Women with major depression at risk of relapse during pregnancy

January 31, 2006

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.
-end-
(JAMA. 2006;295:499-507. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: This work was funded by the National Institute of Mental Health. Co-author D. Jeffrey Newport, M.D., has served on the speakers bureaus for GlaxoSmithKline, Lilly, and Pfizer. Co-author Zachary N. Stowe, M.D., has served on the speakers bureaus for GlaxoSmithKline, Wyeth, and Pfizer; has received grants from GlaxoSmithKline and Wyeth; and has served on advisory boards for Bristol-Myers Squibb and GlaxoSmithKline. None of the other authors reported disclosures.

The JAMA Network Journals

Related Depression Articles from Brightsurf:

Children with social anxiety, maternal history of depression more likely to develop depression
Although researchers have known for decades that depression runs in families, new research from Binghamton University, State University of New York, suggests that children suffering from social anxiety may be at particular risk for depression in the future.

Depression and use of marijuana among US adults
This study examined the association of depression with cannabis use among US adults and the trends for this association from 2005 to 2016.

Maternal depression increases odds of depression in offspring, study shows
Depression in mothers during and after pregnancy increased the odds of depression in offspring during adolescence and adulthood by 70%.

Targeting depression: Researchers ID symptom-specific targets for treatment of depression
For the first time, physician-scientists at Beth Israel Deaconess Medical Center have identified two clusters of depressive symptoms that responded to two distinct neuroanatomical treatment targets in patients who underwent transcranial magnetic brain stimulation (TMS) for treatment of depression.

A biological mechanism for depression
Researchers report that in depressed individuals there are increased amounts of an unmodified structural protein, called tubulin, in lipid rafts compared with non-depressed individuals.

Depression in adults who are overweight or obese
In an analysis of primary care records of 519,513 UK adults who were overweight or obese between 2000-2016 and followed up until 2019, the incidence of new cases of depression was 92 per 10,000 people per year.

Why stress doesn't always cause depression
Rats susceptible to anhedonia, a core symptom of depression, possess more serotonin neurons after being exposed to chronic stress, but the effect can be reversed through amygdala activation, according to new research in JNeurosci.

Which comes first: Smartphone dependency or depression?
New research suggests a person's reliance on his or her smartphone predicts greater loneliness and depressive symptoms, as opposed to the other way around.

Depression breakthrough
Major depressive disorder -- referred to colloquially as the 'black dog' -- has been identified as a genetic cause for 20 distinct diseases, providing vital information to help detect and manage high rates of physical illnesses in people diagnosed with depression.

CPAP provides relief from depression
Researchers have found that continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) can improve depression symptoms in patients suffering from cardiovascular diseases.

Read More: Depression News and Depression Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.