"Pregnancy is not 'protective' with respect to relapse of major depression," write Lee Cohen, MD, and colleagues. Cohen works in Boston at Massachusetts General Hospital's psychiatry department. The findings are published in The Journal of the American Medical Association.
The researchers' advice: Women taking antidepressants should talk to their doctors about the pros and cons of taking those drugs during pregnancy.
"These women must weigh concerns about prenatal exposure from these medications ranging from the risk of malformations to the risk of obstetrical and perinatal complications," they write.
"These women should also consider the risks of depressive relapse during pregnancy and the effects of untreated depression on fetal and maternal well-being," the doctors continue.
Pregnant and Depressed
Pregnancy has historically been viewed as a time when depression lifts, but there's little evidence for that notion, according to Cohen's team.
The FDA recently strengthened its warnings about possible birth defects in babies born to women taking Paxil during pregnancy. However, PaxilPaxil hasn't been proven to have caused those birth defects.
Depression is a serious illness affecting the body as well as the mind. Antidepressants can be a big help, but like any powerful drug, their use during pregnancy warrants careful consideration with a doctor's guidance.
Relapse During Pregnancy
Cohen and colleagues studied 201 pregnant women whose depression had been lifted by antidepressant drugs for at least three months before their last menstrual period.
Some women chose to keep taking antidepressants throughout pregnancy. Others opted to stop taking the drugs or to change their doses before or during pregnancy. The researchers didn't ask any women to stop or alter their use of antidepressants.
Those who stopped taking antidepressants or altered their doses were more likely to have a relapse of major depression during pregnancy, the study shows.
A total of 65 women quit taking antidepressants. More than two-thirds of them (68%) had a relapse of major depression during pregnancy.
Eighty-two women kept taking antidepressants throughout pregnancy. About a quarter of them (26%) had a relapse of major depression during pregnancy. Women who raised or lowered their antidepressant dose during pregnancy fell somewhere between those two groups, write the researchers.
About six in 10 women who stopped taking antidepressants or lowered their doses due to their pregnancy started taking antidepressants again while still pregnant. They still reported more depression than those who never quit taking antidepressants, the study shows.
"With this information, some women with histories of recurrent depressive illness may choose to maintain antidepressant therapy during attempts to conceive and during pregnancy," the researchers write.
That choice "might be particularly understandable," the researchers write, "given the growing amount of reproductive safety information available for commonly used antidepressants, including tricyclic antidepressants, SSRIs (selective serotonin re-uptake inhibitors), and dual-action antidepressants (SNRIs)."
In the journal, two of Cohen's colleagues note ties to several drug companies whose products include antidepressants. The study was funded by the National Institute of Mental Health.