Anxiety and depression are two of the most prevalent conditions affecting women of reproductive age in the UK. Whilst talking therapies are often an effective component of treatment for these conditions, or in isolation, medications are also commonly prescribed. The first-line medications are typically selective serotonin reuptake inhibitors (SSRIs).
It is estimated that SSRIs are prescribed in 5% of all pregnancies.
Antidepressant prescription rates and the prevalence of SSRI use for anxiety have significantly increased in recent years, disproportionately affecting women living in lower-income households and more deprived areas. These trends are expected to continue in the coming years.
Untreated maternal mental illness can lead to an increased risk of pregnancy complications, pre-term birth, post-partum suicidality, and cognitive and behavioural difficulties in the child. Therefore, maternal mental health conditions must be adequately treated.
The Risks of SSRIs During and After Pregnancy
A recent study published in the British Journal of General Practice Open, however, has raised concerns about the guidance provided to healthcare providers on prescribing SSRIs to women of reproductive age. SSRIs have been associated with potential risks during pregnancy, including congenital disabilities, postpartum haemorrhage (PPH), and persistent pulmonary hypertension of the newborn (PPHN).
The research team conducted a systematic review of local prescribing formularies in England and Wales, which are essential resources used by healthcare providers to make informed decisions about medication prescriptions. The study found that a significant number of these formularies lacked comprehensive guidance on the risks associated with SSRI use during pregnancy and breastfeeding.
Key Findings
- A significant proportion of formularies did not include specific guidance on SSRI use for women of reproductive age, pregnant women, or breastfeeding women.
- Many formularies failed to mention or provide links to relevant safety alerts issued by the Medicines and Healthcare products Regulatory Agency (MHRA) regarding the potential risks of SSRIs.
- There was a lack of consistency in the recommendations provided by different formularies, leading to potential confusion for healthcare providers. This included different recommendations on whether to recommend contraception for women of reproductive age, the need for counselling, and the most appropriate medications to prescribe.
Why This Matters
The inadequate guidance in local formularies could lead to unintended exposure of pregnant women and their babies to SSRIs. Considering the potential for adverse health outcomes, it is crucial for healthcare providers to have access to accurate and up-to-date information to make informed decisions about prescribing SSRIs to women of reproductive age.
Without this information, clinicians and women are unable to make informed decisions on the best management plan for them weighing the potential risks of the medication against untreated anxiety and/or depression.
Recommendations
- Local formularies should be updated to include comprehensive guidance on SSRI use during pregnancy and breastfeeding, including information on potential risks and alternative treatment options.
- Healthcare providers should be encouraged to engage in shared decision-making with their patients, discussing the potential risks and benefits of SSRIs and exploring alternative treatment options if necessary.
- Further research is needed to better understand the long-term effects of SSRI exposure during pregnancy and to develop evidence-based guidelines for the safe and effective use of these medications in women of reproductive age.
- Better provisions to improve timely access to talking therapies, particularly in people with perinatal or postpartum mood and anxiety disorder may help reduce the need to use medications in this group.
In Conclusion
The findings of this study highlight the need for improved guidance and education for healthcare providers on prescribing SSRIs to women of reproductive age. By ensuring that healthcare providers have access to accurate and up-to-date information, we can help support mothers to make the best decision for their health and/or any children.