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Depression Relapse During Pregnancy

Pregnancy is not protective for women with longstanding, recurrent depression — but antidepressant use during pregnancy might be.

Pregnancy was once thought to protect against psychiatric disorders, but recent studies have shown similar rates of major depression in gravid and nongravid women. Still, few data exist regarding the risk for depression relapse during pregnancy — a vital concern for women weighing the risks of antidepressant exposure for the fetus (see Journal Watch Psychiatry Feb 22 2006).

Researchers naturalistically followed 201 currently euthymic, pregnant women with histories of depression (euthymia 3 months before pregnancy; mean depression duration, 15.4 years). At baseline, 44% reported five or more depressive episodes, 53% had psychiatric comorbidities, and 92% were taking antidepressants (predominantly SSRIs or serotonin-norepinephrine reuptake inhibitors).

The choice to maintain or discontinue antidepressants during pregnancy was not associated with duration of illness, number of previous episodes, or presence of psychiatric comorbidities. However, women who continued treatment were significantly more likely to be taking SSRIs than were those who discontinued treatment.

Overall, 43% of women in the sample relapsed during pregnancy (26% of women who continued treatment and 68% of those who discontinued it), half of them in the first trimester. Of women who discontinued treatment, depression risk was lower in those who resumed taking medication, but they remained at higher risk than women who continued treatment. Having more than four recurrent episodes or illness lasting more than 5 years significantly increased relapse risk.

Comment: These findings reinforce the observation that pregnancy is not protective for women with depression. In these euthymic women, relapse rates increased with treatment discontinuation. For ethical reasons, treatment decisions were not randomized. However, the researchers did examine relapse in women with highly recurrent, longstanding depressive illness. For women with such severe illness, these results provide useful information for making collaborative decisions about treatment during pregnancy.

— Deborah Cowley, MD

Published in Journal Watch Psychiatry February 22, 2006

Citation(s):

Cohen LS et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 2006 Feb 1; 295:499-507.

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