Use of antidepressants before, during, and after pregnancy between 2015 and 2021 in Switzerland: a retrospective analysis of Swiss health care claims data

Abstract

Objective: Depression and anxiety are common during pregnancy, but the prevalence of antidepressant use during pregnancy in Switzerland is not well documented. We explored antidepressant use before, during, and after pregnancy in Switzerland.

Methods: We conducted a descriptive study using a Swiss health care insurance claims database (Helsana) between 2015 and 2021. We included pregnancies resulting in birth of women who were continuously insured during three 270-day periods: preconceptional, pregnancy, and postpartum. In these periods, we quantified the exposure prevalence to antidepressants overall and stratified by region and use of co-medication. Antidepressants of interest included selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors, Hyperici herba and others. Additionally, we assessed prevalence of antidepressant discontinuation during pregnancy.

Results: We included 34,584 pregnancies of whom 1386 (4.0%) were exposed (≥1 claim) to antidepressants preconceptionally, 788 (2.3%) during pregnancy, and 1273 (3.7%) postpartum. Of 1386 women with preconceptional use, 60% had no antidepressant claim during pregnancy. Antidepressant use decreased from 1.6% in trimester one to 1.1% in trimester three. The most frequently dispensed antidepressants during pregnancy were SSRIs (75.0%). Exposure to antidepressants was two-fold higher in the French-speaking region (2.6%) than in Central Switzerland (1.3%). About one-third of women continuing antidepressant treatment during pregnancy also used benzodiazepines (co-medication) at least once during this time.

Conclusion: 4 of 100 women in Switzerland took antidepressants before pregnancy, but 60% discontinued treatment when they became pregnant. Since untreated depression in pregnancy may lead to severe long-term consequences for mother and child, this might be of concern.

Keywords: Antidepressant drugs; Claims database; Drug utilization; Pharmacoepidemiology; Pregnancy; SSRI; Switzerland.