Something is happening. The issue of perinatal depression is spending a lot of time in the media spotlight these days. But rather than focusing on the risks of medications used during pregnancy (the usual headline grabber), these reports highlight the high prevalence of mood and anxiety disorders in pregnancy and postpartum women and the need to pay more attention to the mental health needs of this vulnerable population. Last week the U.S. Preventive Services Task Force (USPSTF) recommended that clinicians screen ALL ADULTS for depression, specifically highlighting the importance of screening in pregnant and postpartum women.
This week, the Center for Disease Control (CDC) called for an acceleration of research into the safety of antidepressants used during pregnancy in order to provide evidence-based information to healthcare providers so that they may “effectively weigh the risks and benefits of treatment options for reproductive-aged women who could become pregnant”.
This new focus stems from research indicating that a significant proportion of reproductive-aged women are prescribed antidepressants. The CDC used Truven Health’s MarketScan Commercial Claims and Encounters data to estimate the number of antidepressant prescriptions filled by women aged 15–44 years with private employer-sponsored insurance. During 2008–2013, an average of 15.4% of women aged 15–44 years filled at least one prescription for an antidepressant in a single year. This number makes sense given that the prevalence of depression in women in this age group is estimated to be about 11%, and even more women in this age group suffer from some type of anxiety disorder.
Because depression (and anxiety) is most often a recurrent or chronic illness, many women require antidepressant treatment on an ongoing basis. The concern is that many women treated with antidepressants may not be fully informed regarding the reproductive safety of the medications they are using, and that our information regarding the reproductive safety for antidepressants may be lacking or incomplete. Furthermore, because about half of all pregnancies are unplanned, exposure to medications may occur before a woman is aware that she is pregnant.
The CDC recently launched an initiative called Treating for Two that aims to provide women and doctors with better guidance about the safest medications during pregnancy. In last year’s report, they addressed the use of opioid medication among women of reproductive age; now they will focus on expanding our knowledge base on the use of antidepressants during pregnancy.
This sounds like a promising initiative given that it seeks to gather input from various academic and professional organizations and may help us to develop more consensus regarding the identification and treatment of women in this vulnerable population:
Partners are essential every step of the way to promote and advance our initiative and reach our target audiences. A coordinated effort between federal agencies and non-federal partners will advance and sustain this national public health-healthcare strategy. A large and growing interagency workgroup is dedicated to Treating for Two activities, driving forward the science, communication, and policy efforts. In addition, we’ve engaged several academic and professional organizations and continue to expand our partnership network. Through these collaborations, we can turn information into action that improves the health of women and babies.
At the Center for Women’s Mental Health, the National Pregnancy Registry for Antidepressants (NPRAD) was established in order to evaluate the safety of antidepressant medications that may be taken by women during pregnancy to treat a wide range of mood, anxiety, or psychiatric disorders. The goal of this Registry is to gather information on the safety of these medications during pregnancy for both mother and child.
TO PARTICIPATE CALL TOLL-FREE: 1-844-405-6185
All pregnant women ages 18-45 are eligible to enroll in the registry. If you are interested in participating in the National Pregnancy Registry, please call the toll-free number above or fill out this Patient Interest Form to be contacted by a member of our research team. All information is kept strictly confidential.
Ruta Nonacs, MD PhD
Treating for Two (CDC website)