title: Does antidepressant use attenuate the risk of a major depressive episode in pregnancy?
abstract: BACKGROUND
  Many women become pregnant while undergoing antidepressant treatment and are concerned about continuing antidepressant medication. However, antidepressant discontinuation may increase the risk of a new episode of major depressive disorder. We sought to estimate differences in the risk of developing a new major depressive episode among pregnant and postpartum women with recurrent illness who either did or did not use antidepressants.
  
  
  METHODS
  Participants were recruited from obstetrical settings; we analyzed a subgroup of 778 women with a history of a depressive disorder. Diagnoses were determined by the Composite International Diagnostic Interview administered twice in pregnancy and once after delivery. We used Cox Regression to model onset of a major depressive episode with a time-dependent predictor of antidepressant use.
  
  
  RESULTS
  There was no clear difference in risk of a major depressive episode between women who took antidepressants and women who did not (hazard ratio [HR] = 0.88; 95% CI = 0.51-1.50). After accounting for antidepressant use, clearly hazardous factors included 4 or more depressive episodes before pregnancy (HR = 1.97; 95% CI = 1.09-3.57), black race (HR = 3.69; 95% CI = 2.16-6.30), and Hispanic ethnicity (HR = 2.33; 95% CI = 1.47-3.69).
  
  
  CONCLUSIONS
  Failure to use or discontinuation of antidepressants in pregnancy did not have a strong effect on the development of a major depressive episode. Women with 4 or more episodes before pregnancy were at high risk of a major depressive episode, independent of antidepressant use. Black and Hispanic women also were at high risk of a major depressive episode, but it is possible that this effect is attributable to unmeasured factors.
authors: Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA. kimberly.yonkers@yale.edu
authors: Kimberly A
authors: KA
authors: Yonkers
authors: Nathan
authors: N
authors: Gotman
authors: Megan V
authors: MV
authors: Smith
authors: Ariadna
authors: A
authors: Forray
authors: Kathleen
authors: K
authors: Belanger
authors: Wendy L
authors: WL
authors: Brunetto
authors: Haiqun
authors: H
authors: Lin
authors: Ronald T
authors: RT
authors: Burkman
authors: Carolyn M
authors: CM
authors: Zelop
authors: Charles J
authors: CJ
authors: Lockwood
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents