Date Published: February 22, 2019
Publisher: Public Library of Science
Author(s): Nina M. Molenaar, Marlies E. Brouwer, Astrid M. Kamperman, Huibert Burger, Alishia D. Williams, Witte J. G. Hoogendijk, Claudi L. H. Bockting, Mijke P. Lambregtse-van den Berg, Markos Tesfaye.
Antidepressant medication is commonly used for the prevention of depression recurrence in the perinatal period, yet it is unknown what vulnerability markers may play a role in recurrence. The objective of the current study was to provide a descriptive overview of the associated characteristics of women who experienced a perinatal recurrence of depression despite ongoing antidepressant use, and further, to identify clinically measurable vulnerability markers associated with recurrence.
Eighty-five pregnant women with a history of depression who used antidepressants (e.g. Selective Serotonin Reuptake Inhibitors or Serotonin and Noradrenaline Reuptake Inhibitors) at the start of the study were included. Clinical features, including information on psychiatric history and antidepressant use, were collected throughout the perinatal period (in this study defined as the period between 12 weeks of pregnancy untill three months postpartum). The clinical features of women experiencing recurrence of depression were described in detail. To identify vulnerability markers associated with recurrence of depression, we performed exploratory univariable logistic regression analyses.
Eight women (9.4%) experienced a recurrence of depression; two during pregnancy and six in the first 12 weeks postpartum. All women with recurrence of depression had first onset of depression during childhood or adolescence and had at least 2 psychiatric co-morbidities. Identification of vulnerability markers associated with recurrence of depression yielded associations with depressive symptoms around 16 weeks of pregnancy (OR 1.28, 95%CI 1.08–1.52), number of psychiatric co-morbidities (OR 1.89, 95%CI 1.16–3.09) and duration of antidepressant use (OR 1.01, 95%CI 1.00–1.02).
Implementing adequate risk assessment in pregnant women who use antidepressants can help identify predictors for recurrence of depression in future studies and thus ultimately lead to improved care.
Mental illness during the perinatal period (i.e. during pregnancy up to three months postpartum) is a common health problem , with approximately 25% of women experiencing any psychiatric disorder in this period . Perinatal depressive disorder is most common, with a recent meta-analysis observing a pooled prevalence of 11.9% . Untreated perinatal depression is not only unfavourable for the mother; it is also associated with adverse outcomes in the offspring . Exposure to antenatal depressive disorder is associated with increased risks of premature delivery, low birth weight [5–7], and behavioural, emotional, cognitive and motor problems in early childhood [8–10]. Ante- and postnatal depression can furthermore influence the mother-infant relationship, posing increased risks for poor infant development [11–13].
A total of 478 pregnant women were referred for further counselling for both the RCT and the observational cohort. Thirty-one women (6.5%) were unreachable for counselling, 44 (9.2%) decided to participate in the RCT and 248 (51.9%) declined to participate in both trials. Of the remaining 155 women willing to participate in the observational cohort, another 70 (14.6%) were excluded for the current study: six had an incomplete baseline record, 49 did not have a history of depressive disorder, two were currently depressed, three had a miscarriage and ten were lost to follow-up. This resulted in a total sample of 85 women (Fig 1).
In this prospective cohort study, 85 pregnant women with a history of depression and baseline antidepressant use were assessed for depression recurrence. In total, eight women (9.4%) experienced a recurrence of depression at follow-up. All women with recurrence had experienced their first onset of depression during childhood/adolescence and had at least two psychiatric co-morbidities. Due to the low rate of recurrence, we were only able to explore univariable vulnerability markers associated with recurrence. Results yielded associations for recurrence with depressive symptoms around 16 weeks of pregnancy, number of psychiatric co-morbidities and duration of antidepressant use.