The Pharmaceutical Journal
Vol 276 No 7387 p160
11 February 2006

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Depression therapy a dilemma in pregnancy

Women who discontinue antidepressants during pregnancy are more likely to have a relapse of their illness than those who do not, a study has found (JAMA 2006;295:499). In contrast, two recent studies have examined the association between various neonatal conditions and antenatal use of selective serotonin reuptake inhibitors.

In the JAMA study, investigators enrolled 201 pregnant women with major depression and found that 68 per cent of those who stopped taking their antidepressant medicines experienced a major depressive relapse during pregnancy, compared with 26 per cent of those who continued their treatment (hazard ratio 5, 95 per cent confidence interval 2.8–9.1; P<0.001). This, the authors state, refutes the “common belief that characteristic hormonal changes associated with pregnancy are inherently ‘protective’ with respect to … risk of depressive relapse and that discontinuation of psychiatric medications should be almost uniformly pursued given concerns regarding prenatal exposure”. However, the authors admit that risk of relapse could indeed be lower for pregnant women with less severe depression who discontinue treatment.

The first of the other two studies (Archives of Pediatrics and Adolescent Medicine 2006;160:173) found that neonatal abstinence syndrome — in which withdrawal from substances present in maternal blood results in neuro-behavioural changes in a neonate — occurs in 30 per cent of babies exposed to SSRIs during pregnancy, compared with none of the babies unexposed to SSRIs (P<0.001). The second study found an association between the development of persistent pulmonary hypertension of the newborn (PPHN) and SSRI use in late pregnancy (New England Journal of Medicine 2006;354:579). The case-control study looked at 377 cases of PPHN and 836 matched controls and found that, after week 20 of gestation, 14 infants exposed to an SSRI had PPHN, compared with six of those who had not been exposed to an SSRI (adjusted odds ratio 6.1, 95 per cent confidence interval 2.2–16.8).

Neither antenatal exposure to non-SSRI antidepressants nor exposure to SSRIs during the first half of pregnancy was associated with PPHN. This suggests, say the authors, that maternal depression itself is unlikely to be independently associated with PPHN.