The study has shown that age of pregnant women and psychiatric disorders of pregnant women are unlikely to explain the declining trend of antidepressant use during pregnancy. In August 2011, the US Food and Drug Administration issued a safety warning concerning high doses of citalopram on heart, which could be one of potential explanations. However, more research are needed to confirm the association.
Jakob Christensen points out that additional studies should follow-up by looking into the pregnant women's health -- in particular when it comes to psychiatric health, which can include symptoms that are difficult to discern.
"There's no doubt about the fall since 2011 because antidepressants are only available from the pharmacy with a prescription, and the fall is so significant that it's more than relevant to take a closer look at whether pregnant women with depressive symptoms get the correct treatment, and in this way prevent the consequences of depression in the best possible way."
The register-based study is based on 1.2 million pregnancies in the period from 1997 to 2016. Of these, almost 30,000 women (2.4 per cent) collected at least one prescription for antidepressants during pregnancy. When the consumption was at its highest in 2011, almost one in twenty pregnant women collected prescriptions for antidepressants. The study has just been published in the scientific journal Brain and Behavior.
Jakob Christensen is also a clinical pharmacologist who has spent a number of years conducting research into the consequences of treatment with medicines during pregnancy. He says:
"In general, the use of antidepressants during pregnancy is considered to be safe, but questions have arisen concerning a slightly increased risk of congenital malformations and psychiatric symptoms in children where the mother has taken antidepressants during pregnancy. It's natural to suppose that some women have chosen not to take the medicine because they were worried that the child could be harmed," says Jakob Christensen. But he points out that choosing not to take the medicine is not always the best option.
Yuelian Sun adds:
"However, there were not episodes occurred around 2011 causing change on safety concern to unborn babies. On the contrast, safety concern of citalopram to pregnant women from physicians could also lead to declining of antidepressant use among pregnant women."
Depression in pregnant women is not uncommon, and the depression can continue and worsen after childbirth. This has been well-documented in previous research studies, says Jakob Christensen.
"This risk for the child must then be balanced with the risk of depression in the mother. An untreated depression can have major consequences for both the mother and the newborn child, for example by not thriving or in a worst case in the form of suicidal thoughts," he says.
https://www.sciencedaily.com/releases/2019/10/191029105619.htm
Antidepressants linked to heightened pregnancy related diabetes risk
Venlafaxine and amitriptyline and longer course of treatment associated with greatest risks
October 1, 2019
Science Daily/BMJ
Taking antidepressants while expecting a baby is linked to a heightened risk of developing diabetes that is specifically related to pregnancy, known as gestational diabetes, finds research published in the online journal BMJ Open.
The risk was greatest among mums to be who were taking venlafaxine, a type of drug known as a serotonin and norepinephrine reuptake inhibitor (SNRI), and amitriptyline, which belongs to an older class of antidepressant, known as tricyclics, the findings indicate.
Gestational diabetes affects up to one in five pregnant women worldwide. These pregnancies are prone to complications, such as overweight babies and prolonged labour due to the baby getting stuck in the birth canal.
The children of these pregnancies may also be more vulnerable to obesity and diabetes later on, while the mums are more likely to develop type 2 diabetes and cardiovascular disease.
Previous research looking at the potential link between antidepressant use and gestational diabetes risk has proved inconclusive and has been hampered by study design, say the researchers.
They drew on information from the Quebec Pregnancy Cohort, which incorporates three Canadian databases, and includes all pregnancies and children born in Quebec between 1998 and 2015.
Each case of gestational diabetes (20,905), identified after 20 weeks of pregnancy, was randomly matched with 10 unaffected pregnancies (209,050) of the same age and calendar year of delivery.
Antidepressant use was assessed using information on prescriptions filled for these drugs between the start of pregnancy and the diagnosis of gestational diabetes. In all, 9741 (just over 4%) of the mums took antidepressants, singly or combined.
These included citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline, which belong to a class of drugs known as selective serotonin reuptake inhibitors, or SSRIs for short; venlafaxine; and amitriptyline.
After taking account of potentially influential factors, such as the mum's age, welfare assistance, area of residence and other underlying conditions, taking antidepressants during pregnancy was associated with a heightened risk of developing gestational diabetes.
Taking any of these drugs was associated with a 19% heightened risk of being diagnosed with the condition compared with not taking antidepressants during pregnancy.
The risk was greatest for two antidepressant drugs, in particular: venlafaxine (27% heightened risk); and amitriptyline (52% heightened risk).
What's more, the risk increased, the longer certain types of antidepressants were taken, specifically SNRIs and tricyclics, singly or when combined.
Short term use was associated with a 15% heightened risk; medium term use was associated with a 17% heightened risk; and long term use with a 29% heightened risk.
When further analysis was done on a smaller group of women (21,395) who had been diagnosed with depression/anxiety before they became pregnant, the results were similar to those of the main analysis.
This is an observational study, and as such, can't establish cause. But there are some possible explanations for what they found, say the researchers.
This includes that antidepressants directly affect glucose metabolism, especially as serotonin is involved in this process. And one of the side effects of antidepressants is weight gain, a risk factor for diabetes.
But the pros and cons of taking antidepressants during pregnancy need to be weighed up carefully, caution the researchers, particularly for women whose depression is severe.
"The treatment of depression is a major concern and is challenging because depression is prevalent before and during pregnancy, and untreated depression can lead to relapse during pregnancy and in the [period immediately after birth]," they write.
https://www.sciencedaily.com/releases/2019/10/191001184927.htm