Abstract
Background: Previous studies indicated that affect fluctuations, the use of antidepressant medication (ADM), as well as depression during pregnancy might have adverse effects on offspring outcomes. The aim of the current proof-of-principle study is to explore the effect of tapering ADM while receiving online preventive cognitive therapy (PCT) on pregnant women and the offspring as compared to pregnant women continuing ADM.Objectives: We sought to compare positive and negative affect fluctuations in pregnant women receiving online PCT while tapering ADM vs. pregnant women continuing ADM, and to investigate if affect fluctuations in early pregnancy were related to offspring birth weight.Method: An experience sampling methodology (ESM)-trial ran alongside a Dutch randomized controlled trial (RCT) and prospective observational cohort of women using ADM at the start of pregnancy. In the ESM-trial fluctuations of positive and negative affect were assessed in the first 8 weeks after inclusion. Recurrences of depression were assessed up to 12 weeks post-partum, and birth records were used to assess offspring birth weight. The RCT has been registered at the Netherlands Trial Register (NTR4694, https://www.trialregister.nl/trial/4551).Results: In total, 19 pregnant women using ADM at start of their pregnancy participated in the ESM-trial. There were no significant differences in positive and negative affect fluctuations, nor recurrence rates between women receiving PCT while tapering ADM vs. women continuing ADM. We found no association between affect fluctuations, pre-natal depressive symptoms, and birth weight (all p > 0.05).Conclusion: This explorative study showed that tapering ADM while receiving online PCT may protect pregnant women against recurrences of depression and affect fluctuations, without affecting birth weight. There is a high need for more controlled studies focusing on tapering ADM with (online) psychological interventions during pregnancy.
Highlights
Major depressive disorder (MDD) is a highly disabling and recurrent disorder that affects people worldwide, including pregnant women
MDD and recurrences in the perinatal period can place women and their offspring at risk of shortand long-term psychological and somatic problems, including low birth weight, pre-term birth, and shorter gestational age, which in turn are associated with psychopathology at later ages [8,9,10], development of MDD, anxiety, and developmental disorders [11,12,13,14,15]
In a recent randomized controlled trial (RCT) [38,39,40,41], we investigated the efficacy of preventive cognitive therapy (PCT) with gradual, guided discontinuation of antidepressant medication (ADM) compared to ADM continuation among formerly depressed women taking ADM at the start of their pregnancy
Summary
Major depressive disorder (MDD) is a highly disabling and recurrent disorder that affects people worldwide, including pregnant women. Women with a history of mental disorders are at increased risk of perinatal depression [1, 2]. MDD and recurrences in the perinatal period can place women and their offspring at risk of shortand long-term psychological and somatic problems, including low birth weight, pre-term birth, and shorter gestational age, which in turn are associated with psychopathology at later ages [8,9,10], development of MDD, anxiety, and developmental disorders [11,12,13,14,15]. Previous studies indicated that affect fluctuations, the use of antidepressant medication (ADM), as well as depression during pregnancy might have adverse effects on offspring outcomes. The aim of the current proof-of-principle study is to explore the effect of tapering ADM while receiving online preventive cognitive therapy (PCT) on pregnant women and the offspring as compared to pregnant women continuing ADM
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