Depression A Risk During Pregnancy

Pregnant women who stop taking antidepressants run a high risk of slipping back into depression, a study found — dispelling a myth that the surge of hormones during pregnancy keeps mothers-to-be happy and glowing.

The study offers new information but no clear answers for expectant mothers who must balance the risk of medications harming the fetus against the danger of untreated depression.

"It's important that patients not assume that the hormones of pregnancy are going to protect them from the types of problems they've had with mood previously," said Dr. Lee Cohen of Massachusetts General Hospital, one of the study's co-authors.

Indeed, on The Early Show Wednesday, Dr. Catherine Spong, a pregnancy specialist with the National Institute for Child Health and Human Development,

The study does not deal with postpartum depression — the depression that sets in after delivery and that is often blamed on hormonal changes. The research looks only at depression during pregnancy, a condition far less understood.

But, says Spong, "This study provides critical information for pregnant women with major depression.

"Even though it was previously thought that pregnancy protected against recurring episodes of depression, relapses continue to occur. This is vitally important for these women."

No one knows how many pregnant women are on antidepressants, but it's safe to say millions of women of childbearing age take them. Medco Health Solutions estimates 8.4 million American women ages 20 to 44 take antidepressants.

Other research has shown risks to the fetus — including possible heart defects — from antidepressant use during pregnancy.

"Drugs rarely, if ever, are actually studied in pregnancy to determine whether they are safe," Spong observes. "It's important to look at what type of antidepressant is being used and when it's being used during pregnancy. Although antidepressants generally are considered to be safe during pregnancy, some have been linked to complications, such as complications of the developing baby's heart as well as the withdrawal syndrome that occurs after birth. These are, in general, very rare, though."
Researchers followed 201 pregnant women with histories of major depression who were taking drugs such as Prozac, Zoloft, Effexor and Paxil.

Because of ethical concerns, the researchers did not randomly assign the women to either stop or continue medication. Instead, the women decided what to do; researchers then watched what happened.

Sixty-eight percent of those who stopped taking antidepressants slipped into depression. They were five times more likely to suffer a relapse than the women who continued on drugs.

But staying on antidepressants did not shield expectant mothers from depression entirely; 26 percent of those who continued drug treatment became depressed anyway.

Dr. Katherine Wisner of the University of Pittsburgh School of Medicine says the study makes an important contribution by quantifying the risk of relapse. She was not involved in the study but does similar work.

"I was taught in my residency that women don't get depressed during pregnancy," says Wisner, who was a psychiatry resident in the early 1980s. But "I had patients who were depressed. I asked my supervisor, `You mean I'm really not seeing patients who are depressed?'"

The study appears in Wednesday's Journal of the American Medical Association and was funded by the National Institute of Mental Health. Two of the co-authors declared in the paper that they have financial ties to several antidepressant manufacturers.

Other researchers have shown that antidepressant use during the last three months of pregnancy can make newborns jittery and irritable and can cause serious breathing problems. In addition, the Food and Drug Administration has warned that Paxil may be linked to fetal heart defects if a pregnant woman takes it during the first three months of pregnancy.

Dr. Peter Kramer, author of "Listening to Prozac" and "Against Depression," says the study provides information that can help women and doctors decide what to do.

"Ideally, everyone would like to go through pregnancy off all medication," Kramer says. "But these are serious issues, and both decisions can be justified."

Kramer suggested some women might want to get off antidepressants but schedule more psychotherapy while pregnant.

Spong says women "absolutely" shouldn't immediately go off antidepressants if they learn they are pregnant: "As with any medication in pregnancy, it's very important for her to talk with her doctor as to the risks and benefits of that medication. And a woman with major depression clearly needs close and careful monitoring, as relapses can occur during pregnancy."