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Antidepressant discontinuation during pregnancy and relapse risk in the perinatal period

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Advancing personalised antidepressant treatment during pregnancy

Due to perceived threats of some antidepressant medications, some pregnant women choose to stop, risking a relapse. By assessing risk levels, a new project is aiming for a more targeted approach.

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For women using antidepressant medication, pregnancy can bring an extra consideration: whether or not to continue taking the medicine. They must carefully consider the probable risk of relapse against potential harm to their unborn child. Yet, there is a paucity of research examining the effectiveness of antidepressant treatment during pregnancy. Most existing studies are based on specific populations derived from clinical samples and other non-experimental observations. This has a limiting effect on treatment advice. “No personalised recommendations are available on who can safely taper or cease their antidepressant usage without increasing the risk of relapse,” says Xiaoqin Liu, senior researcher at Aarhus University in Denmark and principal investigator on the PregnancyAD project. To fill in this gap, the EU-funded PregnancyAD project, undertaken with the support of the Marie Skłodowska-Curie Actions programme, performed a combined analysis of demographics, clinical features and genetic data from both the national registers and the Integrative Psychiatric Research (iPSYCH) sample in Denmark. The research aimed to figure out the potential effectiveness and risks of antidepressant treatment across the pregnant population, leading towards a more personalised case-by-case approach. “Our findings are consistent with prior research and offer reassuring evidence that the use of antidepressants during pregnancy has limited impacts on children,” notes Liu.

Studying the risk of relapse

To investigate whether genetic susceptibility is associated with post-partum relapse risk, the PregnancyAD team first examined relapse risk based on patient treatment patterns. The researchers found post-partum relapse risk corresponded to different antidepressant treatment trajectories: whether they stopped at all, early or late pregnancy, and how long they had been using the drugs beforehand. The team then explored whether the genetic liability to major depression was linked to these antidepressant treatment trajectories. “These trajectories are primarily influenced by the severity of the disorders rather than genetic susceptibility to major depression,” says Liu.

Working towards personal risk assessments

To identify whether women who discontinued antidepressants had a higher relapse risk, the research first focused on psychiatric emergencies. Discontinuing antidepressants during pregnancy increased the risk of psychiatric emergencies to 5.0 % from 3.7 % in those continuing. For approximately every 76 pregnant women who decided to discontinue antidepressants, an additional psychiatric emergency occurred. Then, the team analysed less severe psychiatric outcomes and utilised a machine learning approach to model antidepressant treatment trajectories. For long-term users of antidepressant medication, stopping in late pregnancy increases the likelihood of experiencing relapse risk and a need for new medications after delivery. Liu notes that similar trends were not found among short-term users, or those who discontinued early in pregnancy, meaning previous treatment strategies can inform the potential risk of relapse. “Our findings suggest that women with severe mental illness, particularly those who have established stability through ongoing treatment, may derive substantial advantages from continuing their antidepressant regimen during pregnancy,” explains Liu.

Supporting decision-making during pregnancy

“It is crucial to emphasise that most women can safely discontinue their antidepressant medication without concerns of relapse,” remarks Liu. “The decision to continue or discontinue antidepressants should ideally be a collaborative one involving clinicians, patients and their families to ensure the most well-informed and tailored course of action,” she adds.

Keywords

PregnancyAD, pregnancy, antidepressants, relapse, risk, personal, mental illness, treatment

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