title: Discontinuation of antidepressants during attempts to conceive: a pilot trial of cognitive behavioral therapy for the prevention of recurrent depression.
abstract: BACKGROUND
  Many women discontinue antidepressants (ADs) when trying to conceive, although risk of depressive relapse is high. We examined the feasibility and potential clinical effect of cognitive behavioral therapy for the prevention of recurrence (CBT-PR) for women with a history of recurrent major depressive disorder (MDD) who planned to discontinue maintenance AD treatment for pregnancy.
  
  
  METHODS
  This was an open preliminary study of CBT-PR in women (N = 12) planning or early in pregnancy with remitted MDD on maintenance ADs with a plan to discontinue ADs for pregnancy. Participants received 12 sessions of CBT-PR during the acute phase and optional monthly booster sessions during follow-up. Participants were assessed monthly during the acute phase and then twice additionally during follow-up by an independent rater using mood scales (depression module of the Mini-International Neuropsychiatric Interview and Montgomery-Åsberg Depression Rating Scale); pregnancy status was also assessed.
  
  
  RESULTS
  Over the 24 weeks of the trial, 75% (n = 9) of participants did not restart ADs and did not relapse to depression. Of the 3 who reintroduced AD, 2 experienced a depressive relapse, whereas one did not meet full criteria for MDD. Adherence to the intervention was very good with all participants completing all therapy sessions and assessments.
  
  
  CONCLUSIONS
  Cognitive behavioral therapy for the prevention of recurrence seems feasible and may provide protection for women with recurrent depression on ADs who discontinue their medication while trying to conceive. The extent to which euthymia is sustainable with CBT-PR requires further study; the results of which may broaden treatment choices for women in anticipation of and during pregnancy.
authors.affiliation: From the *Center for Women's Mental Health, and †Behavioral Medicine Service, Massachusetts General Hospital; and ‡Harvard Medical School, Boston, MA.
authors.forename: Christina
authors.initials: C
authors.lastname: Psaros
authors.forename: Marlene
authors.initials: M
authors.lastname: Freeman
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.forename: Maria
authors.initials: M
authors.lastname: Barsky
authors.forename: Lee S
authors.initials: LS
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000639:trends; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D005306:Fertilization / Q000187:drug effects; D005500:Follow-Up Studies; D006801:Humans; D010865:Pilot Projects; D011247:Pregnancy; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D016896:Treatment Outcome; D028761:Withholding Treatment / Q000639:trends
chemical_list: D000928:Antidepressive Agents