{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T07:57:47Z","timestamp":1790063867879,"version":"4.0.1"},"update-to":[{"DOI":"10.1371\/journal.pmed.1003895","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T00:00:00Z","timestamp":1644796800000}}],"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T00:00:00Z","timestamp":1643587200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010665","name":"H2020 Marie Sk\u0142odowska-Curie Actions","doi-asserted-by":"publisher","award":["891079"],"award-info":[{"award-number":["891079"]}],"id":[{"id":"10.13039\/100010665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"crossref","award":["R01MH122869"],"award-info":[{"award-number":["R01MH122869"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003554","name":"Lundbeckfonden","doi-asserted-by":"publisher","award":["R155-2014-1724"],"award-info":[{"award-number":["R155-2014-1724"]}],"id":[{"id":"10.13039\/501100003554","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003554","name":"Lundbeckfonden","doi-asserted-by":"publisher","award":["R313-2019-569"],"award-info":[{"award-number":["R313-2019-569"]}],"id":[{"id":"10.13039\/501100003554","id-type":"DOI","asserted-by":"publisher"}]},{"name":"AUFF NOVA","award":["AUFF-E 2016-9-25"],"award-info":[{"award-number":["AUFF-E 2016-9-25"]}]},{"name":"Fabrikant Vilhelm Pedersen og Hustrus Legat"},{"DOI":"10.13039\/501100005416","name":"Norges Forskningsr\u00e5d","doi-asserted-by":"publisher","award":["288696"],"award-info":[{"award-number":["288696"]}],"id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Women prescribed antidepressants face the dilemma of whether or not to continue their treatment during pregnancy. Currently, limited evidence is available on the efficacy of continuing versus discontinuing antidepressant treatment during pregnancy to aid their decision. We aimed to estimate whether antidepressant discontinuation before or during pregnancy was associated with an increased risk of psychiatric emergency (ascertained by psychiatric admission or emergency room visit), a proxy measure of severe exacerbation of symptoms\/mental health crisis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>\n                      We carried out a propensity score\u2013matched cohort study of women who gave birth to live-born singletons between January 1, 1997 and June 30, 2016 in Denmark and who redeemed an antidepressant prescription in the 90 days before the pregnancy, identified by Anatomical Therapeutic Chemical (ATC) code N06A. We constructed 2 matched cohorts, matching each woman who discontinued antidepressants before pregnancy (\n                      <jats:italic>N<\/jats:italic>\n                      = 2,669) or during pregnancy (\n                      <jats:italic>N<\/jats:italic>\n                      = 5,467) to one who continued antidepressants based on propensity scores. Maternal characteristics and variables related to disease severity were used to generate the propensity scores in logistic regression models. We estimated hazard ratios (HRs) of psychiatric emergency in the perinatal period (pregnancy and 6 months postpartum) using stratified Cox regression.\n                    <\/jats:p>\n                    <jats:p>\n                      Psychiatric emergencies were observed in 76 women who discontinued antidepressants before pregnancy and 91 women who continued. There was no evidence of higher risk of psychiatric emergency among women who discontinued antidepressants before pregnancy (cumulative incidence: 2.9%, 95% confidence interval [CI]: 2.3% to 3.6% for discontinuation versus 3.4%, 95% CI: 2.8% to 4.2% for continuation; HR = 0.84, 95% CI: 0.61 to 1.16,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.298). Overall, 202 women who discontinued antidepressants during pregnancy and 156 who continued had psychiatric emergencies (cumulative incidence: 5.0%, 95% CI: 4.2% to 5.9% versus 3.7%, 95% CI: 3.1% to 4.5%). Antidepressant discontinuation during pregnancy was associated with increased risk of psychiatric emergency (HR = 1.25, 95% CI: 1.00 to 1.55,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.048). Study limitations include lack of information on indications for antidepressant treatment and reasons for discontinuing antidepressants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this study, we found that discontinuing antidepressant medication during pregnancy (but not before) is associated with an apparent increased risk of psychiatric emergency compared to continuing treatment throughout pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1003895","type":"journal-article","created":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T13:40:39Z","timestamp":1643636439000},"page":"e1003895","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":37,"title":["Antidepressant discontinuation before or during pregnancy and risk of psychiatric emergency in Denmark: A population-based propensity score\u2013matched cohort study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4519-1536","authenticated-orcid":true,"given":"Xiaoqin","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Molenaar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2849-524X","authenticated-orcid":true,"given":"Esben","family":"Agerbo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9832-8500","authenticated-orcid":true,"given":"Natalie C.","family":"Momen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4121-8631","authenticated-orcid":true,"given":"Anna-Sophie","family":"Rommel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8787-3183","authenticated-orcid":true,"given":"Angela","family":"Lupattelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veerle","family":"Bergink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trine","family":"Munk-Olsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,1,31]]},"reference":[{"issue":"10","key":"pmed.1003895.ref001","doi-asserted-by":"crossref","first-page":"e2022119","DOI":"10.1001\/jamanetworkopen.2020.22119","article-title":"Concordance of Cardiovascular Risk Factors and Behaviors in a Multiethnic US Nationwide Cohort of Married Couples and Domestic Partners","volume":"3","author":"D Shiffman","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"283","key":"pmed.1003895.ref002","first-page":"1","article-title":"Antidepressant Use Among Persons Aged 12 and Over:United States,2011\u20132014.","author":"LA Pratt","year":"2017","journal-title":"NCHS Data Brief"},{"key":"pmed.1003895.ref003","doi-asserted-by":"crossref","first-page":"b3999","DOI":"10.1136\/bmj.b3999","article-title":"Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database.","volume":"339","author":"M Moore","year":"2009","journal-title":"BMJ"},{"issue":"12","key":"pmed.1003895.ref004","doi-asserted-by":"crossref","first-page":"e0144474","DOI":"10.1371\/journal.pone.0144474","article-title":"Use of SSRI and SNRI Antidepressants during Pregnancy: A Population-Based Study from Denmark, Iceland, Norway and Sweden.","volume":"10","author":"H Zoega","year":"2015","journal-title":"PLoS ONE"},{"issue":"6","key":"pmed.1003895.ref005","doi-asserted-by":"crossref","first-page":"544.e1","DOI":"10.1016\/j.ajog.2007.01.033","article-title":"Increasing use of antidepressants in pregnancy.","volume":"196","author":"WO Cooper","year":"2007","journal-title":"Am J Obstet Gynecol"},{"issue":"21","key":"pmed.1003895.ref006","doi-asserted-by":"crossref","first-page":"2142","DOI":"10.1001\/jama.2015.5605","article-title":"Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn.","volume":"313","author":"KF Huybrechts","year":"2015","journal-title":"JAMA"},{"issue":"3","key":"pmed.1003895.ref007","doi-asserted-by":"crossref","DOI":"10.4088\/JCP.19r12965","article-title":"Long-Term Effects of Intrauterine Exposure to Antidepressants on Physical, Neurodevelopmental, and Psychiatric Outcomes: A Systematic Review.","volume":"81","author":"AS Rommel","year":"2020","journal-title":"J Clin Psychiatry"},{"issue":"1","key":"pmed.1003895.ref008","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00737-019-0951-5","article-title":"Dispensing patterns of selective serotonin reuptake inhibitors before, during and after pregnancy: a 16-year population-based cohort study from the Netherlands.","volume":"23","author":"NM Molenaar","year":"2020","journal-title":"Arch Womens Ment Health."},{"issue":"10","key":"pmed.1003895.ref009","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1080\/14767058.2016.1205026","article-title":"Deterioration\/relapse of depression during pregnancy in Japanese women associated with interruption of antidepressant medications.","volume":"30","author":"S Suzuki","year":"2017","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"5","key":"pmed.1003895.ref010","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1001\/jama.295.5.499","article-title":"Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment","volume":"295","author":"LS Cohen","year":"2006","journal-title":"JAMA"},{"issue":"6","key":"pmed.1003895.ref011","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1097\/EDE.0b013e3182306847","article-title":"Does antidepressant use attenuate the risk of a major depressive episode in pregnancy?","volume":"22","author":"KA Yonkers","year":"2011","journal-title":"Epidemiology"},{"issue":"4","key":"pmed.1003895.ref012","doi-asserted-by":"crossref","DOI":"10.4088\/JCP.19l13099","article-title":"Preventive Cognitive Therapy With Antidepressant Discontinuation During Pregnancy: Results From a Randomized Controlled Trial.","volume":"81","author":"NM Molenaar","year":"2020","journal-title":"J Clin Psychiatry"},{"issue":"9","key":"pmed.1003895.ref013","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1002\/pds.3798","article-title":"Methodological considerations in assessing the effectiveness of antidepressant medication continuation during pregnancy using administrative data.","volume":"24","author":"SA Swanson","year":"2015","journal-title":"Pharmacoepidemiol Drug Saf."},{"issue":"4","key":"pmed.1003895.ref014","doi-asserted-by":"crossref","DOI":"10.4088\/JCP.19r13134","article-title":"The Risk of Relapse of Depression During Pregnancy After Discontinuation of Antidepressants: A Systematic Review and Meta-Analysis.","volume":"81","author":"H Bayrampour","year":"2020","journal-title":"J Clin Psychiatry"},{"issue":"4","key":"pmed.1003895.ref015","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1177\/0004867418762057","article-title":"Guidelines on treatment of perinatal depression with antidepressants: An international review.","volume":"52","author":"NM Molenaar","year":"2018","journal-title":"Aust N Z J Psychiatry"},{"issue":"5","key":"pmed.1003895.ref016","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1176\/appi.ajp.2008.08081170","article-title":"Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes.","volume":"166","author":"KL Wisner","year":"2009","journal-title":"Am J Psychiatry"},{"issue":"8","key":"pmed.1003895.ref017","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1001\/jamapsychiatry.2016.0934","article-title":"Neonatal Outcomes in Women With Untreated Antenatal Depression Compared With Women Without Depression: A Systematic Review and Meta-analysis","volume":"73","author":"A Jarde","year":"2016","journal-title":"JAMA Psychiat"},{"issue":"34","key":"pmed.1003895.ref018","doi-asserted-by":"crossref","first-page":"E1085","DOI":"10.1503\/cmaj.170088","article-title":"Perinatal suicide in Ontario, Canada: a 15-year population-based study.","volume":"189","author":"S Grigoriadis","year":"2017","journal-title":"CMAJ"},{"issue":"21","key":"pmed.1003895.ref019","doi-asserted-by":"crossref","first-page":"2582","DOI":"10.1001\/jama.296.21.2582","article-title":"New parents and mental disorders: a population-based register study","volume":"296","author":"T Munk-Olsen","year":"2006","journal-title":"JAMA"},{"issue":"1","key":"pmed.1003895.ref020","first-page":"44","article-title":"Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling.","volume":"26","author":"A Einarson","year":"2001","journal-title":"J Psychiatry Neurosci"},{"issue":"1","key":"pmed.1003895.ref021","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s10654-018-0356-1","article-title":"The Danish Medical Birth Register","volume":"33","author":"M Bliddal","year":"2018","journal-title":"Eur J Epidemiol"},{"key":"pmed.1003895.ref022","doi-asserted-by":"crossref","first-page":"h517","DOI":"10.1136\/bmj.h517","article-title":"Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: cohort study using a primary care database","volume":"350","author":"C Coupland","year":"2015","journal-title":"BMJ"},{"key":"pmed.1003895.ref023","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.jad.2016.02.012","article-title":"Predicting persistence to antidepressant treatment in administrative claims data: Considering the influence of refill delays and prior persistence on other medications","volume":"196","author":"GA Bushnell","year":"2016","journal-title":"J Affect Disord"},{"issue":"7","key":"pmed.1003895.ref024","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1002\/sim.5984","article-title":"The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments.","volume":"33","author":"PC Austin","year":"2014","journal-title":"Stat Med"},{"issue":"261","key":"pmed.1003895.ref025","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1002\/pst.433","article-title":"Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.","volume":"10","author":"PC Austin","year":"2011","journal-title":"Pharm Stat."},{"issue":"2","key":"pmed.1003895.ref026","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1093\/aje\/kwt212","article-title":"Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching","volume":"179","author":"M. Lunt","year":"2014","journal-title":"Am J Epidemiol"},{"key":"pmed.1003895.ref027","doi-asserted-by":"crossref","first-page":"203","DOI":"10.2147\/CLEP.S20247","article-title":"Comparison of Charlson comorbidity index with SAPS and APACHE scores for prediction of mortality following intensive care.","volume":"3","author":"S Christensen","year":"2011","journal-title":"Clin Epidemiol."},{"issue":"7","key":"pmed.1003895.ref028","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1177\/1403494811401482","article-title":"The Danish National Patient Register.","volume":"39","author":"E Lynge","year":"2011","journal-title":"Scand J Public Health"},{"issue":"10","key":"pmed.1003895.ref029","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1002\/pds.4433","article-title":"Positive predictive value of a register-based algorithm using the Danish National Registries to identify suicidal events.","volume":"27","author":"C Gasse","year":"2018","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"8","key":"pmed.1003895.ref030","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1001\/archgenpsychiatry.2010.86","article-title":"Full spectrum of psychiatric outcomes among offspring with parental history of mental disorder.","volume":"67","author":"K Dean","year":"2010","journal-title":"Arch Gen Psychiatry"},{"issue":"6","key":"pmed.1003895.ref031","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1080\/03610910902859574","article-title":"Using the Standardized Difference to Compare the Prevalence of a Binary Variable Between Two Groups in Observational Research.","volume":"38","author":"PC Austin","year":"2009","journal-title":"Commun Stat Simul Comput"},{"key":"pmed.1003895.ref032","volume-title":"Depression during Pregnancy and Lactation","author":"H Nordeng","year":"2015"},{"issue":"1","key":"pmed.1003895.ref033","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s12874-017-0338-0","article-title":"Double-adjustment in propensity score matching analysis: choosing a threshold for considering residual imbalance.","volume":"17","author":"TL Nguyen","year":"2017","journal-title":"BMC Med Res Methodol"},{"issue":"1","key":"pmed.1003895.ref034","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1186\/s12916-018-1193-5","article-title":"Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births.","volume":"16","author":"SY Gao","year":"2018","journal-title":"BMC Med."},{"key":"pmed.1003895.ref035","article-title":"Antidepressant and mental health care utilization in pregnant women with depression and\/or anxiety: an interrupted time-series analysis.","author":"NT Trinh","year":"2021","journal-title":"medRxiv"},{"issue":"4","key":"pmed.1003895.ref036","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s00737-005-0094-8","article-title":"Use of antidepressants by pregnant women: evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making.","volume":"8","author":"L Bonari","year":"2005","journal-title":"Arch Womens Ment Health"},{"key":"pmed.1003895.ref037","article-title":"Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder: a systematic review and meta-analysis","author":"M Kato","year":"2020","journal-title":"Mol Psychiatry"},{"issue":"12","key":"pmed.1003895.ref038","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1176\/appi.ajp.157.12.1933","article-title":"Risk-benefit decision making for treatment of depression during pregnancy.","volume":"157","author":"KL Wisner","year":"2000","journal-title":"Am J Psychiatry"},{"issue":"4","key":"pmed.1003895.ref039","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.ajog.2016.12.007","article-title":"Risk perception regarding drug use in pregnancy.","volume":"216","author":"SF Widnes","year":"2017","journal-title":"Am J Obstet Gynecol"},{"issue":"11","key":"pmed.1003895.ref040","doi-asserted-by":"crossref","first-page":"e111327","DOI":"10.1371\/journal.pone.0111327","article-title":"Neonatal adaptation in infants prenatally exposed to antidepressants\u2014clinical monitoring using Neonatal Abstinence Score.","volume":"9","author":"L Forsberg","year":"2014","journal-title":"PLoS ONE"},{"issue":"5","key":"pmed.1003895.ref041","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1097\/00001648-200109000-00006","article-title":"Do pregnant women report use of dispensed medications?","volume":"12","author":"C Olesen","year":"2001","journal-title":"Epidemiology"}],"updated-by":[{"DOI":"10.1371\/journal.pmed.1003895","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T00:00:00Z","timestamp":1644796800000}}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003895","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T14:04:51Z","timestamp":1644847491000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003895"}},"subtitle":[],"editor":[{"given":"Mark","family":"Tomlinson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,1,31]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1003895","relation":{},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,31]]}}}