Antidepressant discontinuation linked to relapse among pregnant women with depression

Women with severe or recurrent depression were more likely to relapse during pregnancy after antidepressant discontinuation, according to results of a systematic review and meta-analysis published in Journal of Clinical Psychiatry.

“There are increased risks [for] adverse pregnancy and child outcomes associated with untreated depression,” Hamideh Bayrampour, MSc, PhD, of the department of family practice at University of British Columbia, and colleagues wrote. “Prenatal exposure to antidepressants might also increase the risk [for] the adverse outcomes. However, it is challenging to disentangle the risk of exposure to antidepressants from underlying clinical and social factors associated with the indication of use.”

Although multiple studies have examined risks associated with prenatal antidepressant exposure, the effects of antidepressant discontinuation, such as the risk for relapse, are unclear. To address this research gap, the investigators searched four databases through March 2019 using keywords including antidepressants, pregnancy, preconception, recurrence, relapse and discontinuation. They identified 2,172 English-language studies involving pregnant women who discontinued antidepressants 3 months before pregnancy or during pregnancy and that examined depression relapse during pregnancy. Of these, they reviewed the full texts of 37 articles and included data of four studies in the meta-analysis.

Results showed no higher risk for depression relapse during pregnancy among women who discontinued antidepressants compared with those who continued them (risk ratio [RR] = 1.74; 95% CI, 0.97-3.1). The subanalysis based on depression severity and recurrence among the study populations revealed the risk for relapse was significantly higher among populations suggestive of severe or recurrent depression (RR = 2.3; 95% CI, 1.58-3.35); however, the risk was not higher for populations suggestive of mild or moderate depression severity (RR = 1.59; 95% CI, 0.83-3.04).

“[Although] the effectiveness and safety of psychotherapy interventions as a complete alternate therapy for women who discontinue antidepressants remain to be further examined, there is evidence that a combination of psychotherapy and pharmacotherapy interventions is as effective as antidepressants when tapering off medications, is more effective than the use of antidepressants alone and can increase medication adherence,” Bayrampour and colleagues wrote. “Women with severe/recurrent depression should be informed about the increased risk [for] relapse following antidepressant discontinuation, and those who discontinue antidepressants should be monitored for relapse.”