Monday, March 7, 2022

Some Pregnant Women Taking SSRIs Experience Symptoms of Depression, Breakthrough Anxiety

The majority of pregnant women who continue to take selective serotonin reuptake inhibitors (SSRIs) for depression show few or no depressive symptoms during pregnancy and the postpartum period. However, about 1 in 3 of these women still experiences depressive symptoms despite taking medication, and about 1 in 5 experiences worsening anxiety over the course of pregnancy. These were the findings of a study in Psychiatric Research & Clinical Practice.

“Our findings demonstrate that the treatment goal to achieve full resolution of maternal depression symptoms remains a clinical challenge,” wrote Gabrielle A. Mesches, M.S., and Jody D. Ciolino, Ph.D., of Northwestern University Feinberg School of Medicine and colleagues. “Our findings support the implementation of measures of both anxiety and depression to obtain a more complete clinical assessment of residual symptoms during SSRI maintenance treatment of maternal [depression].”

The study findings come from the Optimizing Medication Management for Mothers with Depression (OPTI‐MOM) study, which enrolled 88 pregnant women (18 weeks’ pregnant or less) who had at least one prior episode of major depressive disorder; were not in a current episode; and were treated with sertraline, fluoxetine, citalopram, or escitalopram. The women were assessed for depression and anxiety every four weeks until delivery and again at six and 14 weeks postpartum using such scales as the Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder Scale, 7‐item (GAD-7). The authors noted that the women chose to continue SSRI therapy during pregnancy prior to study enrollment.

A score of 15 or more is the validated EPDS screening cutoff for probable antenatal major depressive disorder. The longitudinal assessments revealed three trajectories of depressive symptoms among the women that were relatively stable throughout pregnancy: 18% of women experienced minimal symptoms (EPDS scores below 5), 50% experienced mild symptoms (EPDS scores at 5), and 32% experienced subthreshold symptoms (EPDS scores from 8 to 11).

The authors also identified four anxiety trajectories, three of which were stable throughout pregnancy: 7% of women had asymptomatic anxiety (GAD-7 scores of 0), 53% had minimal anxiety (GAD-7 scores around 2), and 23% had mild anxiety (GAD-7 scores from 6 to 8). However, 18% of the women experienced breakthrough anxiety, in which their GAD-7 scores were low at the start of pregnancy but then rose almost to 10 (considered the clinical cutoff for anxiety disorder) at the end of pregnancy.

“This group of SSRI‐treated women may represent a subgroup who, despite their low anxiety scores in early pregnancy, are sensitive to stress across pregnancy and require additional intervention to mitigate escalating symptoms as they prepare for birth,” the authors wrote.

To read more on this topic, see the Psychiatric News article “How to Manage Meds Before, During, and After Pregnancy.”

(Image: iStock/tatyana_tomsickova)

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