Study warns about halting anti-depressants during pregnancy

Pregnant women who stop using anti-depressants may be putting themselves at great risk for another depressive episode, a new study has found, which dismisses the myth that pregnancy hormones ward off depression.

 "White-knuckling it through pregnancy with recurrent depression may not be in the best interest of mom or the baby," said Dr. Lee Cohen, director of Massachusetts General Hospital's Center for Women's Mental Health and lead author of the study. 



 Researchers at the hospital tracked 201 women with a history of depression through their pregnancies to see whether those who stopped their medication had an increased risk of relapse. The study, published this week in the Journal of the American Medical Association, found that 67 percent of the women who stopped taking anti-depressants relapsed during pregnancy. 



 One in every six to seven women is at risk for major depression. Treating pregnant women has always involved weighing drug benefits to the mother against any possible risk to the developing fetus. But this study "puts the issue to bed once and for all," said Dr. David Kupfer, professor and chairman of psychiatry at the University of Pittsburgh Medical Center. 



 Folklore on pregnancy has suggested pregnancy hormones protect against depression. But Kupfer, Cohen and others say pregnancy could be a chronic stressor for women with a history of depression. 



 "The risk of the medicine has to be measured against the risk of a depressive illness," said Dr. Margaret Spinelli, director of the maternal mental health program at the New York State Psychiatric Institute in Manhattan. The most commonly prescribed anti-depressants, selective-serotonin reuptake inhibitors, or SSRIs, have not been associated with congenital abnormalities. But some newborns can develop a withdrawal syndrome characterized by irritability, jitteriness and fluctuations in temperature. 



 For at least one drug, Paxil, there may be far more serious effects. In September, GlaxoSmithKline, makers of the controversial anti-depressant, issued a warning to doctors. Company epidemiologists identified an increased risk of congenital heart defects among babies whose mothers took the anti-depressant during the first trimester of pregnancy. Paxil has been banned in the United Kingdom for use in those younger than 18 since it was linked to suicidal thoughts. 



 Not every woman is comfortable taking anti-depressant medicines during pregnancy. That is why Spinelli and her colleagues are testing a nondrug treatment -- interpersonal psychotherapy, a 12-week treatment for depression. Small studies in pregnant women with a history of depression show that it may work. Spinelli is embarking on a larger study at three medical centers in Manhattan. 



 "You always want to try the least invasive method," she said.