The DOI matches its Crossref record.
Pregnancy as a Major Determinant for Discontinuation of Antidepressants: An Analysis of Data From The Health Improvement Network
Abstract
Background Potential adverse effects of antidepressants during pregnancy have caused concern about their use. There are, however, very limited detailed data on patterns of antidepressant prescribing in pregnancy. Objective To examine secular trends in prescribing during pregnancy, to assess whether pregnancy is a major determinant for stopping antidepressants, and to identify characteristics of those who stopped antidepressants during pregnancy. Method In this cohort study, we obtained data on 114,999 pregnant women (median age at delivery, 30.5 years [interquartile range, 26-34 years]) who had a live birth between 1992 and 2006 and 22,677 nonpregnant women from The Health Improvement Network primary care database, one of the largest sources of continuous anonymized primary care data in the United Kingdom and broadly representative of UK general practice. This database includes information on age, sex, medical diagnosis and symptoms, health promotion activities, referrals to secondary care, and prescriptions for each registered individual. The database also holds information about social deprivation as measured using quintiles of the Townsend score. We used Cox regression analysis to compare time to last prescription in pregnant versus nonpregnant women and to identify characteristics of those women who stopped antidepressants during pregnancy. Results Antidepressant prescribing in pregnancy increased nearly 4-fold from 1992 to 2006 (relative risk = 3.87; 95% CI, 1.73-8.66; P…
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“and often discontinue medication during pregnancy due to concern over potential harm to the fetus.14–16”
From Pregnancy and the Acceptability of Computer-Based Versus Traditional Mental Health Treatments (2017) · cites this paper as [16]
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“…was selected a priori for analysis based on findings of prior literature suggesting that age (Donald et al., 2021; Hurault-Delarue et al., 2019; Petersen et al., 2011), year of delivery (Molenaar et al., 2020b; Wikman et al., 2020), parity (Molenaar et al., 2020b), chronic physical diseases…”
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Modini, C., Leske, S., Roberts, S., Whelan, N., Chitakis, A., Crompton, D., & Ellwood, D. (2021) · Archives of Women's Mental Health · doi:10.1007/s00737-021-01107-6 · Cited by 11
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“…is important, for both women, who were seen to cease medication abruptly on confirmation of pregnancy, consistent with studies in the literature [36], and for GPs who viewed management in pregnancy as distinct from those who are not pregnant and face uncertainty around the safety of medication.”
BackgroundTrinh, N., Nordeng, H., Bandoli, G., Palmsten, K., Eberhard-Gran, M., & Lupattelli, A. (2022) · Clinical Epidemiology · doi:10.2147/clep.s379370 · Cited by 9
“8%) but may be lower than in the UK, where only 10% of women remained on AD treatment at the beginning of their third trimester.(4,35) However, Norwegian clinical guidelines recommend against discontinuing regular psychotropic drugs without consulting the attending physician(s), and discourage switching from one psych…”
BackgroundPetersen, J. M., Esposito, D. B., & Werler, M. M. (2020) · Archives of Women s Mental Health · doi:10.1007/s00737-020-01027-x · Cited by 10
Predictors and Patterns of Psychiatric Treatment Dropout During Pregnancy Among Low-Income Women
Kornfield, S. L., Kang‐Yi, C. D., Mandell, D. S., & Epperson, C. N. (2017) · Maternal and Child Health Journal · doi:10.1007/s10995-017-2394-9 · Cited by 14
“Maintaining psychiatric care during pregnancy can greatly enhance maternal well-being and the success of the pregnancy; however, few studies have comprehensively examined mental health utilization patterns during pregnancy among low-income women (Bennett et al. 2010; Petersen et al. 2011; Wu et al. 2014).”
Antepartum Depression: Treatment With Computer-Assisted Cognitive-Behavioral Therapy
Hantsoo, L. V., Epperson, C. N., Thase, M. E., & Kim, D. R. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.13020254 · Cited by 9
“, lack of time or child care) or fear of adversely affecting fetal health with antidepressant use (3).”
BackgroundLupattelli, A., Corrao, G., Gatti, C., Rea, F., Trinh, N., & Cantarutti, A. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.07.066 · Cited by 8
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“Less than 40 % of women continued antidepressant treatment in the perinatal period, confirming previous findings that pregnancy is a period where many women make important treatment decisions (Petersen et al., 2011).”
ResultConcepts for selection and utilization of psychiatric medications in pregnancy
Vickery, P. B. (2023) · Mental Health Clinician · doi:10.9740/mhc.2023.12.255 · Cited by 7
Suicide Among Women and the Role of Women’s Health Care Providers
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Bénard‐Laribière, A., Pambrun, É., Sutter‐Dallay, A., Gautier, S., Hurault‐Delarue, C., Damase‐Michel, C., Lacroix, I., & Pariente, A. (2020) · Archives of Women s Mental Health · doi:10.1007/s00737-020-01033-z · Cited by 7
Antidepressant use during pregnancy and risk of congenital heart defects: A case‐time‐control study
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“Women may discontinue AD use in early pregnancy probably due to their concern of adverse effects of ADs to fetus, and many pregnant women and new mothers perceive the risks of AD treatment in pregnancy similar to what they perceive for alcohol and smoking (41-43).”
BackgroundSelf-citationIntegrated Perinatal Mental Health Care
Kruper, A., & Wichman, C. L. (2017) · Psychiatric Annals · doi:10.3928/00485713-20170531-01 · Cited by 6
Ethical and Clinical Dilemmas in Using Psychotropic Medications During Pregnancy.
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Epigenetics of Psychopathology
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Trinh, N. T., Semark, B. D., Munk‐Olsen, T., Liu, X., Thapa, S. B., Yılmaz, Z., Petersen, L. V., & Lupattelli, A. (2023) · Translational Psychiatry · doi:10.1038/s41398-023-02516-0 · Cited by 3
“Existing studies suggest a high prevalence of antidepressant discontinuation when women enter the course of pregnancy, regardless of the underlying condition [9].”
BackgroundChaput, K. H., Freeman, M., McMorris, C. A., Metcalfe, A., Cameron, E. E., Jung, J. W., Tough, S., Hicks, L. M., Dimidjian, S., & Tomfohr‐Madsen, L. M. (2023) · Trials · doi:10.1186/s13063-023-07077-7 · Cited by 3
“Previous research has also found that pregnancy is a major determinant of antidepressant medication cessation [8], and that therapy-based depression treatments are the documented preference of the perinatal population [9].”
Vallee, J., Wong, Y., Mannino, E., Nordeng, H., & Lupattelli, A. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18010046 · Cited by 5
“It is known that pregnancy is a well-established driver for antidepressant discontinuation, irrespective of underlying severity of maternal mental illness [27,50].”
BackgroundPrenatal antidepressant utilization and trajectories in Switzerland using the MAMA cohort.
Dupuis, M., Scharf, T., Gerbier, E., Abolhassani, N., Jenkinson, S. P., Spoendlin, J., Auer, R., Baggio, S., & Panchaud, A. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120833 · Cited by 2
Intranasal sertraline for the investigation of nose-to-brain delivery to mitigate systemic exposure
Williams, S. C., Lantz, T. C., Doulames, V., Alakesh, A., Mejia, D. R., Jons, C., Huang, Z., Eckman, N., & Appel, E. A. (2025) · bioRxiv · doi:10.1101/2025.08.10.669549 · Cited by 2
“29,30 Strikingly, 68% of these patients experience relapse during their pregnancy, 31 and they have a 52% increase in their risk of experiencing a psychiatric emergency during their pregnancy that results in a hospital visit compared to those who continued antidepressant use.”
Martin, F., Sharp, G. C., Easey, K., Madley-Dowd, P., Bowen, L., Nimmo-Smith, V., Sadik, A., Richardson, J. L., Rai, D., & Forbes, H. (2025) · The British journal of general practice : the journal of the Royal College of General Practitioners · doi:10.3399/bjgp.2025.1093 · Cited by 2
“33 The upwards trend over time reflects the increased antidepressant prescribing in the general UK population over recent decades 19,34 and shows the growing need for evidence-based advice on antidepressant use during pregnancy.”
Pearls for Caring for the Boarding Psychiatric Patient in the Emergency Department.
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“Nevertheless, pregnancy and breastfeeding are the main reasons why women avoid or discontinue antidepressants, leading to the risk of relapse (Petersen et al., 2011; Payne, 2021).”
BackgroundPsychotropic medication use during pregnancy and gestational age at delivery
Haviland, M. J., Nillni, Y. I., Fox, M. P., Savitz, D. A., Hatch, E. E., Rothman, K. J., Hacker, M. R., Wang, T. R., & Wise, L. A. (2020) · Annals of Epidemiology · doi:10.1016/j.annepidem.2020.08.010 · Cited by 3
“(11) Although psychotropic medications are commonly used to treat depression and stress,(12) many pregnant women discontinue their use due to concerns about adverse pregnancy outcomes.(13,14) Studies of psychotropic medications and preterm delivery have produced inconsistent results.”
BackgroundTreating Maternal Depression: Considerations for the Well-Being of the Mother and Child
Brummelte, S. (2018) · Policy Insights from the Behavioral and Brain Sciences · doi:10.1177/2372732217740594 · Cited by 2
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“Nevertheless, pregnant women are often reluctant to use psychiatric medications (Petersen et al. 2011, 2015) and reduce use by 80% during pregnancy (Hippman and Balneaves 2018).”
Optimizing Venlafaxine Therapy in Pregnancy: A Maternal–Fetal PBPK Modeling Approach
Choi, S.-Y., Yang, E., & Shin, K.-H. (2025) · Drug Design, Development and Therapy · doi:10.2147/dddt.s553888 · Cited by 1
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“In the case of pregnant women, primary adherence (dis-pensation by prescription rate) studies are scarce, but some of them indicate that many women discontinue their anti-depressant once they become aware of the pregnant status [18].”
Lupattelli, A., Branquinho, M., Cardoso, C., Tauqeer, F., Bjørndal, L. D., & Fonseca, A. (2024) · Patient Education and Counseling · doi:10.1016/j.pec.2024.108337 · Cited by 1
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“…medication treatment during pregnancy particularly where benefits would outweigh the risks, yet reports have shown that treatments for mental health disorders, such as depression, may often be discontinued in pregnancy (American College of Obstetrics and Gynecology, 2023; Petersen et al., 2011).”
BackgroundMarr, K., Maguet, C., Scarlett, H., Dray‐Spira, R., Dubertret, C., Gressier, F., Sutter‐Dallay, A., Melchior, M., & van der Waerden, J. E. B. (2023) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13647
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Immunosuppressive therapy in SLE
Wise, L. M., & Stohl, W. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-820583-9.00044-0
Epidemiology of the Use of Psychotropic Drugs in Pregnant and Nursing Women
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The Role of Healthcare Databases in Pharmacovigilance of Psychotropic Drugs
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Lambert, T., Callaghan, C., Jung, J. W., Skiffington, J., Tomfohr-Madsen, L., & Chaput, K. (2026) · BMC Psychology · doi:10.1186/s40359-026-04862-2
Marson, E., Petersen, I., Saxena, S., Schartau, P., & Smith, H. (2026) · Archives of Women's Mental Health · doi:10.1007/s00737-026-01683-5
“…3% of women of childbearing age require antidepressant treatment (McCrea et al. 2016) , yet many discontinue their medication during pregnancy due to concerns about potential risks to the fetus (Trinh et al. 2023, Trinh et al. 2022, Hung et al. 2023, Wik-man et al. 2020, Petersen et al. 2011).”
Self-citationDanelli, A., Marxer, C. A., Graber, S. M., Huber, C., Zürcher, S. J., Panchaud, A., Surbek, D., Meier, C. R., & Spoendlin, J. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121483
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“Prior studies have shown that self-rated severity of illness 34 and safety concerns during pregnancy 11,35,36 play an important role in medication adherence in pregnancy.”
Julce, C., Flahive, J., Lightbourne, T., Podila, S., Mahanna, A., Zimmermann, M., Sheldrick, R., Simas, T. M. M., & Byatt, N. (2025) · Early Intervention in Psychiatry · doi:10.1111/eip.70070
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Administer antidepressants during pregnancy on a case-by-case basis
Lamb, Y. N., & Fung, S. S.-P. (2024) · Drugs & Therapy Perspectives · doi:10.1007/s40267-024-01053-0
“The most frequently provided reason for pregnant patients discontinuing antidepressants is anxiety over the possible adverse effects of antidepressant exposure on the foetus [4].”
McLaughlin, P., & Cleare, A. (2020) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20170530-79
Women’s Behavioral Health Needs
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“Upon discovering pregnancy, women are likely to discontinue a prescription medication they suspect might be harmful [4,5].”
BackgroundMethods and results: EMR-based assessment of behavioral healthcare needs in the obstetric setting
Rowan, P., Greisinger, A., & Smith, F. A. (2014) · Journal of Integrative Psychology and Therapeutics · doi:10.7243/2054-4723-2-4
“Upon discovering pregnancy, women are likely to discontinue a prescription medication they suspect might be harmful [4,5].”
BackgroundMENTAL HEALTH TREATMENT AND METABOLIC DISORDERS IN PREGNANCY: A LONGITUDINAL STUDY
Breadon, C., Arunogiri, S., Turbić, A., Lavale, A., Maldonado, R., & Fahms, J. K. A. (2024) · ASEAN Journal of Psychiatry · doi:10.54615/2231-7805.47357
“…diagnosis of GDM widely adopted between 2011-2016, a change in the ethnic and demographic background of women giving birth in Australia, as well as a marked underlying increase in rates of GDM in the broader population associated with an increase in rates of obesity, as shown in this paper [3-5].”
ResultCritical Assessment of Observational Studies and Shared Decision Making in Perinatal Psychiatry
Forrest, L. F., & Lieshout, R. J. V. (2020) · Springer eBooks · doi:10.1007/978-3-030-29081-8_27
Metadata
- Authors
- Petersen, I., Gilbert, R. E., Evans, S. J. W., Man, S.-L., & Nazareth, I.
- Affiliations
- University College London (GB)
- Corresponding author
- Petersen, Irene
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2011-03-08
- Volume
- 72
- Issue
- 07
- Pages
- 979-985
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2004855735
- Cited by
- 192
- References
- 0
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 12 · 2023: 10 · 2022: 17 · 2021: 9 · 2020: 18 · 2019: 7 · 2018: 10 · 2017: 11 · 2016: 10 · 2015: 23 · 2014: 21 · 2013: 15 · 2012: 12
- FWCI
- 15.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (G0601726)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- antidepressant discontinuation, pregnancy, antidepressant prescribing, selective serotonin reuptake inhibitors, maternal mental health, perinatal depression, secular trends, Townsend score, social deprivation, primary care prescribing, drug safety in pregnancy, third trimester, parity, maternal alcohol use, maternal obesity, maternal diabetes, maternal hypertension, smoking during pregnancy, prenatal alcohol exposure
- MeSH terms
- Adolescent, Adult, Age Factors, Antidepressive Agents, Major Depressive Disorder, Depressive Disorder, Major, Drug Utilization, Female, Gestational Age, United Kingdom, Humans, Infant, Newborn, Practice Patterns, Physicians', Pregnancy, Pregnancy Complications, Socioeconomic Factors, Cohort Studies, Selective Serotonin Reuptake Inhibitors, Medication Adherence, Young Adult, General Practice, Drug-Related Side Effects and Adverse Reactions
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