The effect of regulatory advisories on maternal antidepressant prescribing

Bobo W.V., Epstein R.A. Jr, Hayes R.M., Shelton R.C., Hartert T.V., Mitchel E., Horner J., Wu P. The effect of regulatory advisories on maternal antidepressant prescribing, 1995-2007: an interrupted time-series study of 228,876 pregnancies Archives of Womens Mental Health 17:17–26, 2014



This large-scale analysis of the Tennessee State Medicaid (TennCare) database indicated that the use of antidepressants increased in pregnant women from 1995 to 2001, and then declined rapidly after the release of health advisories warning about possible adverse pregnancy effects of antidepressant medications. These results indicate that health advisories by agencies like the FDA have significant effects on prescribing behavior. However, they also raise concerns about whether women are receiving adequate treatment of depression during pregnancy.


The data reported in this paper show huge variations in frequency of prescribing medications for depressed pregnant women. These changes are likely to be the result of multiple factors, including early reports of safety of certain antidepressant medications, intensive marketing of medications, and advisories by regulatory authorities. These data indicate that diagnosis and treatment of depression in pregnancy does not reflect the actual proportion of depressed women in the population


This publication highlights the need to dissociate treatment of depression in pregnancy from external factors that influence diagnosis and prescribing patterns. Ideally, the Psychiatric community in particular and medical community in general will diligently diagnose depression in depressed women and provide safe and effective treatments.