Results Out on Kaiser Permanente Study on Depression Before, During & After Pregnancy

According to a new study from Kaiser Permanente, more than one in seven women are depressed in the nine months before pregnancy, during their pregnancy, or in the nine months after giving birth. Highlights from an article on the study on WebMD:

The new research expands on information already known about depression after childbirth. "People have known for quite a while that postpartum depression is a serious, sometimes devastating event," says researcher Evelyn Whitlock, MD, MPH, senior investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. "One of the things we were able to do is look across the spectrum — nine months before pregnancy, the nine months of pregnancy, and the nine months postpartum. I think this is the first study to do that" …

The study, with an accompanying editorial urging more research, is published in the October issue of the American Journal of Psychiatry.

Whitlock and her colleagues evaluated 4,398 women, all members of the Kaiser Permanente HMO, who had given birth between 1998 and 2001.

Before pregnancy, 8.7% were identified as depressed by their health care providers; 6.9% were classified as depressed during the pregnancy, and 10.4% were depressed in the nine months after delivery. In all, 15.4%, or more than one in seven of the women, were depressed during at least one of the three periods.

About half of the women who had postpartum depression also were depressed before the pregnancy occurred or during pregnancy. More than half of those depressed before pregnancy became depressed during the pregnancy, suggesting the condition is not temporary or relieved by getting pregnant or by giving birth.

Whitlock also found that 93.4% of those with pregnancy-related depression had seen a mental health provider and/or gotten antidepressants. About 77% of women took an antidepressant before becoming pregnant, 67% during pregnancy, and 82% after giving birth. Since the study, reports of possible side effects of antidepressant use during pregnancy, including lung problems and heart problems in newborns, have been published. As a result, doctors emphasize that a careful evaluation of the risks and benefits is crucial before deciding on an antidepressant during pregnancy …

Boston Globe Covers Antepartum Depression

At the Postpartum Support International conference, I was reminded over and over that ours is a spectrum disorder. In a spectrum disorder the symptoms and characteristics can present themselves in a wide variety of combinations, from mild to severe. As many of you know, you can experience postpartum depression, postpartum anxiety, postpartum obsessive compulsive disorder and postpartum psychosis. One size does NOT fit all.

One area that has gotten less focus, but is now beginning to get more attention, is antepartum depression, or depression during pregnancy. Click here for a link to a good story on this by Jody Santos in the Boston Globe.

Click here for more stories about depression during pregnancy.

Depression During Pregnancy

Thanks to Katherine Cruise for sending me the link to this article in USA Today a few days ago about depression during pregnancy: http://www.usatoday.com/news/health/2006-03-12-depression-pregnancy_x.htm

In terms of taking meds during pregnancy, I can only share my own experience. As you know, I was on Cymbalta during pregnancy. My daughter did not develop any heart defects or lung defects as far as I know, and she did not experience withdrawal. She seems like a perfectly healthy and happy 1-week old.

This, of course, doesn't guarantee your outcome. Each person and their situation is different. It's important to talk to your doctor.

Study busts pregnant and happy myth

I got this news from CNN.com yesterday: Study busts pregnant and happy myth. I give it to you here, now, verbatim:

CHICAGO, Illinois (AP) — Pregnant women who stop taking antidepressants run a high risk of slipping back into depression, a study found, busting the myth that the surge of hormones during pregnancy keeps mothers-to-be happy and glowing.

The study offers new information but no clear answers for expectant mothers who must balance the risk of medications harming the fetus against the danger of untreated depression.

"It’s important that patients not assume that the hormones of pregnancy are going to protect them from the types of problems they’ve had with mood previously," said study co-author Dr. Lee Cohen of Massachusetts General Hospital.

The study does not deal with postpartum depression — the depression that sets in after delivery, and is often blamed on hormonal changes. The research looks only at depression during pregnancy, a condition far less understood.

No one knows how many pregnant women are on antidepressants, but it is safe to say millions of women of childbearing age take them. Medco Health Solutions estimates 8.4 million American women ages 20 to 44 take antidepressants.

Other research has shown risks to the fetus, including possible heart defects, from antidepressant use during pregnancy.

Researchers followed 201 pregnant women with histories of major depression who were taking drugs such as Prozac, Zoloft, Effexor and Paxil.

Because of ethical concerns, the researchers did not randomly assign the women to either stop or continue medication. Instead, the women decided what to do, then researchers watched what happened.

Sixty-eight percent of those who stopped taking antidepressants slipped into depression. They were five times more likely to suffer a relapse than the women who continued on drugs.

But staying on antidepressants did not shield expectant mothers from depression entirely; 26 percent of those who continued drug treatment became depressed anyway.

Dr. Katherine Wisner of the University of Pittsburgh School of Medicine said the study makes an important contribution by quantifying the risk of relapse. She was not involved in the study but does similar work.

"I was taught in my residency that women don’t get depressed during pregnancy," said Wisner, who was a psychiatry resident in the early 1980s. But "I had patients who were depressed. I asked my supervisor, ‘You mean I’m really not seeing patients who are depressed?"’

The study appears in Wednesday’s Journal of the American Medical Association and was funded by the National Institute of Mental Health. Two of the co-authors declared in the paper that they have financial ties to several antidepressant manufacturers.

Other researchers have shown that antidepressant use during the last three months of pregnancy can make newborns jittery and irritable, and sometimes can cause them serious breathing problems. In addition, the Food and Drug Administration has warned that Paxil may be linked to fetal heart defects when taken during the first three months of pregnancy.

Dr. Peter Kramer, author of "Listening to Prozac" and "Against Depression," said the study provides information that can help women and doctors decide what to do.

"Ideally, everyone would like to go through pregnancy off all medication," Kramer said. "But these are serious issues, and both decisions can be justified."

Kramer suggested some women might want to get off antidepressants but schedule more psychotherapy while pregnant.

Copyright 2006 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

Tag: postpartum depression, PPD research