Phenotypic differences between pregnancy-onset and postpartum-onset major depressive disorder.
Phenotypic differences between pregnancy-onset and postpartum-onset major depressive disorder.
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DOI：
10.4088/jcp.12m07693
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发表时间：
2012-12-01
期刊：
影响因子：
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通讯作者：
Bleiberg, Kathryn L
中科院分区：
文献类型：
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作者：
Altemus, Margaret;Neeb, Christine C;Bleiberg, Kathryn L
目的：比较妊娠期抑郁症与产后抑郁症的临床特征。怀孕和产后期间的激素环境是完全不同的，因此可能会促进不同亚型的major depression.METHOD：数据收集从医疗记录的229名妇女进行了评估，在学术医疗中心生殖精神病学诊所。所有在2005年至2010年期间接受评估的孕妇或产后第一年接受DSM-IV诊断的重度抑郁症患者均纳入研究。妊娠发作和产后发作的受试者之间的比较包括人口统计学、精神病诊断史、心理社会压力源、生育史和当前发作症状。发病时间在妊娠三个月内和产后一年内，以及抗抑郁药物的停药的影响也examined.RESULTS：妇女与严重抑郁发作，在怀孕期间开始有较高的发病率产后和非围产期严重抑郁症（均P值<0.001）。在怀孕期间开始的重度抑郁症也更常见与心理社会压力有关。产后抑郁症以强迫症状和精神病性症状多见。这些发现在176例在围产期抑郁症发生前一年未停止抗抑郁药物治疗的受试者的亚组中也很明显。94%的产后抑郁症发作发生在产后4个月内。对于在过去一年内停用抗抑郁药物的女性来说，妊娠期重度抑郁发作更有可能在妊娠早期发生;否则，抑郁发作在整个妊娠期分布更均匀。有围产期和非围产期抑郁症病史的妇女在怀孕期间比产后更容易复发，这一发现指出，有必要密切监测这些妇女在怀孕期间的抑郁症。此外，这些风险因素和临床特征差异的研究结果表明，产后发作的抑郁症可能有一个病理生理学不同于抑郁症，在怀孕期间开始。围产期抑郁症的发病时间应考虑在遗传和治疗研究的设计。
OBJECTIVE: To compare clinical features of major depression that begins during pregnancy to clinical features of postpartum-onset depression. The hormonal environments of pregnancy and postpartum periods are quite different and therefore may promote distinct subtypes of major depression.METHOD: Data were collected from medical records of 229 women who were evaluated in an academic medical center reproductive psychiatry clinic. All patients evaluated between 2005 and 2010 who were pregnant or in the first year postpartum and received a DSM-IV diagnosis of major depressive disorder were included. Comparisons between the pregnancy-onset and postpartum-onset subjects included demographics, psychiatric diagnostic history, psychosocial stressors, reproductive history, and current episode symptoms. Time of onset within trimesters of pregnancy and within the postpartum year as well as the effects of discontinuation of antidepressant medication were also examined.RESULTS: Women with major depressive episodes that began during pregnancy had higher rates of prior episodes of postpartum and nonperinatal major depression (both P values < .001). Major depression that began during pregnancy was also more commonly associated with psychosocial stressors. Obsessive-compulsive symptoms and psychotic symptoms were more common in postpartum-onset depression. These findings were also evident in the subgroup of 176 subjects who did not discontinue antidepressant medication during the year prior to development of perinatal depression. The onset of 94% of postpartum major depressive episodes occured within the first 4 months postpartum. Episodes of major depression during pregnancy were more likely to develop in the first trimester for women who discontinued antidepressant medication within the past year; otherwise, depression onset was more evenly distributed across trimesters.CONCLUSIONS: Women with a history of perinatal and nonperinatal major depression are more likely to relapse during pregnancy than postpartum, a finding that points to the need for closely monitoring these women for depression during pregnancy. In addition, these findings of differences in risk factors and clinical features suggest that postpartum-onset major depression may have a pathophysiology distinct from major depression that begins during pregnancy. Time of onset of perinatal depression should be considered in the design of genetic and treatment studies.