Reintroduction of Antidepressant Therapy across Pregnancy in Women Who Previously Discontinued Treatment
A Preliminary Retrospective StudyCohen L.S. · Altshuler L.L. · Stowe Z.N. · Faraone S.V.
aPerinatal and Reproductive Psychiatry Clinical Research Program, bDepartment of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Mass., cMood Disorders Research Program, Department of Psychiatry and Behavioral Medicine, University of California, Los Angeles, Calif., and dPregnancy and Postpartum Mood Disorders Program, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Ga., USA
Background: Pregnancy has frequently been described as a time of emotional well-being conferring ‘protection’ against psychiatric disorders. However, data to support this impression are sparse. Methods: A retrospective review was undertaken in order to examine rates of reintroduction of antidepressants across pregnancy among a cohort of 54 euthymic pregnant women who had discontinued these medications around the time of conception. Reintroduction of antidepressants was used as a marker suggesting relapse of depression. Results: Forty-two percent (n = 23) of these women reintroduced antidepressant therapy during pregnancy, with nearly half of these (n = 11) doing so in the first trimester. A greater time spent in episodes since depressive onset and a prior history of suicide attempts was associated with antidepressant reintroduction. Conclusions: Nearly half of the women who discontinued antidepressants during pregnancy to avoid fetal exposure appeared to experience symptoms severe enough to prompt reintroduction of treatment with these medications. The implications of these findings are discussed with respect to treatment planning for women who are maintained on antidepressants and who plan to conceive.