Longitudinal study of depression, anxiety, irritability, and stress in pregnancy following evidence-based counseling on the use of antidepressants

BACKGROUND. Pregnant women who suffer from clinical depression and use antidepressant medications may receive conflicting information about fetal safety. Little information exists on the effect of continuation of antidepressants on depressive symptoms during pregnancy. OBJECTIVES. To determine the effectiveness of maintaining antidepressants during pregnancy, as measured by changes in symptoms of depression, anxiety, irritability, and stress following reassuring evidence-based counseling. METHODS. Depressed women who were pregnant and taking antidepressants, and who called the Motherisk program for advice, participated in a study that involved reassuring evidence-based counseling on the risk of antidepressants in pregnancy, followed by four telephone interviews: one in each trimester and one in the postpartum period. Depression, anxiety, irritability, and stress scales were completed at each call. RESULTS. Of the 58 women who enrolled in the study, 38 completed 75% of the follow-ups. Eight women (14%) discontinued their medication during the study. Depression scores were highest at enrollment in the first trimester and decreased as pregnancy progressed. When data from all women, regardless of dose adjustments, were analyzed, no statistically significant differences were seen between depression scores at any time point; mean depression scores were below the cut off for depression throughout the study period. Irritability, anxiety, and stress scores were not found to be statistically different at any time point during the study. CONCLUSION. Evidence-based reassurance and continuous antidepressant pharmacotherapy during gestation can provide pregnant women with effective symptom control for their depression. Women should consult their healthcare provider to ensure that they are being treated effectively; a risk/benefit assessment should be conducted on a case-by-case basis.