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 ca
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