Publication History
Submitted: February 02, 2023
Accepted: February 20, 2023
Published: March 01, 2023
Identification
D-0105
Citation
John Petter (2023). Anti-Depressant Consumption, Patterns, Prevalence, and Risk Considerations among Women in the Fertile Age Range. Dinkum Journal of Medical Innovations, 2(03):85-90.
Copyright
© 2023 DJMI. All rights reserved
85-90
Anti-Depressant Consumption, Patterns, Prevalence, and Risk Considerations among Women in the Fertile Age RangeReview Article
John Petter 1*
- University of Marry Washington, Virginia: jopedep@umw.edu
* Correspondence: jopedep@umw.edu
Abstract: Despite the severe outcomes of antidepressant use on mother and child, the prevalence rate in developed countries like USA and Netherlands is 8.7% and 2 % respectively. In this study, we are studying the trends, prevalence, and risk factors of antidepressant use among women of the reproductive age group. The present systemic review is conducted using PRISMA guidelines and registered in PROSPERO. The search engines were PubMed, Google Scholar, and Science Direct. All those which didn’t match the title, in other languages, and were duplicated were excluded from the study. The screening was done based on abstracts. Selected articles were studied and data was finalized. The risk factors in the reproductive age group are loneliness, marital conflicts, many Children, postpartum blues, postpartum depression, physical and sexual abuse, gender, cultural and racial differences, and socioeconomic status. The use of antidepressants gradually increased from 1995 to 2001 followed by a sharper increase till 2004 with a subsequent reduction in usage due to perinatal complications. The prevalence rate for antidepressant use is increasing steadily in developed countries with two third being SSRIs.it later on decreased or remained constant due to warnings. The main risk factors are postpartum depression, gender differences, physical and sexual abuse, and poor socioeconomic status. The use of antidepressants increased followed by a decrease in later years. The prevalence rate varied geographically with most prevalence classes being SSRIs, SNRIs, and TCAs.
Keywords: anti-depressants, young age, fertility, risk factors, pattern, prevalence
- INTRODUCTION
Major Depressive Disorder (MDD) is a psychiatric illness marked by a constant feeling of despair and alienation for at least 2 weeks that manifests itself as a hurdle in daily life activities, cognitive impairment, asthenia, anorexia, insomnia, irresoluteness, and suicidal thoughts. Depression is a common mental health problem among the general population including the reproductive age group. A population-based epidemiological study has proved that the prevalence of depression is 21.3% in women and 12.7% in men [1]. Several studies have shown that anti-depressants are being used by women during all reproductive phases of their life – premenstrual stage, pregnancy, and the postpartum period. Depression is more prevalent in women owing to biological and psychosocial factors such as hormonal changes, menopause, childhood abuse, tragic life experiences, parenthood, old maternal age, infertility, family issues, and the burden of responsibilities. Changing hormonal milieu in adolescence and other socioeconomic factors lead to a greater incidence of the first depressive episodes during young adulthood [2]. The gradual transition from menarche to menopause contributes to episodes of depression during different reproductive life stages. The prevalence of prescribed antidepressants during pregnancy has been estimated to be approximately 2% in the Netherlands and 8.7% in the USA [3]. Antidepressant prescribing rates increased steadily from 1995-2001 followed by sharper increases from 2002-2004 [4]. Another study has proved that the prevalence increased six folds from 1997-2011 but decreased sharply thereafter [5]. Despite the severe outcomes of antidepressants both on the mother and the fetus/child, they are still being prescribed by physicians due to the alarming increase in depression among women of childbearing age. Many studies have thrown light on the fact that antidepressant prescriptions during gestation are less than the postpartum and other phases of reproductive life. The prevalence of antidepressant use in one year after birth was higher than antidepressant use during pregnancy but lower than antidepressant use in one year before pregnancy [5]. Considering the negative impact of antidepressants on the developing fetus, women tend to prefer non-pharmacological interventions which have lessened the use of antidepressants among women over the years. To our knowledge, there has been no review article on the prevalence and trends of antidepressant use among women of the reproductive age group. This study specifically summarizes the prevalence and trends of antidepressants.
- MATERIALS AND METHODS
The literature search was conducted for published articles in English from the inception of time till 12th June 2022. Three search engines are used for this systematic review; PubMed, Google Scholar, and Science Direct. The keywords used were “Antidepressants” OR “Trends” OR “Prevalence” OR “Risk Factors” OR “Pregnancy” OR “Women of Reproductive Age”. The inclusion criteria were applied to collect the articles with study designs like cross-sectional, cohort, systematic review and meta-analysis that described trends, prevalence and risk factors of anti-depressants among females of reproductive age on the above-mentioned search engines were searched, studied, and isolated. The exclusion criteria were applied to all those articles, papers, and systematic reviews and meta-analyses that didn’t match our title, and study designs and were published in languages other than English. Duplicate articles were also excluded. The data extraction was done in four groups. Two groups used the search engine Google Scholar. One group searched PubMed and the remaining group studied Science direct. The related articles were selected and inclusion-exclusion criteria were applied to them. The data extracted from the included articles were based on the general study characteristics (the first author, year of publication, study design, and duration of study), the relevant aspects of the articles (trends, risk factors, and prevalence of the antidepressant use in women of reproductive age) and the main outcomes. First, we selected articles relevant to our title of study, and then trends, prevalence, and risk factors for the use of antidepressants in reproductive-age females were studied. The reproductive age group selected was 15-49 years according to the WHO definition of reproductive age for females. The data regarding the title was screened based on the abstracts of the selected articles. The full articles were studied and the data was finalized.
- RESULTS AND DISCUSSION
According to Lee S. Cohen, MD, the prevalence of major depressive illness in women is double that of men, making it a severe problem. Antidepressant use has increased around five times between the ages of 15–19 (4.8%) and 40–45 (24.6%) (6). The risk of perinatal problems from antidepressant use was the subject of health advisory warnings published by the US Food and Drug Administration (FDA) in June 2004 and Health Canada two months later. Selective serotonin reuptake inhibitors (SSRIs) were once thought to be safe to use during pregnancy. However, due to these cautions, antidepressant use began to gradually rise between 1995 and 2001, then sharply increased between 2002 and late 2004. Following that, the trend reversed as fewer people were taking antidepressants. Nevertheless, other research also revealed that after 2004 there was no further decline in the prescription of antidepressants [4]. In 1987, fluoxetine became the first SSRI to be marketed, and afterwards came serotonin and norepinephrine reuptake inhibitors (SNRIs). After 25 years, these two in particular SSRIs replaced TCAs as the primary antidepressants in North America, much of Europe, and Asia [3]. The use of antidepressants varies by country; for example, SSRIs are used in Europe, TCAs are used in Germany, Citalopram is used in Denmark, Sertraline is used in Iceland, and Escitalopram is used in Norway. Overall trends in Denmark’s prescription of antidepressants climbed gradually between 1997 and 2011, but in 2016 they significantly declined. On the other hand, compared to the year prior to and following pregnancy, antidepressant use was decreased during pregnancy [5]. According to a different study, pregnant women who had been taking antidepressants before switched to different kinds of antidepressants. 6 percent of women changed to a different class of antidepressants in the first trimester. The most often exchanged class was SSRIs (1.6%), which were followed by SNRIs (1%), and serotonin modulators (1.2%). Women responded more to venlafaxine (1%) and paroxetine (1%), respectively, as antidepressants [7]. According to the national co-morbidity survey, serious depression was prevalent in 12.7% of men and 21.3% of women. When it comes to major depressive disorder, the female-to-male ratio falls between 1.6 and 3.1 [8]. In Europe, the estimated prevalence of major depressive illness ranges from 3.0 to 11.2%. Prenatal and postpartum depression rates ranged from 12% to 18% in North America [9]. Over time, antidepressant use has been continuously rising in North America and Europe. According to estimates, 16.3% of prescriptions for antidepressants were written in 2009; of them, two thirds contained SSRIs. The following antidepressant classes were most common: MAOI 0.0%, TCA 2.7%, other antidepressants 2.9%, and 12.6% overall [6]. Reports from several nations revealed varying prevalence rates of antidepressants. For instance, in Italy, it ranged from 5.9% to 11.6% between 1999 and 2004. In Germany, it was 10.2% between 2000 and 2002. 5.8% was the prevalence rate in a 2001–2003 pan-European research. In 2002, it was 7.6% in Canada. It was 13.8% in the USA between 2001 and 2003, and 13.4% in 2005 [6]. According to a different study, the overall prevalence of prescribing antidepressants rose by 0.046 prescriptions per 1000 women per month until May 2004, the time frame immediately preceding warnings from the US FDA and Health Canada. The prevalence dropped by 1.48 prescriptions per 1000 women per month following this warning. Nevertheless, 8.1% of antidepressant prescriptions were filled during pregnancy in a larger US survey of pregnant women from 2000 to 2007, indicating that these warnings had no appreciable impact on the prevalence [4]. 2% of people in the Netherlands were using SSRIs and TCAs, according to a research. According to a nationwide birth defect prevention research, between 1998 and 2005, the use of antidepressants during pregnancy grew by 300% [3]. Prescriptions for antidepressants increased steadily in Denmark during pregnancy, from 0.4% in 1997 to 4.6% in 2011. subsequently fell to 3.1% in 2016 [5]. According to the studies, mood swings and melancholy in women are partly caused by hormonal changes in the body. Adolescence is characterised by a sharp change in the prevalence rate of depression [2]. Premenstrual syndrome is linked to progesterone levels during the luteal phase of the menstrual cycle, and similar hormonal changes cause depression in the premenstrual period, following menopause, and as an adverse consequence of oral contraceptives. Another risk factor for depression is pre-menstrual dysphoric disorder (PMDD), as serotonin is a hormone that stimulates depression in PMDD [1]. In a similar vein, depression is also significantly increased by pregnancy. Ten percent of pregnant women fulfil the criteria for a serious depressive disorder, and the prevalence of depression during pregnancy ranges from 25 to 35 percent [1]. Pregnant women have a 9% prevalence rate of serious depression, according to another study [7]. A history of depression, younger age, loneliness, marital disputes, having many children, spaced-out pregnancies, losing a significant other or prior children, and concomitant illness are among the risk factors for depression during pregnancy [1]. Another risk factor for depression that strikes new mothers two weeks after birth is postpartum blues. Between 50% and 80% of women report having postpartum blues, and 25% report having serious depression [1]. An additional risk factor for antidepressant medication use is postpartum depression. Depressive episodes are also influenced by the premenstrual transition, which is the change from regular menstrual cycles to the cessation of menses [2]. Reduced levels of oestrogens, FSH, inhibin, activing, follistatin, and insulin-like factors are among the hormonal alterations associated with menopause. Depression brought on by menopause is mostly caused by a drop in estradiol levels [1]. Research indicates that there is a risk factor related to gender differences, as females experience depression at a rate around twice as high as males. In America, by the age of 18, there is a stable 2:1 female to male ratio. Research indicates that depression susceptibility may be inherited, and additional data points to a greater degree of genetic susceptibility in females than in males [2]. For women, depression is also a result of ongoing stress caused by racial prejudice. Additionally, research indicates that stressful life events are associated with a higher risk of severe depression in women [2]. Depression in women is also largely caused by sexual and physical violence. Compared to women who were not raped as children, victims of childhood rape had an almost twice as high lifetime prevalence rate of depression (52%) (2). Similarly, 48% of assaulted women report having depression. Physical maltreatment throughout childhood is another important indicator of adult depression. Socioeconomic position and poverty are additional stressors that contribute to depression. The journal papers that presented results that were sufficiently similar to those of the global antidepressant usage among women of reproductive age were evaluated for inclusion in this systematic review. The extant literature has either shown prevalence numbers across national boundaries or individually examined the negative effects of antidepressants. The majority of research that are currently available do not specifically address the combination of prevalence studies with the determinants, risk factors, and collective causes. There was a gap in the literature as a result, which made this comprehensive review necessary. According to our analysis, women are twice as likely as males to have major depressive disorder and to need antidepressant prescriptions as a result. When stratified findings were examined, the age range of 40–45 showed almost five times higher utilisation than the 15–19 age group. Reviews that have already been written about clinical depression in women have been able to comment on the main causes regardless of age group since they have concentrated on specific risk factors. They consist of both psychological and biological elements. Recurring main results in these studies included the following: pregnancy, hormonal changes, traumatic life experiences, childhood maltreatment, burden of obligations, ethnic racial disparities, socioeconomic factors, and genetic vulnerability of the gender. Pregnancy, the progressive transition from menarche to menopause, and postpartum hormonal changes were considered as the main risk factors in the group under research based only on reproductive ages in our review. To properly address and identify age-specific risk factors, more contextual and longitudinal qualitative research concentrating on the various stages of reproductive life would be required. Promising findings were obtained from a number of independent reviews concerning the frequency with which women were prescribed antidepressants over the course of their reproductive lives. The most prominent patterns showed that between 1997 and 2011, prescription rates increased by up to six times. In the USA, the highest incidence rate was 13.8% between 2001 and 2003; in contrast, a study involving countries in Europe and North America revealed a frequency of 16.3%. We then saw a significant decline in prescriptions as well as consumption throughout the course of the last ten years, from 2011 to 2017. Based on our study, our review concludes that the decline in prevalence can be attributed to health authorities issuing more warnings about the negative health effects of antidepressants, which in turn affected pregnant women’s perceptions. One notable discovery was that the prevalence was lower during pregnancy than it was the year prior to and following gestation. This finding might be explained by the fact that pregnant women prefer non-pharmacological therapies because antidepressants have negative effects on the health of the foetus. However, given that this study did not contain any studies on how pharmacological effects are perceived, this interpretation should be used with caution. It is also important to note that, with a few notable exceptions, all of the research included in this article were conducted in Anglo-Saxon, Northern European, and North American nations, thus the predominance may not be indicative of a general trend. The inherent problems of publication bias also apply to this review because it only examined English-language literature. Another drawback was the lack of information on antidepressant actual consumption, which could lead to disparities between the frequency of prescriptions and actual utilisation.
- CONCLUSION
The literature on the prevalence and risk factors of antidepressant use among women in the reproductive age range has been examined in this qualitative review. This review filled up a lot of gaps in the literature by identifying important patterns in risk factors and prevalence. The present review aims to enhance public health policies concerning women’s health and well-being. This study will contribute to our understanding of the significance of early identification and treatment strategies for women experiencing depression and will assist develop strategies that will improve the lives of mothers everywhere. To properly comprehend and contextualise the various trends and reach definitive conclusions, more thorough research will be beneficial. Age-specific research conducted over larger geographic regions would be a wonderful complement to the scant body of current material.
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Publication History
Submitted: February 02, 2023
Accepted: February 20, 2023
Published: March 01, 2023
Identification
D-0105
Citation
John Petter (2023). Anti-Depressant Consumption, Patterns, Prevalence, and Risk Considerations among Women in the Fertile Age Range. Dinkum Journal of Medical Innovations, 2(03):85-90.
Copyright
© 2023 DJMI. All rights reserved