Recurrence of depression in the perinatal period: Clinical features and associated vulnerability markers in an observational cohort

Abstract

Objective Antidepressant medication is commonly used for the prevention of depression recurrence in the perinatal period, yet it is unknown what vulnerability markers may play a role in recurrence. The objective of the current study was to provide a descriptive overview of the associated characteristics of women who experienced a perinatal recurrence of depression despite ongoing antidepressant use, and further, to identify clinically measurable vulnerability markers associated with recurrence. Methods Eighty-five pregnant women with a history of depression who used antidepressants (e.g. Selective Serotonin Reuptake Inhibitors or Serotonin and Noradrenaline Reuptake Inhibitors) at the start of the study were included. Clinical features, including information on psychiatric history and antidepressant use, were collected throughout the perinatal period (in this study defined as the period between 12 weeks of pregnancy untill three months postpartum). The clinical features of women experiencing recurrence of depression were described in detail. To identify vulnerability markers associated with recurrence of depression, we performed exploratory univariable logistic regression analyses. Results Eight women (9.4%) experienced a recurrence of depression; two during pregnancy and six in the first 12 weeks postpartum. All women with recurrence of depression had first onset of depression during childhood or adolescence and had at least 2 psychiatric co-morbidities. Identification of vulnerability markers associated with recurrence of depression yielded associations with depressive symptoms around 16 weeks of pregnancy (OR 1.28, 95%CI 1.08–1.52), number of psychiatric co-morbidities (OR 1.89, 95%CI 1.16–3.09) and duration of antidepressant use (OR 1.01, 95%CI 1.00–1.02). Conclusion Implementing adequate risk assessment in pregnant women who use antidepressants can help identify predictors for recurrence of depression in future studies and thus ultimately lead to improved care.

Tapering Antidepressants While Receiving Digital Preventive Cognitive Therapy During Pregnancy: An Experience Sampling Methodology Trial

“…This article focuses on the ESM-trial run alongside an RCT and an observational cohort. Participants for the ESM-trial were drawn from an RCT ["Stop or Go study" (39)] and a prospective, longitudinal, observational cohort (38,40), to investigate the effects of PCT while tapering ADM vs. the continuation of ADM. All studies were approved by the Medical Ethical Committee of the Erasmus Medical Center Rotterdam, the Netherlands (MEC-2014-505). All participants provided written informed consent prior to participation.…”

“…The RCT protocol has been pre-registered (Netherlands Trial Register: NTR4694) and published (39). The observational cohort has been described in other publications (38,40) and the protocol has not been pre-registered, as this group of participants was a reference group for the RCT. The ESM-trial started at a later stage of the studies due to the development and coordination of the mobile application, and is therefore not reported in the protocol article.…”

“…Psychological prevention treatments have furthermore been demonstrated to be effective in lowering depressive symptoms during pregnancy (17,36), and may lower the risk of recurrence of MDD (37). In a recent randomized controlled trial (RCT) (38)(39)(40)(41), we investigated the efficacy of PCT with gradual, guided discontinuation of ADM compared to ADM continuation among formerly depressed women taking ADM at the start of their pregnancy. The women (n = 44) were followed throughout pregnancy and up to 3 months post-partum to evaluate recurrences of MDD and the potential impact of the interventions on mother and offspring.…”

“…Offspring birth weight is important to investigate due to its relation with future developmental, mental, and somatic disorders. Using an ESM-design alongside the previously described RCT and observational cohort (38)(39)(40)(41), the aims of the current study are to (1) explore whether there are more fluctuations in negative and positive affect in pregnant women receiving PCT while tapering ADM vs. continuing ADM; (2) explore whether affect fluctuations predict subsequent recurrences and/or pre-natal depressive symptoms; and (3) explore whether affect fluctuations predict lower offspring birth weight.…”

Ethical aspects in the management of postpartum depression

“…Modificările dispoziției pot apărea atât fiziologic, "baby blues", cât și patologic, depresia postpartum. [1][2] [3] Starea de "baby blues" se manifestă în primele zece zile postpartum și se caracterizează prin stări de neliniște, anxietate, iritabilitate cu toleranță scăzuta la frustrări, tristețe moderată, schimbări bruște ale dispoziției și stări de oboseală. Această simptomatologie se remite spontan fără a fi nevoie de intervenție psihiatrică și reprezintă perioada de adaptare a mamei la noua situație.…”