Pregnant Women Have Lingering Depression Despite Antidepressant Treatment

Summary: Many women experienced lingering depression throughout pregnancy and postpartum, despite using SSRI antidepressants, a new study reports.

Source: Northwestern University

Despite using antidepressants (selective serotonin reuptake inhibitors), many pregnant women had lingering depression and anxiety symptoms throughout their pregnancy and postpartum, reports a new Northwestern Medicine study.

The study also found anxiety symptoms are common in treated depressed women, with symptoms worsening over time in some women.

This is the first study to measure the different trajectories of depression and anxiety in pregnant and postpartum women. Through pregnancy, 18% of the women had minimal, 50% had mild and 32% clinically relevant depressive symptoms.

“This is the first longitudinal data to show that many pregnant women report depression and anxiety symptoms during pregnancy and postpartum, despite their choice to continue treatment with antidepressants,” said senior author Dr. Katherine Wisner, director of the Asher Center for the Study and Treatment of Depressive Disorders and professor of psychiatry and of obstetrics and gynecology at Northwestern University Feinberg School of Medicine.

“It lets us know these women need to be continually monitored during pregnancy and postpartum, so their clinicians can tailor their treatment to alleviate their symptoms.”

“Psychological and psychosocial factors change rapidly across childbearing,” said co-author Dr. Catherine Stika, a clinical professor of obstetrics and gynecology at Northwestern and a Northwestern Medicine gynecologist. “Repeated screenings will allow your clinician to adapt the type and/or intensity of intervention until your symptoms improve.”

Depression also impacts a woman’s infant. “This is key as children exposed to a depressed mother have an increased risk of childhood developmental disorders,” Wisner said.

The study will be published March 4 in Psychiatric Research and Clinical Practice.

The new research also showed that pregnant women taking selective serotonin reuptake inhibitors to treat their depression showed sub-optimal health, including elevated body mass index, infertility, migraines, thyroid disorders and asthma. A history of eating disorders predicted elevated depression trajectory scores.

Perinatal depression and anxiety are widespread, affecting 20% of women during pregnancy and after birth. An estimated 500,000 pregnancies in the U.S. annually will result in women who have or will have psychiatric illness during pregnancy.

Abstract

Trajectories of Depressive and Anxiety Symptoms Across Pregnancy and Postpartum in Selective Serotonin Reuptake Inhibitor‐Treated Women

Objective

Tracking perinatal mood and anxiety disorders is championed by the American Psychiatric Association and the International Marcé Society for Perinatal Mental Health. We conducted this study to examine trajectories of monthly depressive and anxiety symptoms through pregnancy and postpartum.

Methods

This is a prospective longitudinal observational cohort study of pregnant women interviewed at baseline (≤18th gestational week), every four weeks through delivery and at 6 and 14 weeks postpartum at three urban academic medical centers (N = 85) and a single rural health center (N = 3) from 2016 to 2020. Pregnant women had at least one prior episode of major depressive disorder, were not in a current episode, and were treated with sertraline, fluoxetine, citalopram, or escitalopram. Of 192 women screened, 88 (46%) women enrolled, and 77 (88%) women completed the postpartum follow‐up.

Symptom trajectories were generated with scores from the Edinburgh Postnatal Depression Scale, the Quick Inventory of Depressive Symptoms, the Generalized Anxiety Disorder Scale, 7‐item, and the Patient‐Reported Outcomes Measurement Information System Global Health measure. A semi‐parametric, group‐based mixture model (trajectory analysis) was applied.

Results

Three relatively stable depression trajectories emerged, described as Minimal, Mild, and Subthreshold, in each group across pregnancy. Two of the four anxiety trajectories were stable, including Asymptomatic and Minimal, while the third, termed Breakthrough, was ascending with increasing symptoms and the fourth trajectory, described as Mild, had descending symptoms.

Conclusions

Screening for anxiety with depression for pregnant women will yield a comprehensive view of psychiatric symptoms and treatment targets in perinatal women.