Pregnancy No Assurance that Depressed Women Will Not Need to Continue on Antidepressants – Study

It is commonly believed that the “surge” of hormones women experience during pregnancy causes them to be happier and experience a positive mental state. In the case of clinically depressed women, however, pregnancy alone may not offer an escape from the problems associated with their depression

The Associated Press has reported on the publication of a new study in the Journal of the American Medical Association (JAMA) that found pregnant women who stop taking antidepressants are at a high risk of “slipping back into depression.”
While the study expands upon previous data on the subject, it offers no solution to the “Catch 22” faced by clinically depressed pregnant women who are confronted with the dilemma of choosing between medications that have the potential to harm their unborn child and 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 study co-author Dr. Lee Cohen of Massachusetts General Hospital, as reported by the Associated Press.

The study, which only examined depression during pregnancy, not postpartum depression, followed 201 pregnant women who had histories of major depression and were being treated with medications like Prozac, Zoloft, Effexor and Paxil.

The number of pregnant women who are on antidepressants at any one time is unknown, but one estimate is that 8.4 million American women of childbearing age (20-44) take antidepressants, which previous studies have shown pose risks to an unborn fetus, including possible heart defects. The FDA has warned that Paxil may be linked to fetal heart defects when taken during the first trimester.

Other studies have shown that antidepressant use during the last trimester can make newborns jittery and irritable, and may even cause them to suffer serious breathing problems.

To complete the study, the researchers did not randomly assign the women to either stop or continue medication, due to ethical concerns. Each woman decided for herself whether she would continue with her treatment; then researchers observed the results.

Sixty-eight percent of those who stopped taking antidepressants lapsed back into depression. They were 500% more likely to slip back into depression than the women who remained on medication.

The study did find, however, that although many women who continued their medication avoided a relapse, 26% of those, who remained medicated, became depressed.

Some doctors always suspected that pregnancy alone was no guaranty that clinically depressed women could stop their medications and remain problem-free. Thus, this study offers information that can act as a starting point for doctors and expectant mothers who have been on medication. One possibility would be to discontinue the drugs and increase psychotherapy.

While being completely drug-free during pregnancy is the ideal situation, the dangers of serious clinical depression must be considered in the equation. Since the safety of the fetus, as well as that of the mother, are “serious issues,” one expert stated “both decisions can be justified.”

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