For non-depressed, pregnant women with histories of major depressive disorder, preventive treatment with antidepressants may not necessarily protect against postpartum depression, according to University of California, Los Angeles (UCLA) research. But asking questions about daily activities – especially work – appears to be an effective screening tool for helping doctors identify women at risk of depression after they have their babies.
According to the study 20% of adult women will experience an episode of major depressive disorder at some point in their lives. Women with a history of depression are particularly vulnerable to depression after they give birth. UCLA researchers recognised that there is a lack of data on predictors of postpartum depression in women with previous histories of depression but who don't suffer from it during pregnancy.
From April 2003 to March 2009, researchers recruited 343 pregnant women who were not suffering from depression at the time of conception but who had been diagnosed with major depressive disorder at some time prior to pregnancy. Women with bipolar disorder, schizophrenia or a substance abuse disorder were not included.
Scientists enrolled participants in the study between 12 and 36 weeks gestation. A study psychiatrist assessed each woman's mood and psychotropic medication at least twice, once within 60 days before their babies' due dates and again within 60 days after delivery. The researchers used structured, clinical interviews including questions about work activities and difficulties, insomnia and suicidal thoughts.
In contrast to previous studies, UCLA researchers found that among women with prior histories of major depressive disorder but who were not depressed when they become pregnant, only 11% developed postpartum depression. That figure is significantly lower than the 25% to 40% depression occurrence found in other studies.
Additionally, researchers also found that prescribing preventive antidepressants for this group of women did not affect the risk for developing postpartum depression, and also that a better predictor of postpartum depression were clinical interviews with the women about work activities, insomnia and suicidality.
The findings suggest that structured interviews about difficulties at work could alert doctors to patients at risk of postpartum depression who might benefit from being referred to a psychiatrist for monitoring after they give birth.
Abstract
Objective: Risk factors for postpartum depression in euthymic pregnant women with histories of major depressive disorder (MDD) were evaluated.
Methods: From April 2003 to March 2009, 343 pregnant women with a history of Structured Clinical Interview for DSM-IV (SCID)–diagnosed major depressive disorder were prospectively assessed from the third trimester into the postpartum period using the SCID mood module and 17-item Hamilton Depression Rating Scale (HDRS). Data from 300 subjects who completed at least 2 mood module assessments (1 within 60 days before and the other within 60 days after delivery) were analyzed for predictive associations between variables assessed in the third trimester and the development of a postpartum depression.
Results: The majority of women were euthymic in pregnancy by SCID criteria. Women with third trimester SCID-diagnosed depression (n = 45) versus euthymia (n = 255) had a significantly higher risk for having depression after delivery (24% vs 11%, P = .013). For pregnant euthymic women, third trimester total HDRS scores significantly predicted postpartum depression (P < .0001); specifically, scores on 3 HDRS items alone—work activities, early insomnia, and suicidality—significantly predicted postpartum depression. Antidepressant use in the third trimester in euthymic women did not confer protection against the onset of postpartum depression.
Conclusions: Among women with a history of MDD who are euthymic in the third trimester, 3 HDRS items—work activities, early insomnia, and suicidality—may be useful as screening items for clinicians working with pregnant women with histories of MDD to identify a group at risk for developing postpartum depression. Additionally, in euthymic women with a history of MDD, antidepressant use in the third trimester may not reduce the risk of developing postpartum depression.
Authors
Rita Suri, Zachary N Stowe, Lee S Cohen, D Jeffrey Newport, Vivien K Burt, Ana R Aquino-Elias, Bettina T Knight, Jim Mintz, Lori L Altshuler
[link url="http://newsroom.ucla.edu/releases/clinical-interviews-effective-in-predicting-post-partum-depression-among-expectant-women"]University of California – Los Angeles material[/link]
[link url="http://www.psychiatrist.com/jcp/article/Pages/2017/aheadofprint/15m10427.aspx"]Journal of Clinical Psychiatry abstract[/link]