Patterns of antidepressant use during pregnancy: a nationwide population-based cohort study

Br J Clin Pharmacol. 2018 Aug;84(8):1764-1775. doi: 10.1111/bcp.13608. Epub 2018 Jun 3.


Aims: We explored the patterns of antidepressant use during pregnancy.

Methods: A cohort of women who started a pregnancy in 2014 was identified using data from the French reimbursement healthcare system (covering approximately 99% of the population). Antidepressant usage (initiated before or during pregnancy) was assessed. Explored changes in antidepressant treatment were: associations, switches, discontinuation and resumption of antidepressants during pregnancy.

Results: The cohort included 766 508 pregnancies (755 519 women). Antidepressant use during pregnancy was 25.7 per 1000 [95% CI: 25.3-26.0]. New use concerned 3.9 per 1000 [95% CI: 3.7-4.0]; the most initiated class during pregnancy was selective serotonin reuptake inhibitors (SSRIs), while the most prescribed individual drug in second and third trimesters was amitriptyline, a tricyclic. Most changes were observed before pregnancy and during the first trimester: 63% of ongoing treatments in the year before pregnancy were discontinued before conception; 68% of treatments maintained after conception were discontinued during the first trimester; switches or antidepressant associations mostly occurred during the periconceptional period or during the first trimester. Regardless of initial antidepressant, switches to sertraline were the most frequent. Associations mainly consisted of a prescription of tri-/tetracyclic or mirtazapine/mianserin in addition to an SSRI. Discontinuation during pregnancy led to treatment resumption in 22% of pregnancies.

Conclusions: These results suggest that pregnancy was planned or the treatment especially adapted in accordance with existing recommendations in a large proportion of women under antidepressants or in whom such treatments have been initiated after starting a pregnancy.

Keywords: antidepressive agents; drug utilization; insurance health reimbursement; pharmacoepidemiology; pregnancy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antidepressive Agents / therapeutic use*
  • Cohort Studies
  • Databases, Factual / statistics & numerical data
  • Depression / drug therapy*
  • Drug Substitution / statistics & numerical data
  • Drug Utilization / statistics & numerical data*
  • Female
  • France
  • Humans
  • Insurance Claim Review / statistics & numerical data
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Young Adult


  • Antidepressive Agents