Patterns of antidepressant prescribing in and around pregnancy: a descriptive analysis in the UK Clinical Practice Research Datalink

Objective:
To describe the prevalence and patterns of antidepressant prescribing in and around pregnancy.

Design:
Drug utilisation study.

Setting:
Primary care in the United Kingdom (UK).

Population:
Women with a pregnancy between 1996 and 2018 in the UK Clinical Practice Research Datalink (CPRD) GOLD Pregnancy Register.

Methods:
Using primary care prescription records, we identified individuals who had been prescribed antidepressants in and around pregnancy and described changing prevalence of prescribing during pregnancy over time. We defined ‘prevalent’ or ‘incident’ antidepressant use, where ‘prevalent’ users were prescribed antidepressants both before and during pregnancy, and ‘incident’ users were newly prescribed antidepressants during pregnancy, then compared patterns of prescribing between these two groups. We also investigated characteristics associated with antidepressant discontinuation anytime during pregnancy and post-pregnancy prescribing.

Main outcome measures:
Antidepressant prescribing during pregnancy.

Results:
A total of 1,033,783 pregnancies were identified: 79,144 (7.7%) were prescribed antidepressants during pregnancy and 15,733 of these (19.9%) were ‘incident’ users. Antidepressant prescribing during pregnancy increased from 3.2% in 1996 to 13.4% in 2018. Most women, both ‘prevalent’ and ‘incident’ users, discontinued antidepressants anytime during pregnancy (54.8% and 59.9%, respectively). The majority of those who discontinued during pregnancy resumed in the 12 months after pregnancy (53.0%). Younger age, previous stillbirth, and higher deprivation were associated with more frequent discontinuation anytime during pregnancy.

Conclusions:
Antidepressant use during pregnancy appears to be increasing in the UK. Most women discontinued antidepressants at some point before the end of pregnancy, but post-pregnancy resumption of antidepressants was common.