Pregnant and postpartum women experience depression, anxiety despite treatment with antidepressants

Despite using antidepressants (selective serotonin reuptake inhibitors), many pregnant women had lingering depression and anxiety symptoms throughout their pregnancy and postpartum, reports a new Northwestern Medicine study.

The study also found anxiety symptoms are common in treated depressed women, with symptoms worsening over time in some women.

This is the first study to measure the different trajectories of depression and anxiety in pregnant and postpartum women. Through pregnancy, 18% of the women had minimal, 50% had mild and 32% clinically relevant depressive symptoms.

This is the first longitudinal data to show that many pregnant women report depression and anxiety symptoms during pregnancy and postpartum, despite their choice to continue treatment with antidepressants. It lets us know these women need to be continually monitored during pregnancy and postpartum, so their clinicians can tailor their treatment to alleviate their symptoms."

Dr. Katherine Wisner, senior author, director of the Asher Center for the Study and Treatment of Depressive Disorders and professor of psychiatry and of obstetrics and gynecology at Northwestern University Feinberg School of Medicine

"Psychological and psychosocial factors change rapidly across childbearing," said co-author Dr. Catherine Stika, a clinical professor of obstetrics and gynecology at Northwestern and a Northwestern Medicine gynecologist. "Repeated screenings will allow your clinician to adapt the type and/or intensity of intervention until your symptoms improve."

Depression also impacts a woman's infant. "This is key as children exposed to a depressed mother have an increased risk of childhood developmental disorders," Wisner said.

The study will be published March 4 in Psychiatric Research and Clinical Practice.

The new research also showed that pregnant women taking selective serotonin reuptake inhibitors to treat their depression showed sub-optimal health, including elevated body mass index, infertility, migraines, thyroid disorders and asthma. A history of eating disorders predicted elevated depression trajectory scores.

Perinatal depression and anxiety are widespread, affecting 20% of women during pregnancy and after birth. An estimated 500,000 pregnancies in the U.S. annually will result in women who have or will have psychiatric illness during pregnancy.

The prospective longitudinal observational cohort study, entitled "Optimizing Medication Management for Mothers with Depression (OPTI-MOM)," included 88 pregnant women. They completed assessments every four weeks from study entry until delivery and at six and 14 weeks postpartum. Participants were enrolled at urban academic medical centers including Northwestern University Feinberg School of Medicine, University of Texas-Galveston, University of Pittsburgh and a rural health center (Marshfield Clinic Health System in Wisconsin).

The study was a collaboration with the University of Pittsburgh, Magee Women's Hospital; The Ohio State University Wexner Medical Center; and the University of Texas Medical Branch.