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Pregnancy Is No Protection Against Depression Relapse


 

Women who discontinue antidepressant medication when they become pregnant have nearly a 70% rate of depression relapse during the course of the pregnancy, reported Dr. Lee S. Cohen of Massachusetts General Hospital, Boston, and his associates.

“Pregnancy has historically been described as a time of emotional well-being, providing general 'protection' against psychiatric disorder.

“However, systematic data to support this impression are sparse,” the researchers noted.

They undertook what they described as the first study to examine the risk of depression relapse during pregnancy in women with recurrent depression, noting that there is an almost uniform belief that antidepressants should be discontinued during pregnancy to avert prenatal exposure to the drugs.

The 4-year prospective study involved 201 pregnant women with diverse socioeconomic backgrounds who had histories of recurrent depression and were being treated at one of three medical centers “with specific expertise in the treatment of psychiatric illness during pregnancy,” they wrote (JAMA 2006;295:499–507).

The mean age at onset of depression was 18 years, and the mean duration of depression was 15 years. A total of 44% of the women reported five or more prior recurrences. All had been taking antidepressants for at least 3 months before enrolling in the study, and almost all (92%) were taking SSRIs or dual-action antidepressants either alone or in combination with other agents.

Of the 65 women who discontinued their medication, 44 (68%) relapsed during pregnancy. About half of them relapsed during the first trimester and another 40% during the second trimester. This compares with a 26% relapse rate among women who maintained their medication throughout pregnancy.

After the data were adjusted to account for several variables such as type of medication used and number of prior episodes of depression, “women who discontinued their medication had a fivefold increased risk of relapse over the course of their pregnancy, compared with women who maintained their medication,” the researchers wrote.

Of the patients who discontinued (65 women) or decreased (34 women) their antidepressant medications, 61% resumed taking the drugs during pregnancy because of resurgence of depressive symptoms.

These findings have significant implications, “given the prevalence of depression in reproductive-age women, the prevalence of antidepressant use in this population, and the frequency of unplanned pregnancy,” according to the investigators.

Women should be made aware of the risk of depressive relapse following discontinuation of antidepressants. More of those who have recurrent depressive illness may well choose to maintain antidepressant therapy during attempts to conceive and during pregnancy, Dr. Cohen and his associates noted.

“These women must weigh concerns about prenatal exposure to these medications … [but] should also consider the risks of depressive relapse during pregnancy and the effects of untreated depression on fetal and maternal well-being,” they added.

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