title: Antidepressant treatment persistence in low-income, insured pregnant women.
abstract: BACKGROUND
  Pregnant women with depression face complicated treatment decisions, either because of the risk associated with not treating depression or because of the risks associated with antidepressant use. Approximately 1 in 5 women experience depressive symptoms during pregnancy. This information suggests that many women may take an antidepressant at some time during pregnancy. Once pregnant women initiate antidepressant prescription pharmacotherapy, medication treatment persistence plays an important role in managing depression, yet little is known regarding antidepressant use behavior in pregnant women.
  
  
  OBJECTIVE
  To determine antenatal antidepressant treatment nonpersistence and associated factors in low-income, insured pregnant women.
  
  
  METHODS
  We identified eligible pregnant women (≥ 18 years) diagnosed with major depression who initiated antidepressant medications during pregnancy from South Carolina Medicaid claims data (2004-2009). Our main outcome measure was treatment nonpersistence to antidepressant therapy during pregnancy. We defined treatment nonpersistence to antidepressant pharmacotherapy as having a gap between 2 consecutive prescriptions lasting at least 15 days during pregnancy. We applied a proportional hazards model to identify predictors associated with the risk for antidepressant nonpersistence during pregnancy.
  
  
  RESULTS
  Of 804 pregnant women meeting study criteria, nearly 45% of this cohort did not continue to use antidepressant pharmacotherapy, showing a gap ≥ 15 days between 2 prescriptions, after initiating antidepressant therapy during pregnancy. Women reporting nonwhite race were 36% more likely to show a gap in antidepressant medication use during pregnancy than white women. Women with a history of antidepressant use before pregnancy were 44% more likely to discontinue the antidepressant therapy during pregnancy.
  
  
  CONCLUSIONS
  Treatment persistence to antidepressant medications was poor during pregnancy in low-income, insured pregnant women. Individualized treatment might be considered to reduce the risks of untreated depression and antenatal antidepressant use in vulnerable women.
authors.affiliation: University of South Carolina, 701 Grove Rd., Health Sciences Administration Bldg. (MIPH), Greenville, SC 29605. wujun@sccp.sc.edu.
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.forename: Mary Lynn
authors.initials: ML
authors.lastname: Davis-Ajami
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007356:Insurance, Pharmaceutical Services; D053208:Kaplan-Meier Estimate; D008484:Medicaid; D055118:Medication Adherence; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents