Nearly a third of those in a prospective study had clinically relevant depressive symptoms

Despite treatment with antidepressant medication, a significant proportion of women still reported symptoms of anxiety and depression during pregnancy, according to a prospective study.

Among a group of 88 women who took selective serotonin reuptake inhibitors (SSRIs), about a third had clinically relevant symptoms of depression during pregnancy and the postpartum period, reported Gabrielle Mesches, MS, of the Northwestern School of Medicine in Chicago, and colleagues.

Only 18% to 29% of pregnant women who took antidepressants maintained remission, the researchers wrote in Psychiatric Research and Clinical Practice.

Around 40% of pregnant women who took SSRIs also had higher levels of anxiety, with a substantial number experiencing increasing symptoms throughout pregnancy, the team found.

“The assumption is that if women are taking antidepressants in pregnancy, they are well. That’s not always the case,” study co-author Katherine Wisner, MD, also of Northwestern, told MedPage Today.

She explained that depressive symptoms during pregnancy are associated with a number of adverse outcomes, including preterm birth, hypertension, cesarean delivery, low birth weight, neonatal intensive care unit admission, and social and emotional impacts on infants.

If women treated with antidepressants throughout pregnancy are not in remission, they should be offered additional treatment, such as therapy, stress management. or mindfulness interventions, Wisner added. “I really believe that, in addition to medication, some kind of additional treatment should be offered in pregnancy.”

The researchers conducted a prospective, longitudinal cohort study to assess monthly patterns of anxiety and depression during pregnancy. Participants were enrolled at one of three urban academic centers or one rural health center. Pregnant women were included if they 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. Women with bipolar disorder or probable antenatal depression were not included.

Participants completed assessments once a month from study entry (less than 18 weeks’ gestation) through delivery, and again at 6 and 14 weeks postpartum. The study investigators used a series of screening tools, including the 10-item Edinburgh Postnatal Depression Scale and the 7-item Generalized Anxiety Disorder Scale, to assess depression and anxiety symptom severity during pregnancy and postpartum, measuring the changes in these outcomes over time. The team adjusted for covariates including body mass index, race, age, and psychiatric comorbidities.

Women were grouped into “trajectories” — or patterns — of depression and anxiety based on the severity of their symptoms. Depressive symptoms were categorized as minimal, mild, or subthreshold (or clinically relevant), and anxiety symptoms were categorized as asymptomatic, minimal, breakthrough (or increasing), or mild.

Overall, 88 women enrolled in the study and 77 provided complete perinatal and postpartum data. All the study participants identified as female, rather than transgender, non-binary, or other. Women were 34 years old on average, and the mean gestational age was approximately 13 weeks. About 90% of participants were white.

A majority of patients were also diagnosed with at least one psychiatric comorbidity. Nearly 80% had a lifetime anxiety disorder, 10% had a substance abuse disorder within the last year, and 16% had a lifetime eating disorder.

Approximately 18% of women who took SSRIs during pregnancy had minimal depressive symptoms, 50% had mild, and 32% had subthreshold, or clinically relevant, depressive symptoms. Regarding anxiety, 7% of women were asymptomatic, 53% had minimal, 18% had increasing, and 23% had mild symptoms.

Symptoms of depression correlated with anxiety, the researchers found. For example, of all women who had clinically relevant symptoms of depression, nearly 70% scored into the two highest levels of anxiety groups.

Study limitations, Mesches and co-authors said, included that the findings are generalizable only to SSRI-treated women like those in the study — i.e., who are predominantly white, married, and have higher levels of education. Additionally, 11 women in the study were lost to follow-up, which prevents a complete picture of postpartum effects, the team noted.