Psychiatric outcomes following medical and surgical abortion.
BACKGROUND
Hypercortisolaemia is associated with certain depressive disorders. Mifepristone has possible antidepressant properties related to its anti-glucocorticoid activity. To explore the possible mood effects of mifepristone, we examined the mood outcomes after surgical and medical (mifepristone-misoprostol) abortion. The objectives were to determine post-abortion depression risk, evaluate risk factors for post-abortion depression and to explore the relationship between cortisol and depression.


METHODS
We enrolled 47 surgical and 31 medical abortion patients. Women were assessed pre-abortion and 1 month post-abortion with the Edinburgh Postnatal Depression Scale (EPDS) and salivary cortisol levels.


RESULTS
Pre-abortion, 36% (17/47) of surgical and 35% (11/31) of medical patients had high depression risk (EPDS > or = 10; (chi(2) = 0.31, df = 1, P = 0.58). At follow-up, 17% (7/42) of surgical and 21% (5/24) of medical patients had an EPDS > or = 10 (chi(2) = 0.18, df = 1, P = 0.67). The decline post-abortion in the women with EPDS > or = 10 was significant (P = 0.01). Women with past psychiatric history (Fisher's exact P = 0.05) or anxiety disorders (Fisher's exact P = 0.005) had elevated risk for post-abortion depression. Change in cortisol levels was not correlated with change in EPDS (r = 0.10, P = 0.28).


CONCLUSIONS
Most patients experienced post-abortion mood improvement. Mifepristone did not offer additional antidepressant effects. The lack of correlation between cortisol and depression could represent hypersuppression of the hypothalamic-pituitary-adrenal (HPA) axis or insufficient mifepristone dose to alter HPA axis activity.
Sit
Dorothy
D
Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213, USA. sitdk@upmc.edu
Rothschild
Anthony J
AJ
Creinin
Mitchell D
MD
Hanusa
Barbara H
BH
Wisner
Katherine L
KL
D000021:Abortifacient Agents, Steroidal; D000028:Abortion, Induced / Q000379:methods / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D015735:Mifepristone / Q000627:therapeutic use; D019964:Mood Disorders / Q000188:drug therapy; D011247:Pregnancy; D012463:Saliva / Q000737:chemistry*; D014619:Vacuum Curettage
D000021:Abortifacient Agents, Steroidal; D000928:Antidepressive Agents; D015735:Mifepristone; D006854:Hydrocortisone