Greater Use of Cannabis and Benzodiazepines, But Not Antidepressants

Although we have found lowering premiums of liquor and tobacco use for the duration of being pregnant around the very last couple a long time, the use of hashish during pregnancy is on the increase.  Qualitative scientific tests point out that expecting ladies report utilizing cannabis to regulate a selection of psychological symptoms, which include insomnia, anxiety, and depression.  Reports carried out prior to the legalization of professional medical and recreational cannabis (in some states) have demonstrated that pregnant women of all ages with lively depressive signs and/or anxiety are extra very likely to use substances.  A cross-sectional study from Californaia examines the associations involving prenatal hashish use and the use of recommended psychotropic remedies among pregnant sufferers with melancholy or anxiousness in a substantial, integrated health care system (concerning 2012 and 2018).

In this review, info from the Kaiser Permanente Northern California (KPNC) wellbeing care technique was utilized to determine pregnant men and women with a depressive or panic ailment described by Global Classification of Health conditions codes.  Sufferers have been screened for prenatal material use applying a self-described questionnaire and urine toxicology assessments as element of schedule prenatal care.  In addition, any dispensation of antidepressants, benzodiazepines, and/or sedative-hypnotics during being pregnant was assessed.  Severity of depressive signs or symptoms was calculated making use of the Patient Overall health Questionnaire (PHQ-9).

This cross-sectional review examined the associations amongst prenatal cannabis use and the use of approved psychotropic treatment use amid expecting people with a prognosis of an stress and anxiety ailment or melancholy.  The investigation bundled 35,047 pregnancies (32,278 individuals 17.6% beneath 25 decades of age, 48.1% non-Hispanic White).  In this population, 12.8% of the gals screened good for hashish use.

Following altering for individual age, earnings, race/ethnicity, and despair symptom severity, the researchers located that  12.6% of the individuals who screened good for prenatal hashish use were being additional most likely to display favourable for prenatal benzodiazepine use (modified odds ratios [aOR] = 1.40) and for sedative-hypnotic use (aOR = 1.28).  Nonetheless, women of all ages ended up not far more likely to use antidepressants (aOR = 1.05).  The odds of prenatal benzodiazepine and sedative-hypnotic use in blend with prenatal cannabis use have been greater among the pregnancies with significant melancholy symptom severity (31.8% of the sample).  

Other Findings of Concern

When this examine focuses primarily on the association among cannabis use and the use of recommended psychotropic medications, 1 of the most regarding results is that ladies with a diagnosis of depression and/or panic disorder (regardless of hashish use) had been not much more most likely to use an antidepressants but had been additional probably to use benzodiazepines and/or sedative-hypnotic medications. Even when they appeared only at ladies with better melancholy severity (31.8% of the girls experienced a PHQ-9 of 10 or better) , women were much more very likely to use benzodiazepines (aOR 1.37) and sedative-hypnotic remedies (aOR 1.45) but not antidepressants.

Presented this kind of cross-sectional research, it is not possible to absolutely have an understanding of how ladies with depression and/or stress and anxiety make choices relating to treatment use during being pregnant on the other hand, the existing research raises some important concerns.  

When screening for perinatal mood and anxiousness ailments was routinely accomplished all through being pregnant, did these females get acceptable counseling concerning the use of medications all through pregnancy and the pitfalls linked with untreated psychiatric sickness in the mother? Were being they capable to entry mental health services? 

Are females with melancholy and/or anxiety picking to avoid antidepressants and to use alternatively benzodiazepines and sedative-hypnotics (or hashish) mainly because these remedies can be applied as needed as an alternative of on a day-to-day basis?  

If costs of hashish use is higher among frustrated gals, does this suggest that ladies might think that cannabis is safer than antidepressants? Is it easier to get cannabis than antidepressants? Does cannabis lead to or worsen depression in this inhabitants? Is hashish use a symptom of melancholy (akin to lousy self-treatment)?

Potential studies are vital to much better recognize the selection-building course of action even so, this research raises numerous considerations.  In this subset of gals with depression and/or anxiousness, particularly these with extra extreme indications, what we have is a significant proportion of pregnancies with several exposures which have been connected with even worse outcomes for equally the mother and her youngster.  About a third of this populace reported critical depressive signs (Publicity #1).  This group of women have been far more most likely to use psychotropic drugs — benzodiazepines and/or sedative-hypnotics — that did not consequence in resolution of depressive signs or symptoms or anxiety (Exposure #2), although it is achievable that these remedies experienced some effect on the severity of indicators.  Women with critical depressive signs were far more most likely to use cannabis (Exposure #3).  And ultimately, depression throughout being pregnant is a robust predictor of postpartum melancholy (Publicity #4). 

Ruta Nonacs, MD PhD

Hirschtritt ME, Avalos LA, Sarovar V, Ridout KK, Goler NC, Ansley DR, Satre DD, Younger-Wolff KC.  Affiliation Among Prenatal Cannabis Use and Psychotropic Treatment Use in Pregnant Patients With Melancholy and Stress and anxiety.  J Addict Med. 2022 Jan 11.