Pregnancy can trigger depression relapse

By CHRISTINE DELL'AMORE, UPI Consumer Health Reporter

WASHINGTON, Jan. 31 (UPI) -- Putting to rest the idea that pregnancy alone is enough to lift a woman's mood, a new study shows that depressed women who do not take medication are more likely to fall back into a state of sadness during pregnancy.

Researchers in Massachusetts found that women who did not take anti-depressants through their pregnancies were five times more likely to become depressed again than those who stayed on their medication. Their depression can also cause potential harm to their fetuses.


"Women should not think that facing depression by white-knuckling it and hanging in there is the best choice," lead author Lee S. Cohen, director of the Center for Women's Health at Massachusetts General Hospital, told United Press International. "Untreated depression is a toxic exposure in and of itself."

The study will appear in the Feb. 1 issue of the Journal of the American Medical Association.


Cohen and colleagues monitored 201 women, pooled from three clinical research centers, who suffered from major depression in the past. The women all took anti-depressants for depression and were less than 16 weeks pregnant at the start of the study. Of the 65 women who opted to discontinue their medication, 44 -- or 68 percent -- relapsed.

Cohen's results counter a popularly held belief that pregnancy acts as a mood stabilizer. Early, yet scant, literature on the subject suggested that reproductive hormones create a state of emotional well-being for soon-to-be mothers. Reproductive hormones certainly have dramatic effects on brain and behavior, Cohen said. However, "it's almost clinical lore that somehow women will enjoy good mood during pregnancy," he said.

This myth may influence pregnant women to stop taking their anti-depressants, such as SSRI inhibitors, during pregnancy, even when they are doing well on the medication, according to Cohen. In addition, obstetricians routinely discontinue anti-depressants for pregnant women. Cohen stressed the study did not address whether or not a pregnant woman should take anti-depressants.

Scientists have raised concerns about the effects of anti-depressants on pregnant women, yet research has not revealed any major consequences. In general, women often prefer to avoid exposing their fetuses to any medication, Cohen said.


Depression, a very common illness in women, frequently begins during the childbearing years. One in 10 adults -- about 19 million people -- are depressed, and women are twice as likely as men to suffer.

Cohen's study, the first to evaluate depression throughout pregnancy, demonstrates clearly that women with depression in their background should not quickly choose to stop their medication. Women planning on pregnancy should discuss options with their psychiatrist and obstetrician and make the decision a thoughtful and collaborative one, Cohen says. "The high risk for relapse should really give clinicians pause before they do anything arbitrary," he added.

Likewise, if depression goes unaddressed, there are potentially significant averse effects on unborn babies, including low birth weight and pre-term labor, Cohen said.

Previous research has also shown depressed women don't interact as much with their children, said Bonnie Strickland, a professor emeritus of psychology at the University of Massachusetts Amherst. A clinical psychologist, Strickland has done years of research on women and depression.

"Depression is really an awful disease. It's a wise course to try to treat the woman so she is not depressed," she told UPI.

Depressed women often brood more than men, blaming their problems on themselves, Strickland said. The physical and emotional stress of bringing a baby to term may also be a trigger in their weakened state. The study's connection between anti-depressants and improved mental health during pregnancy is vital, she said.


"It's a question that almost everybody thinks about, but a question that physicians didn't have the answer to until this study," Strickland said.

Cohen plans to do a follow-up study, looking at a similar group of women and their occurrence of post-partum depression.

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