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Women who discontinue antidepressant medication when they become pregnant have nearly a 70% rate of depression relapse during the course of the pregnancy, reported Dr. Lee S. Cohen of Massachusetts General Hospital, Boston, and his associates.
"Pregnancy has historically been described as a time of emotional well-being, providing general 'protection' against psychiatric disorder.
"However, systematic data to support this impression are sparse," the researchers noted.
They undertook what they described as the first study to examine the risk of depression relapse during pregnancy in women with recurrent depression, noting that there is an almost uniform belief that antidepressants should be discontinued during pregnancy to avert prenatal exposure to the drugs.
The 4-year prospective study involved 201 pregnant women with diverse socioeconomic backgrounds who had histories of recurrent depression and were being treated at one of three medical centers "with specific expertise in the treatment of psychiatric illness during pregnancy," they wrote (JAMA 2006;295:499-507).
The mean age at onset of depression was 18 years, and the mean duration of depression was 15 years. A total of 44% of the women reported five or more prior recurrences. All had been taking antidepressants for at least 3 months before enrolling in the study, and almost all (92%) were taking SSRIs or dual-action antidepressants either alone or in combination with other agents.
Of the 65 women who discontinued their medication, 44 (68%) relapsed during pregnancy. About ...