2002 International International Biennial Scientific Meeting

ANTIDEPRESSANT MEDICATION DISCONTINUATION IN PREGNANCY: WEIGHING THE RISKS

Sheila M Marcus, Heather A Flynn, Kristen L Barry and Frederic C Blow

University of Michigan Medical School, Department of Psychiatry, Ann Arbor, Michigan

smmarcus@med.umich.edu

Objectives: To determine discontinuation rates of antidepressant medications at conception by women using them prior to pregnancy; as well as the impact of this decision on women's risk for depression recurrence throughout pregnancy. Demographic information and other health behaviors associated with antidepressant discontinuation are reviewed.

Methods: As part of a larger pregnancy screening and intervention project, a total of 3472 pregnant women were screened in ten primary care and obstetric clinics in Michigan and Ohio. Mean age of participants was 28.6 (sd=6) years. Screening included questions regarding overall health behaviors, depression and alcohol screening and antidepressant medication use. Distress was measured by the Center for Epidemiological Studies Depression Scale (CES-D).

Results: Among the 342 women who reported use of antidepressant medication prior to completing the screening measure, 38.3% (n=131) discontinued their medication as a result of the pregnancy. Many of these women became distressed during pregnancy with 48% (n=164) having elevated CES-D scores. Only 31% of women who discontinued antidepressant medication reported receiving depression treatment and the majority (83%, n=108) reported a history of major depression.

Conclusions: These data suggest that a significant percentage of women choose to discontinue antidepressant medications during pregnancy. Medication discontinuation can lead to high prevalence of maternal distress which constitutes a risk for depression recurrence. Maternal depression impacts the feto-placental environment and may adversely influence the developing fetal brain and its neuroregulation. While many patients continue to withdraw antidepressant medications at the time of conception, these results show that the decision may predispose women to relapse throughout their pregnancy. Further research to elucidate both maternal and fetal outcomes using a combination of medication and non-pharmacologic prevention strategies is essential in order to provide women with optimum information about the risks and benefits of treatment during pregnancy.