Greater Use of Cannabis and Benzodiazepines, But Not Antidepressants

When we have found decreasing premiums of alcoholic beverages and tobacco use through pregnancy over the last handful of decades, the use of hashish in the course of being pregnant is on the rise.  Qualitative studies reveal that pregnant women report employing hashish to deal with a range of psychological indicators, such as sleeplessness, stress, and melancholy.  Scientific studies carried out prior to the legalization of medical and recreational cannabis (in some states) have demonstrated that expecting girls with energetic depressive indications and/or nervousness are a lot more possible to use substances.  A cross-sectional analyze from Californaia examines the associations among prenatal hashish use and the use of prescribed psychotropic prescription drugs between pregnant individuals with depression or nervousness in a substantial, built-in healthcare method (involving 2012 and 2018).

In this review, info from the Kaiser Permanente Northern California (KPNC) health care system was utilised to recognize expecting persons with a depressive or anxiety disorder outlined by International Classification of Ailments codes.  Patients have been screened for prenatal material use applying a self-noted questionnaire and urine toxicology tests as section of regime prenatal treatment.  In addition, any dispensation of antidepressants, benzodiazepines, and/or sedative-hypnotics in the course of pregnancy was assessed.  Severity of depressive signs and symptoms was measured utilizing the Individual Health Questionnaire (PHQ-9).

This cross-sectional review examined the associations involving prenatal cannabis use and the use of recommended psychotropic medication use amid expecting folks with a analysis of an panic ailment or depression.  The analysis involved 35,047 pregnancies (32,278 people 17.6% under 25 years of age, 48.1% non-Hispanic White).  In this populace, 12.8% of the ladies screened optimistic for cannabis use.

Following altering for individual age, income, race/ethnicity, and melancholy symptom severity, the researchers uncovered that  12.6% of the sufferers who screened favourable for prenatal hashish use were being far more probably to screen constructive for prenatal benzodiazepine use (modified odds ratios [aOR] = 1.40) and for sedative-hypnotic use (aOR = 1.28).  On the other hand, women have been not much more very likely to use antidepressants (aOR = 1.05).  The odds of prenatal benzodiazepine and sedative-hypnotic use in mix with prenatal cannabis use were greater between pregnancies with critical despair symptom severity (31.8% of the sample).  

Other Findings of Issue

Although this review focuses primarily on the affiliation between cannabis use and the use of prescribed psychotropic prescription drugs, 1 of the most about findings is that women with a analysis of melancholy and/or stress condition (regardless of cannabis use) were not additional likely to use an antidepressants but were much more probably to use benzodiazepines and/or sedative-hypnotic prescription drugs. Even when they seemed only at women of all ages with increased melancholy severity (31.8% of the women of all ages experienced a PHQ-9 of 10 or greater) , girls had been extra probable to use benzodiazepines (aOR 1.37) and sedative-hypnotic drugs (aOR 1.45) but not antidepressants.

Supplied this form of cross-sectional examine, it is not possible to fully recognize how women with despair and/or anxiousness make selections about medication use through pregnancy nevertheless, the recent analyze raises some crucial queries.  

Although screening for perinatal temper and anxiety issues was routinely completed through being pregnant, did these women of all ages acquire suitable counseling relating to the use of remedies through being pregnant and the risks linked with untreated psychiatric ailment in the mom? Were they in a position to access mental health services? 

Are females with melancholy and/or stress and anxiety selecting to avoid antidepressants and to use as an alternative benzodiazepines and sedative-hypnotics (or cannabis) mainly because these drugs can be utilized as desired rather of on a day by day basis?  

If rates of hashish use is larger between depressed women, does this indicate that women of all ages might feel that cannabis is safer than antidepressants? Is it much easier to get hashish than antidepressants? Does hashish bring about or worsen depression in this population? Is cannabis use a symptom of despair (akin to bad self-treatment)?

Potential scientific studies are necessary to improved comprehend the decision-earning method however, this review raises a lot of issues.  In this subset of women with depression and/or nervousness, specifically those with extra significant signs or symptoms, what we have is a significant proportion of pregnancies with several exposures which have been connected with worse results for both the mother and her child.  About a 3rd of this inhabitants claimed extreme depressive indicators (Publicity #1).  This team of women ended up extra most likely to use psychotropic drugs — benzodiazepines and/or sedative-hypnotics — that did not end result in resolution of depressive indicators or stress and anxiety (Publicity #2), even though it is attainable that these prescription drugs had some effect on the severity of indications.  Ladies with intense depressive indications were being much more likely to use hashish (Exposure #3).  And finally, depression for the duration of pregnancy is a robust predictor of postpartum melancholy (Exposure #4). 

Ruta Nonacs, MD PhD

Hirschtritt ME, Avalos LA, Sarovar V, Ridout KK, Goler NC, Ansley DR, Satre DD, Young-Wolff KC.  Affiliation Concerning Prenatal Hashish Use and Psychotropic Treatment Use in Pregnant People With Despair and Stress.  J Addict Med. 2022 Jan 11.