title: Unplanned pregnancy and discontinuation of SSRIs in pregnant women with previously treated affective disorder.
abstract: OBJECTIVE
  To identify the factors associated with discontinuation of selective serotonin reuptake inhibitors (SSRIs) in pregnant women and to determine the rates of SSRI reintroduction during pregnancy.
  
  
  METHODS
  A prospective study was conducted in the Perinatal Psychiatry Service of the Hospital Clínic in Barcelona. The total sample comprised 132 consecutive pregnant women with depressive or anxiety disorder (DSM-IV criteria), seen between January 2005 and December 2008 and who were receiving SSRIs at the time of conception. Clinical, psychometric and socio-demographic variables were collected at the first visit. All women were assessed during treatment with the Edinburgh Perinatal Depression Scale (EPDS) and the Spielberger State-Trait Anxiety Inventory (STAI). Dose and type of antidepressant were recorded at each visit during pregnancy.
  
  
  RESULTS
  Seventy women (53%) discontinued SSRI treatment upon confirmation of pregnancy. Socio-demographic, obstetric and psychiatric variables did not differ significantly between women who maintained and women who discontinued treatment. Only unplanned pregnancy was associated with a greater risk of discontinuation (OR=2.7, 95% CI=1.34-5.52). Women who discontinued treatment also had higher EPDS and STAI scores in the first visit and prenatal visit (34-36 weeks) (p<.05). Of the 70 women who discontinued treatment, 57.1% (N=40) reintroduced treatment, almost half of these in the first trimester of pregnancy.
  
  
  CONCLUSIONS
  Unplanned pregnancy was a risk factor for abrupt discontinuation of SSRIs upon confirmation of pregnancy in women with depressive or anxiety disorder. More than half the pregnant women who discontinued SSRIs reintroduced antidepressant therapy during pregnancy.
authors.affiliation: Perinatal Psychiatry Service, Department of Psychiatry, Hospital Clínic Universitari, Barcelona, Spain. alba.roca@yahoo.es
authors.forename: A
authors.initials: A
authors.lastname: Roca
authors.forename: M L
authors.initials: ML
authors.lastname: Imaz
authors.forename: A
authors.initials: A
authors.lastname: Torres
authors.forename: A
authors.initials: A
authors.lastname: Plaza
authors.forename: S
authors.initials: S
authors.lastname: Subirà
authors.forename: M
authors.initials: M
authors.lastname: Valdés
authors.forename: R
authors.initials: R
authors.lastname: Martin-Santos
authors.forename: Ll
authors.initials: L
authors.lastname: Garcia-Esteve
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage*; D001008:Anxiety Disorders / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019964:Mood Disorders / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011261:Pregnancy Trimester, First; D049168:Pregnancy, Unplanned; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage*; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Antidepressant; Discontinuation; Pregnancy; Relapse; SSRI; Unplanned pregnancy