Continuation and discontinuation of antidepressant treatment before, during and after pregnancy: a cohort study

To assess the relationship between antidepressant treatment before, during and after childbirth. Cohort study. Primary care in the United Kingdom (UK). Women aged 15–49 with a single live birth (2006–2015), stratified by antidepressant history: Changes in antidepressant treatment during the perinatal period. Of 202,303 women, 46,479 (23%) had pre-childbirth antidepressant prescriptions (Cohorts A: 37,161; B: 19,627; C: 14,363), while 155,824 (77%) did not (Cohort D). In cohort A, 76% discontinued treatment in the year before childbirth, compared to 48% in cohort B. Postpartum, 22% of those in cohort A and 33% in cohort B restarted treatment. Overall, 26,835/202,303 (13%) received antidepressants in the year after childbirth. Among women without prior treatment, 10,258/155,824 (7%) started antidepressants postpartum, compared to 16,577/46,479 (36%) of those with prior use. Cohort C had the highest postpartum prescription rate (9,232/14,363, 64%). Antidepressant treatment after childbirth is common, particularly among women who have received treatment before childbirth. Many women discontinue antidepressants before or during pregnancy. The study highlights the importance of considering history of antidepressant treatment when planning postnatal care and counselling women on continuing or stopping antidepressants during pregnancy. This information can aid healthcare professionals in advising women about antidepressant use before, during, and after pregnancy, considering individual circumstances and risks. Previous studies typically have small cohorts and do not describe the changes in antidepressant treatment before pregnancy, during pregnancy and following childbirth. We found that half of those with a previous prescription discontinued treatment during conception/pregnancy, but a third of these restart treatment in the year after childbirth. Of those with no previous antidepressant treatment, 7% were issued a prescription in the year after childbirth compared to 36% of those with any prior treatment. Nearly 2/3 of those who received treatment during conception/pregnancy were issued an antidepressant prescription in the year after childbirth.