Moms-to-be who stop medication risk depression relapse — (The Seattle Times)

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The Seattle Times

Wednesday, February 1, 2006

By Carla K. Johnson,  The Associated Press

CHICAGO — Pregnant women who stop taking antidepressants run a high risk of slipping back into depression, a study found, dispelling the myth that the surge of hormones during pregnancy keeps mothers-to-be happy and glowing.

The study offers new information but no clear answers for expectant mothers, who must balance the risk of medications harming the fetus against 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.

The study does not deal with postpartum depression, which sets in after delivery, and is often blamed on hormonal changes. The research looks only at depression during pregnancy, a condition far less understood.

No one knows how many pregnant women are on antidepressants, but it is safe to say millions of women of childbearing age take them. Medco Health Solutions estimates 8.4 million American women ages 20 to 44 take antidepressants.

Other research has shown risks to the fetus, including possible heart defects, from antidepressant use during pregnancy.

Researchers followed 201 pregnant women with histories of major depression who were taking drugs such as Prozac, Zoloft, Effexor and Paxil.

Because of ethical concerns, the researchers did not randomly assign the women to either stop or continue medication. Instead, the women decided what to do, then researchers watched what happened.

Sixty-eight percent of those who stopped taking antidepressants slipped into depression. They were five times more likely to suffer a relapse than the women who continued on drugs.

“The risk of the medicine has to be measured against the risk of a depressive illness,” said Dr. Margaret Spinelli, director of the maternal mental health program at the New York State Psychiatric Institute in Manhattan. The most commonly prescribed antidepressants, selective-serotonin reuptake inhibitors, have not been associated with congenital abnormalities.

For at least one drug, Paxil, there may be far more serious effects. In September, the drug’s maker, GlaxoSmithKline, issued a warning to doctors after company researchers identified an increased risk of congenital heart defects among babies whose mothers took Paxil during the first trimester of pregnancy.

The study appears in today’s Journal of the American Medical Association and was funded by the National Institute of Mental Health.