Women who suffer from major depression are at significantly higher risk of relapse if they stop taking their antidepressant medications during pregnancy, according to a study published in today's issue of the Journal of the American Medical Association.
Researchers at Harvard University and Massachusetts General Hospital studied 201 pregnant women who had a history of depression but were not currently depressed. Of those patients who continued taking their medication, 26 percent had a relapse. Of those who stopped taking antidepressants, 68 percent relapsed.
The findings dispute the common belief that hormonal changes during pregnancy can be "protective" and fend off depression, the study authors noted.
However, some women may be concerned that the medications could hurt the fetus.
Weighing the Risks
The researchers and many other experts say the study helps doctors and patients weigh the risks that antidepressants pose to the fetus versus the benefits of improved mental health during pregnancy.
Dr. Marc Siegel, an associate professor of medicine at New York University, said that depression during pregnancy is extremely common. "I think the article is a good warning against routinely stopping antidepressant use because of pregnancy," he said.
Siegel believes that if the mother is moderately or more severely depressed, taking antidepressants during pregnancy outweighs the slight risk they pose to the fetus.
"Depression has been associated with more smoking, alcohol use, less sleep, more stress -- all of which are a threat to the fetus during pregnancy," Siegel said.
The Food and Drug Administration recently reported that the antidepressant Paxil increases the risk of birth defects, particularly heart defects, when women take it during the first three months of pregnancy. But there is little evidence that other antidepressants increase the risk of birth defects.
"There is consistent evidence that SSRI antidepressants increase the risk of premature delivery and birth weight, but this risk is relatively small," said Dr. Gregory Simon, an associate professor at the University of Washington. "For other antidepressants, there is no evidence of increased risk of birth defects or malformations."
Dr. Margaret Spinelli, director of the maternal mental health program at the New York State Psychiatric Institute, said that depressed patients have to work with their doctors to find the right combination of medication and alternative therapy.
Zoloft and Celexa "have the best risk-benefit profile," Spinelli said. "I also discuss with my patients alternatives to medications, such as interpersonal psychotherapy, which I have adapted to pregnancy."
The study's authors are currently analyzing additional data to see if they can isolate characteristics that could help determine who could safely discontinue treatment and who would be at risk for recurrence of depression during pregnancy.