Relapse of depression during pregnancy and postpartum periods in Japanese women associated with self-interruption of their medications: Selective serotonin reuptake inhibitors

摘要

Depression has been common in pregnancy (O'Keane and Marsh, 2007). Selective serotonin reuptake inhibitors (SSRIs) have been reported to be the most frequently used antidepressants in pregnant women, with as many as 3-10% of such women in the Western countries (Kieler, 2010; Cooper et al., 2007; Hayes et al., 2012). Recently, the general absence of strong associations between birth defects and SSRIs has been observed to be reassuring (Furu et al., 2015; Lennestal and Kallen, 2007). However, women with mental disorders sometimes perform self-interruption of their medications during pregnancy, and then the self-interruption of medications sometimes deteriorates their state of mental disorders (Suzuki, 2015). The current study examined the risk of relapse in pregnant women who discontinued SSRIs compared with those who maintained treatment with SSRIs. Between January 2010 and June 2014, 5758 Japanese women visited the hospital for definitive diagnosis of pregnancy. Of these, 67 women (1.2%) were diagnosed with depression before pregnancy by Japanese psychiatric specialists and 33 of them (49%; 0.6% in the Japanese women) had been taking SSRIs. When they were diagnosed with pregnancy, however, 9 of them (27%) performed self-interruption of their taking SSRIs. Among the 9 women who discontinued their medication, 5 (56%) relapsed compared with 3 (13%) of the 24 women who maintained medication throughout their pregnancy (odds ratio, 8.75; 95% confidence interval, 1.5-52; P = 0.03 by x2 test). There were no additional relapse cases (0 in 4) in women who discontinued their medication during their postpartum period; however among the 21 women who maintained their medication throughout their pregnancy, 5 (26%; P = 0.62) relapsed during their postpartum period.