Clinical Question: What is the risk of relapse of major depression in women who discontinue their antidepressant medication while pregnant?

Setting: Outpatient (specialty)

Study Design: Cohort (prospective)

Synopsis: The risk of relapse of major depression in women who continue or discontinue antidepressant medication while pregnant is uncertain. The investigators identified 201 pregnant women with a history of major depression who were seeking care from one of three referral centers with specific expertise in the treatment of psychiatric illness. Patients were self-referred or referred by another heath care provider.

All women had a history of major depression before pregnancy, were at less than 16 weeks' gestation, and were currently or recently (less than 12 weeks before last menstrual period) receiving antidepressant treatment. Follow-up occurred for 189 participants (94 percent) for the duration of pregnancy. A total of 86 of the women (43 percent) experienced a relapse of major depression during pregnancy. Women maintaining their medication during pregnancy relapsed significantly less often than those who discontinued medication (26 versus 68 percent; number needed to treat = 2; 95% confidence interval, 1.8 to 4.0). One half of the women who relapsed did so in the first trimester. The highest risk of relapse occurred among women with a duration of depression greater than five years or a history of more than four recurrent depressive episodes.

Bottom Line: Nearly 50 percent of women currently receiving antidepressant medication will experience a relapse of major depression during pregnancy. The risk is highest for those discontinuing their medication. It is likely that this study sample consists of patients with a higher severity of illness than those found in a routine community practice, so the findings may not generalize to other settings. (Level of Evidence: 1b)