Antidepressant treatment persistence in low-income, insured pregnant women

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)631-637
Number of pages7
JournalJournal of Managed Care Pharmacy
Volume20
Issue number6
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Antidepressive Agents
Pregnant Women
Pregnancy
Therapeutics
Depression
Drug therapy
Prescriptions
Drug Therapy
Medication Adherence
Medicaid
Proportional Hazards Models
Hazards

ASJC Scopus subject areas

  • Pharmacy
  • Pharmaceutical Science
  • Health Policy

Cite this

Antidepressant treatment persistence in low-income, insured pregnant women. / Wu, Jun; Davis-Ajami, Mary Lynn.

In: Journal of Managed Care Pharmacy, Vol. 20, No. 6, 01.01.2014, p. 631-637.

Research output: Contribution to journalArticle

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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.",
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