According to a 2011 report released by the National Center for Health Statistics, antidepressant use among Americans aged 12 and older increased by almost 400 percent between 2005 and 2008. This increasing trend is also being significantly depicted among pregnant women.
What’s more concerning is that, based on 2006 data from Behavioral Risk Factor Surveillance System, around 30 percent of reproductive-aged women had current depression or had received a clinical diagnosis, and they most often went untreated.
Antidepressant medication trends among women
Many women need antidepressants on a continuing basis. Given that 50 percent of U.S. pregnancies are unintentional, antidepressant use is likely to occur during the initial weeks of pregnancy, a vital stage for fetal development. Yet, there lacks a clear agreement on the safest medication options for both the mother and fetus.
The most frequently filled antidepressants include sertraline, bupropion and citalopram. Women aged 35 to 44 years account for the largest section of reproductive-aged women filling prescriptions for antidepressants.
The CDC study
CDC analyzed data on women aged 15–44 years who had more than 11 months of enrollment in a private health insurance plan. The annual number, yearly quantity and a general average proportion of reproductive-aged women who filled an antidepressant prescription from an outpatient pharmacy were analyzed based upon specific antidepressant medication and medication class, age group and geographic area.
The study sample included an average of 5.8 million privately insured reproductive-aged women during 2008–2013, and the study highlighted the following trends:
- During this period, 15.4 percent of reproductive-aged women filled a prescription for an antidepressant from an outpatient pharmacy yearly
- 76 percent filled prescriptions for only one type of antidepressant
- The most commonly filled antidepressant prescriptions by reproductive-aged women each year were for sertraline (filled by an average of 3.3 percent each year), bupropion (2.7 percent), citalopram (2.6 percent), escitalopram (2.5 percent) and fluoxetine (2.3 percent)
- Overall, the percentage of reproductive-aged women with antidepressant claims remained relatively stable during 2008–2013
Why is this concerning?
Antidepressant prescriptions of such frequency in this population raises grave health concerns, especially in face of the high proportion of unplanned pregnancies, inadequate information on risks of antidepressant use during pregnancy and probable associations between the use of some antidepressants and the occurrence of birth defects.
- There is some evidence of links between early pregnancy use of paroxetine and five specific birth defects (anencephaly, gastroschisis, omphalocele, atrial septal defects and right ventricular outflow tract obstruction defects)
- Depressed women have higher rates of smoking, binge or heavy drinking, obesity, and physical inactivity, which might also pose risks to a developing fetus during pregnancy
- Byatt et al found the absolute risk of major malformations, including cardiovascular heart defects, which had been associated with some antidepressants, to be marginal
- To date, antidepressants are the most-studied drugs during pregnancy, with more than 30,000 outcomes examining increased risks of adverse effects on exposed infants
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Written by Sana Ahmed, Sovereign Health Group writer
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