Treatment resistant depression in women with peripartum depression

Abstract

Background Peripartum depression is a leading cause of disease burden for women and yet there is little evidence as to how often peripartum depression does not respond to treatment and becomes treatment resistant depression. We sought to determine the incidence of treatment resistant depression (TRD) in women with peripartum depression. Methods Population based retrospective cohort study using a large US claims database. Peripartum depression was defined as having a depression diagnosis during pregnancy or up to 6 months after the end of pregnancy. We included women with prevalent or incident depression. The outcome was the development of TRD within 1 year after the diagnosis of peripartum depression. TRD was defined as having 3 distinct antidepressants or 1 antidepressant and 1 antipsychotic in 1 year. Women with peripartum depression may not be exposed to pharmacological treatments early in pregnancy, therefore we created two groups: 1. women with peripartum depression, and 2. women with peripartum depression diagnosed 3 months before a live birth delivery or within 6 months after that delivery. Results There were 3,207,684 pregnant women, of whom 2.5% had peripartum depression. Of these women half had incident depression during pregnancy. Five percent of women with peripartum depression developed TRD within 1 year of the depression diagnosis. The risk of developing TRD was 50% higher in women with prevalent depression than in women with incident peripartum depression ( P < 0.0001). Results were similar in women with peripartum depression diagnosed later in their pregnancy. Women who went on to develop TRD had more substance use disorders, anxiety, insomnia and painful conditions. Conclusions TRD occurs in approximately 5% of women with peripartum depression. The risk of TRD is higher in pregnant women with a history of depression. Women who went on to develop TRD had more psychiatric comorbidities and painful conditions than women who did not. Electronic supplementary material The online version of this article (10.1186/s12884-019-2462-9) contains supplementary material, which is available to authorized users.

Repetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis

“…Mothers do not prefer the current treatment for peripartum depression. They are not willing to take antidepressants because they are concerned not only about the side effects that they will suffer but also the side effects to the fetus [ 80 , 81 ] Besides, 2.5% of mothers suffer from treatment-resistant depression and have to choose a different treatment method [ 82 ]. In one survey on depression treatments, only 1.2% of the population accepted ECT treatment [ 83 ].…”

Treatment Repetitive Transcranial Magnetic Stimulation to Peripartum Depression: Systematic Review

“…These side effect are constantly experienced in daily life and it can have a huge impact on pregnant women and mothers who need to take care of their infants [85]. In addition, 2.5% of mothers who suffer from treatment resistant depression and these have to choose a different treatment method [86]. Another theratment ECT was much serious.…”

Repetitive Transcranial Magnetic Stimulation Treatment for Peripartum Depression: Systematic Review &amp; Meta-Analysis

“…Mothers do not prefer the current treatment for peripartum depression. They are not willing to take antidepressants because they are concerned not only about the side effects that they will suffer but also the side effects to the fetus [82,83] Besides, 2.5% of mothers suffer from treatment-resistant depression and have to choose a different treatment method [84]. In one survey on depression treatments, only 1.2% of the population accepted ECT treatment [85].…”