Pregnancy and Major Depression a Dangerous Mix

Women who stopped using antidepressants suffered more relapses, research shows

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By Amanda Gardner
HealthDay Reporter

TUESDAY, Jan. 31, 2006 (HealthDay News) -- Pregnancy does not appear to confer a protective effect on women with major depression, as many experts had thought.

Quite the contrary, pregnant women who discontinue their antidepressant medication are at a five times higher risk of relapse than women who don't, new research shows.

The study, appearing in the Feb. 1 issue of the Journal of the American Medical Association, argues strongly for women and their doctors to discuss medication options.

"Hopefully, we'll be less likely to see arbitrary discontinuation of antidepressants in patients with histories of major depression, which has been frequently standard fare," said study author Dr. Lee Cohen, director of the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital in Boston. "This manuscript will round out part of the risk-benefit equation by offering clinicians and their patients a sense of what happens if they either chose to stay on or stop the medicine."

"This challenges a certain myth and hope that people had that a pregnant woman is going to have a quieter time with respect to her mood symptoms than when she's not pregnant," added Dr. Susan Kemker, an assistant attending psychiatrist at Westchester Medical Center and clinical assistant professor of psychiatry at New York Medical College, both in Valhalla, N.Y.

"That is just not the case," she said. "This study shows a risk for relapse which makes the decision-making process for a woman who's pregnant more complicated. It makes it more important for her to really partner with her doctor."

There have been reports that the newer antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which include Prozac, Paxil, and Zoloft, may cause newborns to have withdrawal symptoms. In September 2005, the U.S. Food and Drug Administration issued a warning about possible birth defects in infants born to women taking Paxil during their first trimester. Overall, however, most studies have confirmed the safety of antidepressants taken during pregnancy.

"Our data on psychiatric drugs have been around for a while, and we're not finding increased malformation," said Dr. Jennifer Wu, an obstetrician/gynecologist with Lenox Hill Hospital in New York City. "For the patient who says she's tried coming off and had very bad depressive episodes, physicians in general recently have been starting to keep them on their medication."

Prior to that, many physicians recommended that pregnant women discontinue the medications.

This study compared pregnant women with major depression who stopped or tried to stop taking their medication near the time of conception with women who stayed on their medication. In all, 201 pregnant women at three centers participated. All were less than 16 weeks pregnant at the beginning of the study, and all had a history of major depression before becoming pregnant.

Out of the total sample, 43 percent relapsed during pregnancy, half of them during the first trimester. Sixty-eight percent of women who discontinued their medication experienced a relapse, compared with only 26 percent of women who stayed on their medication. Women who came off their medication also relapses more frequently.

There are also risks if a woman is depressed during her pregnancy.

"Untreated depression actually puts mom at risk, and puts baby at risk," Cohen said. "It is associated with compromised fetal well-being and the well-being of the newborn."

One of the authors' main messages is that women, in conjunction with their doctors, have to make an important decision, one that can't be presented in terms of black and white.

"It is a complicated picture," Wu said. "You really have to individualize care."

More information

Learn more about psychiatric disorders during pregnancy at Massachusetts General Hospital Center for Women's Health.

SOURCES: Lee S. Cohen, M.D., director, Perinatal and Reproductive Psychiatry Clinical Research Program, Massachusetts General Hospital, Boston; Jennifer Wu, M.D., obstetrician/gynecologist, Lenox Hill Hospital, New York City; Susan Kemker, M.D., assistant attending psychiatrist, Westchester Medical Center, and clinical assistant professor, psychiatry, New York Medical College, both in Valhalla, N.Y.; Feb. 1, 2006, Journal of the American Medical Association

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