Deterioration/relapse of depression during pregnancy in Japanese women associated with interruption of antidepressant medications

Abstract

This study examined the risk of deterioration/relapse in pregnant women who discontinued their antidepressant medications based on the discretion of the psychiatric specialists compared with those who performed self-interruption. We reviewed the obstetric records of all singleton deliveries beyond 22 weeks of gestation at Japanese Red Cross Katsushika Maternity Hospital from January 2009 through December 2015. Compared with the women continuing antidepressant medications throughout pregnancy, the incidence of deterioration/relapse was higher in the women who discontinued their antidepressant medications regardless of who made the decision (interruption based on the discretion of the psychiatric specialists: 61%, odds ratio (OR), 8.05; 95% confidence interval (CI), 2.4-27; p < 0.01; self-interruption: 63%, odds ratio (OR), 8.79; 95% confidence interval (CI), 2.6-29; p < 0.01 versus 16%). The continuation of medications and careful observation are required for pregnant women complicated by depressive disorders.

Antidepressant discontinuation before or during pregnancy and risk of psychiatric emergency in Denmark: A population-based propensity score–matched cohort study

“…Although inconclusive due to limited numbers, the point estimate suggests that the increased risk of psychiatric emergencies following antidepressant discontinuation may be more pronounced among women with severe psychiatric disorders, in line with the recent meta-analysis [14]. We note that our observed effect size is smaller than previously reported 5.0 (95% CI: 2.8 to 9.1) or 8.1 (95% CI: 2.4 to 27.0) [9,10], which most likely reflects that previous studies were performed on small and selected study populations, applying different methods, or outcome measurements.…”

“…received similar attention. A limited number of previous studies on relapse or worsening of symptoms after discontinuing antidepressants during pregnancy report conflicting findings [9][10][11][12][13]. In the current study, we found an increased risk of psychiatric emergency among women who discontinued antidepressants during pregnancy compared to those who continued treatment (HR = 1.25, 95% CI: 1.00 to 1.55).…”

“…Whether or not antidepressants can be discontinued safely before or during pregnancy is unclear. A limited number of studies have compared relapse risk in pregnant women who discontinued antidepressants with those who continued, with mixed results: Two studies suggested that discontinuing antidepressants increased relapse risk compared with continuing [9,10], and 2 did not demonstrate clear benefits of continuing antidepressant treatment in pregnancy [11,12], while another study reported reduced risk associated with antidepressant discontinuation [13]. The magnitude of the relative risk of relapse for antidepressant discontinuation versus continuation ranges from 0.45 to 8.79 [9][10][11][12][13].…”

“…A limited number of studies have compared relapse risk in pregnant women who discontinued antidepressants with those who continued, with mixed results: Two studies suggested that discontinuing antidepressants increased relapse risk compared with continuing [9,10], and 2 did not demonstrate clear benefits of continuing antidepressant treatment in pregnancy [11,12], while another study reported reduced risk associated with antidepressant discontinuation [13]. The magnitude of the relative risk of relapse for antidepressant discontinuation versus continuation ranges from 0.45 to 8.79 [9][10][11][12][13]. A recent meta-analysis pooled these results and found a borderline increased relapse risk of depression during pregnancy for women who discontinued antidepressants (risk ratio = 1.74, 95% confidence interval [CI]: 0.97 to 3.10) [14].…”

“…Women are more vulnerable to severe psychiatric episodes during the perinatal period than at any other point during their lives [19]. Earlier studies suggested that the risks of suicidal ideation and admissions are high following antidepressant discontinuation, but these studies were small and had selected patient populations [9,20]. In contrast, a large register-based study found lower prevalence of hospitalization late in pregnancy in women who discontinued (9%) versus women who continued antidepressants (17%) [13].…”