Abstract
US female veterans have higher rates of mental health (MH) disorders compared to US civilian females and, consequently, are at risk for poor MH outcomes during pregnancy. This study evaluated the MH burden and identified the prevalence of antidepressant prescription and discontinuation among pregnant veterans (PGVets). The electronic health records (EHR) of PGVets using the US Veterans Administration’s (VA) maternity care benefits over a two-year period were retrospectively reviewed. Inclusion criteria for this study were a current MH diagnosis of depression, anxiety, or posttraumatic stress disorder (PTSD) at the onset of pregnancy (n=351). Outcomes examined included antidepressant use prior to pregnancy, the use and discontinuation of antidepressants during pregnancy, and risk factors for discontinuation. PGVets had a high MH burden, as indicated by multiple comorbid diagnoses of unipolar depression, anxiety, and PTSD in 67% of the sample. At the onset of pregnancy, 163 (46%) were treated with an antidepressant. Only 56 (34%) continued using antidepressants through the pregnancy. Self-discontinuation (34%) and VA provider discontinuation (31%) of antidepressants were found. Among PGVets with documented past suicidal behaviors, 90% discontinued their active antidepressants. PGVets with indicators for more severe MH diagnoses were most likely to discontinue. The MH burden of PGVets and high rates of antidepressant discontinuation have implications for engaging this population in a higher level of perinatal monitoring and intervention. The findings suggest that VA providers and veterans would benefit from risks and benefits education regarding antidepressant use during pregnancy as well as the provision of alternative therapies.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Explore related subjects
Discover the latest articles and news from researchers in related subjects, suggested using machine learning.References
Bayrampour H, Kapoor A, Bunka M, Ryan D (2020) The risk of relapse of depression during pregnancy after discontinuation of antidepressants: a systematic review and meta-analysis. J Clin Psychiatry 81(4). https://doi.org/10.4088/JCP.19r13134
Bonari L, Koren G, Einarson TR, Jasper JD, Taddio A, Einarson A (2005) Use of antidepressants by pregnant women: evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making. Arch Womens Ment Health 8(4):214–220. https://doi.org/10.1007/s00737-005-0094-8
Callegari L, Edmonds S, Borrero S, Ryan G, Cusack C, Zephyrin L (2018) Preconception care in the Veterans Health Administration. Semin Reprod Med 36(06):327–339. https://doi.org/10.1055/s-0039-1678753
Einarson A, Selby P, Koren G (2001) Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling. J Psychiatry Neurosci 26(1):44–48
Frayne SM, Phibbs CS, Saechao F, Friedman SA, Shaw JG, Romodan Y, Berg E, Lee J, Ananth L, Iqbal S, Hayes PM, Haskell S (2018) Sourcebook: women veterans in the veterans health administration, vol 4: Longitudinal trends in sociodemographics, utilization, health profile, and geographic distribution. Women’s Health Evaluation Initiative, Women’s Health Services, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
Gawron L, Mohanty A, Kaiser J, Gundlapalli A (2018) Impact of deployment on reproductive health in U.S. active-duty servicewomen and veterans. Semin Reprod Med 36(06):361–370. https://doi.org/10.1055/s-0039-1678749
Goldman-Mellor S, Margerison CE (2019) Maternal drug-related death and suicide are leading causes of postpartum death in California. Am J Obstet Gynecol 221(5):489.e1–489.e9. https://doi.org/10.1016/j.ajog.2019.05.045
Grigoriadis S, VonderPorten EH, Mamisashvili L, Tomlinson G, Dennis C-L, Koren G, Steiner M, Mousmanis P, Cheung A, Radford K, Martinovic J, Ross LE (2013) The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry 74(04):e321–e341. https://doi.org/10.4088/JCP.12r07968
Kroll-Desrosiers AR, Crawford SL, Moore Simas TA, Clark MA, Bastian LA, Mattocks KM (2019) Rates and correlates of depression symptoms in a sample of pregnant veterans receiving Veterans Health Administration care. J Women's Health 29(4):333–340. https://doi.org/10.1016/j.whi.2019.04.008
Kroll-Desrosiers AR, Crawford SL, Moore Simas TA, Clark MA, Mattocks KM (2020) Treatment and management of depression symptoms in pregnant veterans: varying experiences of mental health care in the prenatal period. Psychiatry Q 91(2):475–493. https://doi.org/10.1007/s11126-019-09676-7
Mattocks KM, Skanderson M, Goulet JL, Brandt C, Womack J, Krebs E, Desai R, Justice A, Yano E, Haskell S (2010) Pregnancy and mental health among women veterans returning from Iraq and Afghanistan. J Women's Health 19(12):2159–2166. https://doi.org/10.1089/jwh.2009.1892
McHugh ML (2012) Interrater reliability: the kappa statistic. Biochem Med 22(3):276–282
Molenaar NM, Kamperman AM, Boyce P, Bergink V (2018) Guidelines on treatment of perinatal depression with antidepressants: an international review. Aust N Z J Psychiatry 52(4):320–327. https://doi.org/10.1177/0004867418762057
Protecting Moms Who Served Act, Pub. L. No. 117–69, 1496 135 STAT. (2021). https://www.congress.gov/117/plaws/publ69/PLAW-117publ69.pdf
Roca A, Imaz ML, Torres A, Plaza A, Subirà S, Valdés M, Martin-Santos R, Garcia-Esteve L (2013) Unplanned pregnancy and discontinuation of SSRIs in pregnant women with previously treated affective disorder. J Affect Disord 150(3):807–813. https://doi.org/10.1016/j.jad.2013.02.040
Shivakumar G, Kroll-Desrosiers AR, Copeland L, Anderson EH, Maydon A, Mattocks K (2021) Patterns of treatment utilization across the perinatal period in the Center for Maternal and Infant Outcomes and Research in Translation (COMFORT) veterans study. J Womens Health (Larchmt) 30(6):882–890. https://doi.org/10.1089/jwh.2020.8435
Suzuki S, Kato M (2017) Deterioration/relapse of depression during pregnancy in Japanese women associated with interruption of antidepressant medications. J Matern Fetal Neonatal Med 30(10):1129–1132. https://doi.org/10.1080/14767058.2016.1205026
Verreault N, Da Costa D, Marchand A, Ireland K, Dritsa M, Khalifé S (2014) Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset. J Psychosom Obstet Gynecol 35(3):84–91. https://doi.org/10.3109/0167482X.2014.947953
Vigod SN, Wilson CA, Howard LM (2016) Depression in pregnancy. BMJ i1547. https://doi.org/10.1136/bmj.i1547
Wikman A, Skalkidou A, Wikström A-K, Lampa E, Kramer MS, Yong E-L, Skoglund C, Epperson N, Sundström-Poromaa I (2020) Factors associated with re-initiation of antidepressant treatment following discontinuation during pregnancy: a register-based cohort study. Arch Womens Ment Health 23(5):709–717. https://doi.org/10.1007/s00737-020-01050-y
Acknowledgements
The authors express their gratitude to women Veterans for their courage in military service and their resilience in creating meaningful lives after military service.
Funding
This material is the result of work supported with resources and the use of facilities at the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by DM, ES, and MH. The first draft of the manuscript was written by MH and DM, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
The authors have no financial or proprietary interests in any material discussed in this article. This retrospective chart review involving human participants was in accordance with all ethical standards and the Helsinki Declaration and amendments. The study was approved by the Internal Review Board at Baylor College of Medicine, Houston, Texas.
Disclaimer
The views expressed are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Howard, M., Ledoux, T., Llaneza, D. et al. Exploring the prevalence of antidepressant medication discontinuation among pregnant veterans. Arch Womens Ment Health 27, 89–97 (2024). https://doi.org/10.1007/s00737-023-01372-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-023-01372-7