Recurrence of depression in the perinatal period: Clinical features and associated vulnerability markers in an observational cohort.

Nina M Molenaar,Astrid M Kamperman,Marlies E Brouwer,Claudi L H Bockting,Mijke P Lambregtse-Van Den Berg,Huibert Burger,Alishia D Williams,Witte J G Hoogendijk

doi:10.1371/journal.pone.0212964

Abstract

ObjectiveAntidepressant 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.MethodsEighty-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.ResultsEight 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).ConclusionImplementing 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.

Highlights

Mental illness during the perinatal period is a common health problem [1], with approximately 25% of women experiencing any psychiatric disorder in this period [2]
Identification of vulnerability markers associated with recurrence of depression yielded associations with depressive symptoms around 16 weeks of pregnancy, number of psychiatric co-morbidities and duration of antidepressant use
Exposure to antenatal depressive disorder is associated with increased risks of premature delivery, low birth weight [5,6,7], and behavioural, emotional, cognitive and motor problems in early childhood [8,9,10]

Summary

Introduction

Mental illness during the perinatal period (i.e. during pregnancy up to three months postpartum) is a common health problem [1], with approximately 25% of women experiencing any psychiatric disorder in this period [2]. Perinatal depressive disorder is most common, with a recent meta-analysis observing a pooled prevalence of 11.9% [3]. Untreated perinatal depression is unfavourable for the mother; it is associated with adverse outcomes in the offspring [4]. Exposure to antenatal depressive disorder is associated with increased risks of premature delivery, low birth weight [5,6,7], and behavioural, emotional, cognitive and motor problems in early childhood [8,9,10]. Prevention or treatment of perinatal depression is of importance. Perinatal prescription rates of antidepressants vary per study setting and range from 2.1% to 13.4% [17, 19,20,21]

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Results

Discussion

Conclusion