Antidepressant Treatment and Relapse of Depression During Pregnancy

Abstract

To the Editor: In their prospective naturalistic investigation, Dr Cohen and colleagues showed that among women who maintained their antidepressant use throughout the pregnancy, 26% had a relapse of major depression, compared with 68% of those who discontinued taking their antidepressants. They also found that women who increased or decreased their antidepressant use had a rate of relapse between those who maintained and those who discontinued their antidepressants (45% and 35%, respectively). The authors concluded that women with histories of depression who are euthymic while receiving antidepressant therapy should be aware of the association of depressive relapse during pregnancy with antidepressant discontinuation. These findings are very similar to those of lithium treatment for bipolar disorder during pregnancy. First, in the case of lithium continuation, Perlis et al demonstrated that changes in serum lithium level in the maintenance phase (both low to standard and standard to low) were associated with recurrence of bipolar disorder at 36 weeks (rate approximately 50%), whereas unchanged levels were associated with good prognosis (rate approximately 20%). These figures are comparable with the findings of Cohen et al. Second, in the case of lithium discontinuation, Viguera et al showed that the rate of relapse of bipolar disorder in pregnant women following lithium discontinuation was 52%. This rate was dependent on rapidity of lithium discontinuation, with a 63% relapse rate in patients with rapid (1-14 days) discontinuation and 37% relapse with gradual (15-30 days) discontinuation. If the patients in the study by Cohen et al rapidly discontinued their antidepressants within 1 to 2 weeks, their relapse rate of 68% would be comparable. Despite the differences in medication and in diagnoses, the results are very similar. Thus, the conclusion of Cohen et al can be generalized to “women with histories of mood disorder who are euthymic in the context of ongoing antidepressant or lithium therapy should be aware of the association of relapse during pregnancy with the medication discontinuation.”