Antidepressant Prescription Medication Use Patterns among Insured, Low Income Pregnant Women

Jun Wu^1, , Mary Lynn Davis-Ajami², Sharon Keiser³ and Lynda Sykes⁴

¹South Carolina College of Pharmacy, University of South Carolina, Greenville, USA

²Organizational Systems and Adult Health, School of Nursing, University of Maryland, Baltimore, Baltimore, USA

³Sharon Keiser, Department of Obstetrics and Gynecology, Greenville Health System, Greenville, USA

⁴Lynda Sykes, Department of Pharmacy, Greenville Health System, Greenville, USA

Cite this paper

Jun Wu, Mary Lynn Davis-Ajami, Sharon Keiser and Lynda Sykes. Antidepressant Prescription Medication Use Patterns among Insured, Low Income Pregnant Women. American Journal of Public Health Research. 2013; 1(3):72-77. doi: 10.12691/AJPHR-1-3-3

Abstract

Despite of the controversy of antidepressant use during the gestational period, the reported antidepressant use at any time during pregnancy has increased. Our study assessed antidepressant prescription medication use patterns during pregnancy among insured, low-income women in the United States. This retrospective study used South Carolina Medicaid claims data (2004-2009). Included were pregnant women (≥ 18 years) with single or multiparous live birth(s) with a diagnosis for major depression or reported pharmacy claims for antidepressant prescriptions 1 year before becoming pregnant or while pregnant. Antidepressant prevalence prior to and during pregnancy, type of antidepressant, and trimester when the antidepressant use started, characterized antidepressant prescription use patterns. Among 24,077 pregnant women with live births, the prevalence of antidepressant use before becoming pregnant and during pregnancy was 5.5% and 6% respectively. A total of 3,237 pregnant women met inclusion criteria. Of the 1,456 women prescribed antidepressants during pregnancy, 16% showed a history of major depression predating their pregnancy and 67% initiated antidepressant medications after becoming pregnant. Nearly 80% took selective serotonin reuptake inhibitors (SSRIs) during pregnancy, and 32% initiated antidepressants during the first trimester. Age, race, and preexisting depression were associated with antidepressant use. In pregnant, insured low-income women, the majority prescribed antidepressants were new users. Pharmacologic treatment for pregnant women with depressive symptoms, particularly in newly diagnosed major depression remains challenging.

Keywords

antidepressant, insured, low-income, pregnancy, depression

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Mok, C., Lok, E. and Cheung, E, "Concurrent psychiatric disorders are associated with significantly poorer quality of life in patients with rheumatoid arthritis," Scand J Rheumatol, 41(4), 253-259, 2012.
[2]	Centers for Disease Control and Prevention, "Current depression among adults --- united states, 2006 and 2008," Morbidity and Mortality Weekly Report (MMWR), 59(38), 1229-1235, 2010.
[3]	Campayo, A., de Jonge P, Roy J.F., Saz, P., de la Camara. C., Quintanilla, M.A., Marcos,G., Santabarbara, J. and Lobo, A, "Depressive disorder and incident diabetes mellitus: The effect of characteristics of depression," Am J Psychiatry, 167(5), 580-588, 2010.
[4]	Lichtman, J.H., Bigger, J.T,Jr, Blumenthal, J.A., at el. "Depression and coronary heart disease: Recommendations for screening, referral, and treatment: A science advisory from the american heart association prevention committee of the council on cardiovascular nursing, council on clinical cardiology, council on epidemiology and prevention, and interdisciplinary council on quality of care and outcomes research: Endorsed by the american psychiatric association," Circulation, 118(17),1768-1775, 2008.
[5]	Campayo, A., Gomez-Biel, C.H. and Lobo, A, "Diabetes and depression," Curr Psychiatry Rep, 13(1), 26-30, 2011.
[6]	American Pregnancy Association, "Depression during pregnancy," [Online]. Available:
[7]	http://www.americanpregnancy.org/pregnancyhealth/depressionduringpregnancy.html. [Accessed June 4, 2012].
[8]	The American Congress of Obstetricians and Gynecologists, "Depression during pregnancy: Treatment recommendations. A joint report from APA and ACOG," [Online]. Available: http://www.acog.org/About_ACOG/News_Room/News_Releases/2009/Depression_During_Pregnancy. [Accessed June 4, 2012].
[9]	Bonari, L., Pinto, N., Ahn, E., Einarson, A., Steiner, M. and Koren, G, "Perinatal risks of untreated depression during pregnancy," Can J Psychiatry, 49(11), 726-735, 2004.
[10]	Yonkers, K.A., Wisner, K.L., Stewart, D.E., Oberlander, T.F., Dell, D.L., Stotland, N., Ramin, S., Chaudron, L. and Lockwood, C, "The management of depression during pregnancy: A report from the american psychiatric association and the american college of obstetricians and gynecologists," Gen Hosp Psychiatry, 31(5), 403-413, 2009.
[11]	Wisner, K.L., Sit, D.K., Hanusa, B.H., Moses-Kolko, E.L., Bogen, D.L., Hunker, D.F., Perel, J.M., Jones-Ivy, S., Bodnar, L.M. and Singer, L.T, "Major depression and antidepressant treatment: Impact on pregnancy and neonatal outcomes," Am J Psychiatry, 166(5), 557-566, 2009.
[12]	Cohen L.S., Altshuler L.L., Harlow B.L., at el. "Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment," JAMA,; 295(5),499-507, 2006.
[13]	Dominguez R.A. and Goodnick P.J, "Adverse events after the abrupt discontinuation of paroxetine," Pharmacotherapy, 15(6): 778-780, 1995.
[14]	Rosenbaum J.F. and Zajecka J, "Clinical management of antidepressant discontinuation," J Clin Psychiatry, 58 (Suppl 7), 37-40,1997.
[15]	Lorant, V., Croux, C., Weich, S., Deliege, D., Mackenbach, J. and Ansseau, M, "Depression and socio-economic risk factors: 7-year longitudinal population study," Br J Psychiatry, 190,293-298, 2007.
[16]	Roy-Byrne, P.P., Joesch, J.M., Wang, P.S. and Kessler, R.C, "Low socioeconomic status and mental health care use among respondents with anxiety and depression in the NCS-R," Psychiatr Serv, 60(9), 1190-1197, 2009.
[17]	Hayes, R.M., Wu, P., Shelton, R.C., Cooper, W.O., Dupont, W.D, Mitchel, E. and Hartert, T.V, "Maternal antidepressant use and adverse outcomes: A cohort study of 228,876 pregnancies," Am J Obstet Gynecol, 207(1), 49.e1-49.e9, 2012.
[18]	Alwan, S., Reefhuis, J., Rasmussen, S.A. and Friedman, J.M, "National Birth Defects Prevention Study. Patterns of antidepressant medication use among pregnant women in a united states population," J Clin Pharmacol, 51(2), 264-270, 2011.
[19]	Dietz, P.M., Williams, S.B., Callaghan, W.M., Bachman, D.J., Whitlock, E.P. and Hornbrook, M.C, "Clinically identified maternal depression before, during, and after pregnancies ending in live births," Am J Psychiatry, 164(10):1515-1520, 2007.
[20]	Andrade, S.E., Raebel, M.A., Brown, J., Lane, K., Livingston, J., Boudreau, D., Rolnick, S.J., Roblin, D., Smith, D.H., Willy, M.E., Staffa, J.A. and Platt, R, "Use of antidepressant medications during pregnancy: A multisite study," Am J Obstet Gynecol, 198(2), 194.e1-194.e5, 2008.
[21]	Cooper, W.O., Willy, M.E., Pont, S.J. and Ray, W.A, "Increasing use of antidepressants in pregnancy," Am J Obstet Gynecol, 196(6), 544.e1-544.e5, 2007.
[22]	Chambers, C.D., Hernandez-Diaz, S., Van Marter, L.J., Werler, M.M., Louik, C., Jones, K.L. and Mitchell, A.A, "Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn," N Engl J Med, 354(6), 579-587, 2006.
[23]	Kallen. B.A. and Otterblad Olausson, P., "Maternal use of selective serotonin re-uptake inhibitors in early pregnancy and infant congenital malformations," Birth Defects Res A Clin Mol Teratol, 79(4), 301-8, 2007.
[24]	Kendall-Tackett, K. and Hale, T.W, "The use of antidepressants in pregnant and breastfeeding women: A review of recent studies," J Hum Lact, 26(2), 187-195, 2010.
[25]	Pedersen, L.H., Henriksen, T.B., Vestergaard, M., Olsen, J., Bech, B.H, "Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: Population based cohort study," BMJ, 339, b3569, 2009.
[26]	Toh, S., Mitchell, A.A., Louik, C., Werler, M.M., Chambers, C.D. and Hernandez-Diaz, S, "Selective serotonin reuptake inhibitor use and risk of gestational hypertension," Am J Psychiatry, 166(3), 320-328, 2009.
[27]	Wen, S.W., Yang, Q., Garner, P., Fraser, W., Olatunbosun, O., Nimrod, C. and Walker, M, "Selective serotonin reuptake inhibitors and adverse pregnancy outcomes," Am J Obstet Gynecol, 194(4), 961-966, 2006.
[28]	Ramos, E., Oraichi, D., Rey, E., Blais, L. and Berard, A, "Prevalence and predictors of antidepressant use in a cohort of pregnant women," BJOG, 114(9), 1055-1064, 2007.
[29]	Ververs, T., Kaasenbrood, H., Visser, G., Schobben, F., de Jong-van den Berg, L. and Egberts, T, "Prevalence and patterns of antidepressant drug use during pregnancy," Eur J Clin Pharmacol, 62(10):863-870, 2006.
[30]	Plant, E.A. and Sachs-Ericsson, N, "Racial and ethnic differences in depression: The roles of social support and meeting basic needs," J Consult Clin Psychol, 72(1), 41-52, 2004.
[31]	Hernandez, A., Plant, E.A., Sachs-Ericsson, N., and Joiner, T.E, "Mental health among hispanics and caucasians: Risk and protective factors contributing to prevalence rates of psychiatric disorders," J Anxiety Disord, 19(8), 844-860, 2005.
[32]	Sleath, B., West, S., Tudor, G., Perreira, K., King, V. and Morrissey, J, "Ethnicity and prenatal depression: Women's experiences and perspectives on communicating about their emotions and feelings during pregnancy," Patient Educ Couns, 58(1), 35-40, 2005.
[33]	Henshaw, E.J., Flynn, H.A., Himle, J.A., O'Mahen, H.A., Forman, J. and Fedock, G, "Patient preferences for clinician interactional style in treatment of perinatal depression," Qual Health Res, 21(7), 936-951, 2011.
[34]	O'Mahen, H.A. and Flynn, H.A, "Preferences and perceived barriers to treatment for depression during the perinatal period," J Womens Health (Larchmt), 17(8), 1301-1309, 2008.
[35]	Melfi, C.A., Chawla, A.J., Croghan, T.W., Hanna, M.P., Kennedy, S., and Sredl, K, "The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression," Arch Gen Psychiatry, 55(12):1128-1132, 1998.