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Stopping antidepressants during pregnancy
may lead to symptom recurrence
Study is first to investigate whether
discontinuing treatment can lead to relapse during pregnancy
BOSTON - January 31, 2006 - Women who stop taking antidepressant
medications during pregnancy are at a five times greater risk for
recurrence of depression than are women who continue taking their
medication throughout their pregnancies, according to a multi-institutional
study published in the February 1 Journal
of the American Medical Association. The findings, from
the first systematic clinical study of depression relapse during
pregnancy, run counter to a common belief that pregnancy's hormonal
changes can prevent psychiatric problems.
"Clinical lore has held for decades that pregnancy protected
women from mood disorders," says Lee Cohen, MD, director of
the Perinatal
and Reproductive Clinical Research Program at Massachusetts
General Hospital (MGH), who led the investigation. "What drove
this study was a divergence between that belief and what many of
us were seeing clinically, that many women who stopped using antidepressants
during pregnancy appeared to be relapsing."
Many published studies have supported the safety of antidepressant
drugs taken during pregnancy, although there have been some reports
that prenatal exposure to the popular selective serotonin reuptake
inhibitors (SSRIs) might cause transient agitation or distress in
newborns. Most recently, some preliminary unpublished data suggested
a potentially increased risk of cardiovascular defects in infants
exposed to the SSRI paroxetine. The current study was designed to
examine risk for recurrent depression in pregnant women who chose
to continue or to stop antidepressants during pregnancy.
The study enrolled 201 women treated at women's mental health centers
at MGH, University of California Los Angeles (UCLA) School of Medicine,
and Emory University School of Medicine. All participants were less
than 16 weeks pregnant when entering the study, had a history of
depression and had been successfully treated with antidepressant
medications for at least three months before they became pregnant.
The women were provided with audiotapes outlining what was known
about the risk of birth defects associated with antidepressants
and about the possible risk that their depression could recur if
medication was discontinued. They then made their own decisions
whether to maintain or discontinue antidepressant medication during
pregnancy. A total of 82 chose to maintain their medication dosage;
65 discontinued antidepressants; 34 decreased dosage and 20 increased
dosage during their pregnancies. Out of all participants, 43 percent
experienced relapse of depression symptoms during pregnancy, half
during the first trimester. But while 68 percent of those who discontinued
medication relapsed, only 26 percent of those who maintained their
prepregnancy dosage had recurrence of symptoms.
"We know that women who become depressed during pregnancy may
not take appropriate care of themselves or even make it to prenatal
appointments, and there is evidence that maternal depression itself
has an adverse effect on fetal and neonatal well being," says
Cohen. "While this report does not offer explicit guidelines
for individual patients, the study unequivocally suggests that women
taking antidepressants who anticipate pregnancy need to address
with their doctors not only potential risks to their babies if they
continue taking the drugs but also the risk that their disease may
recur if they stop antidepressants. Only by considering both sides
of this risk/benefit equation can patients make informed decisions."
Members of the research team are currently analyzing additional
data from these study participants to look for characteristics that
may indicate who could safely discontinue treatment and who would
be at risk for recurrence. They also are planning to examine the
factors women used as a basis for deciding whether to continue medication
as well as other information that could be helpful to patients and
physicians.
The group at Emory was led by Zachary Stowe, MD, and the UCLA team
was led by Lori Altshuler, MD. Other coauthors of the JAMA
study are Ruta Nonacs, MD, PhD, Adele Viguera, MD, and Alison Reminick
of MGH; Rita Suri, MD, Vivien Burt, MD, PhD, and Victoria Hendrick,
MD, of UCLA; Jeffrey Newport, MD, and Ada Loughead of Emory; and
Bernard Harlow, PhD, and Allison Vitonis of Brigham and Women's
Hospital. The study was supported by grants from the National Institute
of Mental Health.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of nearly $500 million and
major research centers in AIDS, cardiovascular research, cancer,
cutaneous biology, medical imaging, neurodegenerative disorders,
transplantation biology and photomedicine. In 1994, MGH and Brigham
and Women's Hospital joined to form Partners HealthCare System,
an integrated health care delivery system comprising the two academic
medical centers, specialty and community hospitals, a network of
physician groups, and nonacute and home health services.
Media Contact: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
Information about Clinical Trials
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