J Affect Disord. 2025 Jun 21:119726. doi: 10.1016/j.jad.2025.119726. Online ahead of print.
ABSTRACT
OBJECTIVE: To describe the timing and intensity of antidepressant initiation in pregnancy using longitudinal trajectories of antidepressant prescription fills to identify associated sociodemographic, lifestyle, somatic, mental health, pregnancy, and paternal factors.
METHODS: This population-based cohort within the Norwegian Mother, Father and Child Cohort study linked to MoBa Genetics and the Prescribed Drug Registry included 1879 women with a new episode of self-reported depression/anxiety during pregnancy. Antidepressants were measured by week and average daily dose.
RESULTS: There were 87 initiators, from which we identified three prescription fill trajectories: Early-pregnancy initiators with rapid discontinuation (n = 41, 47.1 %), Early-pregnancy initiators with mid-pregnancy discontinuation (n = 30, 34.5 %), and Early-mid pregnancy initiators with continuation (n = 16, 18.4 %) and three dose trajectories: Low dose with discontinuation (n = 45, 51.7 %), High dose with discontinuation (n = 26, 29.9 %), and Medium dose with continuation (n = 16, 18.4 %). Thyroid disorder was associated with Early initiators with rapid discontinuation (adjusted relative risk ratios (aRRR): 4.15, 95 % CI: 1.56-11.03) compared to Unmedicated. Other psychotropics pre-pregnancy increased the likelihood of being Early initiators with mid-pregnancy discontinuation and High dose discontinuers compared to Unmedicated. Higher maternal genetic liability for depression was strongly associated with Early initiators with mid-pregnancy discontinuation (aRRR = 8.57, 95 % CI: 3.09-23.74), High dose discontinuers and Medium dose continuers across comparisons. Adverse reproductive history, immigration and alcohol pre-pregnancy emerged as important factors.
CONCLUSIONS: Approximately 5 out of 100 women with a new episode of depression/anxiety initiated an antidepressant during pregnancy, predominantly in early pregnancy, with most discontinuing early to mid-pregnancy. Identified factors can be utilized by clinicians to provide personalized treatment guidance.
PMID:40550280 | DOI:10.1016/j.jad.2025.119726
