Women with major depression at risk of relapse during pregnancy

Contrary to a common belief that the hormonal changes associated with pregnancy provide a protective effect against depression, women with major depression who discontinue antidepressant medication during pregnancy are at risk of relapse, according to a study in the February 1 issue of JAMA.

Lee S. Cohen, M.D., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues conducted a study to determine the risk of relapse in pregnant women with major depression who discontinued or who attempted to discontinue antidepressant medication close to conception compared with those who maintained treatment with these medications. The study included a total of 201 pregnant women who enrolled between March 1999 and April 2003 at 3 centers with specific expertise in the treatment of psychiatric illness during pregnancy. The participants had a history of major depression prior to pregnancy, were less than 16 weeks’ gestation, and were currently or recently (less than 12 weeks prior to last menstrual period) receiving antidepressant medication.

The researchers found that 43 percent of women in the sample relapsed during pregnancy, and half of those relapsed during the first trimester. Among women who maintained their medication throughout the pregnancy, 26 percent relapsed compared with 68 percent of those who discontinued their medication.

“Given the prevalence of depression in reproductive age women, the prevalence of antidepressant use in this population and the frequency of unplanned pregnancy, the ability to inform patients about risk of depressive relapse if either discontinuation or maintenance of treatment is pursued as a clinical course has significant implications,” the authors write.

“With greater awareness and increasing treatment of depression in the community, growing numbers of women may face a clinical decision regarding use of antidepressant medication during pregnancy. Navigating this clinical course can be facilitated by the accurate delineation of the relative risks of prenatal exposure to medication on the one hand and the risk of relapse of psychiatric disorder on the other. Quantification of these risks affords clinicians the opportunity to make collaborative treatment decisions consistent with individual needs and wishes. Such information can also help to refine treatment guidelines for women with a history of depression who are planning to conceive or who experience mood disorders during pregnancy,” the researchers conclude.


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