Women who stop taking antidepressant medications during pregnancy are at a five times greater risk for recurrence of depression than are women who continue taking their medication throughout their pregnancies, according to a multi-institutional study published in the Journal of the American Medical Association.
The findings, from the first systematic clinical study of depression relapse during pregnancy, run counter to a common belief that pregnancy's hormonal changes can prevent psychiatric problems.
"Clinical lore has held for decades that pregnancy protected women from mood disorders," says Lee Cohen, MD, director of the Perinatal and Reproductive Clinical Research Program at Massachusetts General Hospital (MGH), who led the investigation. "What drove this study was a divergence between that belief and what many of us were seeing clinically, that many women who stopped using antidepressants during pregnancy appeared to be relapsing."
Many published studies have supported the safety of antidepressant drugs taken during pregnancy, although there have been some reports that prenatal exposure to the popular selective serotonin reuptake inhibitors (SSRIs) might cause transient agitation or distress in newborns. Most recently, some preliminary unpublished data suggested a potentially increased risk of cardiovascular defects in infants exposed to the SSRI paroxetine. The current study was designed to examine risk for recurrent depression in pregnant women who chose to continue or to stop antidepressants during pregnancy.
The study enrolled 201 women treated at women's mental health centers at MGH, University of California Los Angeles (UCLA) School of Medicine, and Emory University School of Medicine. All participants were less than 16 weeks pregnant when entering the study, had a history of depression and had been successfully treated with antidepressant medications for at least three months before they became pregnant.