Patterns of antidepressant prescribing around pregnancy: a descriptive analysis using Clinical Practice Research Datalink GOLD

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BACKGROUND: Antidepressant use is increasing during pregnancy but estimates of prevalence and patterns of prescribing are outdated. AIM: To describe the prevalence and patterns of antidepressant prescribing in and around pregnancy. DESIGN AND SETTING: This was a drug utilisation study using the UK's Clinical Practice Research Datalink (CPRD) GOLD Pregnancy Register. METHOD: Using primary care prescription records, individuals were identified who had been prescribed antidepressants in and around pregnancy between 1996 and 2018 and the prevalence of prescribing during pregnancy over time was described. Those with 'prevalent' or 'incident' antidepressant use were defined, where the 'prevalent' group contained individuals who were prescribed antidepressants both before and during pregnancy, whereas individuals in the 'incident' group were newly prescribed antidepressants during pregnancy. Patterns of prescribing were then qualitatively compared between these two groups. The study also investigated post-pregnancy prescribing, as well as characteristics associated with antidepressant discontinuation anytime during pregnancy. RESULTS: A total of 1 033 783 pregnancies were eligible: 79 144/1 033 783 (7.7%) individuals were prescribed antidepressants during pregnancy and 15 733/79 144 (19.9%) were in the 'incident' group. Antidepressant prescribing during pregnancy increased from 3.2% (556/17 653) in 1996 to 13.4% (3889/29 079) in 2018. Most women, both those whose antidepressants were 'prevalent' and 'incident' prescribed, discontinued their medication anytime during pregnancy (54.9% [34 801/63 411] and 59.9% [9427/15 733], respectively). Over half of those who discontinued during pregnancy were prescribed antidepressants in the 12 months after pregnancy (53.0%, 23 457/44 228). Younger age, previous stillbirth, and higher deprivation were associated with more frequent discontinuation anytime during pregnancy. CONCLUSION: Antidepressant prescribing during pregnancy has been increasing in the UK. Over half of the sample discontinued antidepressants at some point before the end of pregnancy, but post-pregnancy resumption of antidepressants was common. The results presented here highlight the benefit of counselling women when initiating antidepressants to support informed decision making.

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