Background: Many women become pregnant while undergoing antidepressant treatment and are concerned about continuing antidepressant medication. However, antidepressant discontinuation may increase the risk of a new episode of major depressive disorder. We sought to estimate differences in the risk of developing a new major depressive episode among pregnant and postpartum women with recurrent illness who either did or did not use antidepressants.
Methods: Participants were recruited from obstetrical settings; we analyzed a subgroup of 778 women with a history of a depressive disorder. Diagnoses were determined by the Composite International Diagnostic Interview administered twice in pregnancy and once after delivery. We used Cox Regression to model onset of a major depressive episode with a time-dependent predictor of antidepressant use.
Results: There was no clear difference in risk of a major depressive episode between women who took antidepressants and women who did not (hazard ratio [HR] = 0.88; 95% CI = 0.51-1.50). After accounting for antidepressant use, clearly hazardous factors included 4 or more depressive episodes before pregnancy (HR = 1.97; 95% CI = 1.09-3.57), black race (HR = 3.69; 95% CI = 2.16-6.30), and Hispanic ethnicity (HR = 2.33; 95% CI = 1.47-3.69).
Conclusions: Failure to use or discontinuation of antidepressants in pregnancy did not have a strong effect on the development of a major depressive episode. Women with 4 or more episodes before pregnancy were at high risk of a major depressive episode, independent of antidepressant use. Black and Hispanic women also were at high risk of a major depressive episode, but it is possible that this effect is attributable to unmeasured factors.
From the Departments of aPsychiatry, bObstetrics, Gynecology, and Reproductive Sciences, cChild Study, dEpidemiology and Public Health, Yale University School of Medicine, New Haven, CT; eDepartment of Obstetrics and Gynecology, Tufts University School of Medicine, Springfield, MA; and fBeth Israel Deaconess Medical Center, Harvard University School of Medicine, Boston, MA.
Submitted 29 March 2011; accepted 4 July 2011; posted 7 September 2011.
Supported by a grant awarded to Dr. Yonkers by the National Institute of Child Health and Development (5-R01-HD045735) entitled “Effects of Perinatal Depression on PTD and LBW.”
Kimberly A. Yonkers is the lead author and received royalties from Up To Date, support for an investigator-initiated study from Eli Lilly, and study medication for an NIMH trial from Pfizer. Dr. Burkman acknowledges consultation to the Veritech corporation. The remaining authors have no disclosures.
Correspondence: Kimberly Yonkers, Departments of Psychiatry and Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 142 Temple Street, Suite 301, New Haven, CT 06510. E-mail: firstname.lastname@example.org.