Pregnant women who discontinue antidepressant medications may significantly increase their risk of relapse during pregnancy, a new study funded by the National Institute of Health's National Institute of Mental Health found.

Women in the study who stopped taking antidepressants while pregnant were five times more likely than those who continued use of these medications to experience episodes of depression during pregnancy, reported Lee Cohen, M.D. of Massachusetts General Hospital and colleagues in the February 1 issue of the Journal of the American Medical Association.

Depression is a disabling disorder that has been estimated to affect approximately 10 percent of pregnant women in the United States. Recently there has been concern about the use of antidepressants during pregnancy; however what has not been addressed is the risk of depression recurrence should someone discontinue antidepressant use. This study sheds light on the risk of relapse associated with discontinuing antidepressant therapy during pregnancy.

In the study, Cohen and colleagues enrolled pregnant women already taking antidepressants and then noted how many of the women decided to stop taking their medications. They then assessed the risk of relapse for the women who stopped versus maintained antidepressant therapy.

Contrary to the belief that hormonal changes shield pregnant women from depression, this study demonstrates that pregnancy itself is not protective. Among the pregnant women who stopped taking antidepressants, 68 percent relapsed during pregnancy compared to 26 percent who relapsed despite continuing their antidepressants. Among the women who discontinued use and relapsed, 50 percent experienced a relapse during the first trimester and 90 percent did so by the end of the second trimester.

This study demonstrates the importance of weighing the risks not only of antidepressant use, but also the risk of relapse should antidepressants be discontinued. It highlights the importance of women discussing with their physicians their own individual risks verses benefits of continuing antidepressant use during pregnancy.

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