Does Antidepressant Use Attenuate the Risk of a Major Depressive Episode in Pregnancy?
Does Antidepressant Use Attenuate the Risk of a Major Depressive Episode in Pregnancy?
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DOI：
10.1097/ede.0b013e3182306847
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发表时间：
2011-11-01
期刊：
影响因子：
5.4
通讯作者：
Lockwood, Charles J.
中科院分区：
文献类型：
--
作者：
Yonkers, Kimberly A.;Gotman, Nathan;Lockwood, Charles J.
背景：许多妇女在接受抗抑郁药治疗时怀孕，并担心继续服用抗抑郁药。然而，停用抗抑郁药可能会增加新的重度抑郁症发作的风险。我们试图估计的差异，在发展中国家的新的重性抑郁症发作的风险与复发性疾病的孕妇和产后妇女谁没有或没有使用antidepressants.Methods：参与者被招募从产科设置，我们分析了一个亚组的778名妇女的抑郁症的历史。诊断是由复合国际诊断访谈决定的，在怀孕期间进行两次，在分娩后进行一次。我们使用考克斯回归模型发病的一个严重的抑郁症发作的时间依赖性预测抗抑郁剂use.Results：有没有明显的差异，在一个严重的抑郁症发作的风险之间的妇女谁采取抗抑郁药和妇女谁没有（风险比[HR] = 0.88; 95%CI = 0.51-1.50）。在考虑抗抑郁药的使用后，明显的危险因素包括怀孕前4次或更多的抑郁发作（HR = 1.97; 95% CI = 1.09-3.57），黑人（HR = 3.69; 95% CI = 2.16-6.30）和西班牙裔（HR = 2.33; 95% CI = 1.47-3.69）。妊娠期未使用或停用抗抑郁药对重度抑郁发作的发生没有明显影响。在怀孕前有4次或4次以上抑郁发作的女性有很高的抑郁发作风险，与抗抑郁药的使用无关。黑人和西班牙裔女性也有重度抑郁发作的高风险，但这种影响可能归因于不可测量的因素。
Background: Many women become pregnant while undergoing antidepressant treatment and are concerned about continuing antidepressant medication. However, antidepressant discontinuation may increase the risk of a new episode of major depressive disorder. We sought to estimate differences in the risk of developing a new major depressive episode among pregnant and postpartum women with recurrent illness who either did or did not use antidepressants.Methods: Participants were recruited from obstetrical settings; we analyzed a subgroup of 778 women with a history of a depressive disorder. Diagnoses were determined by the Composite International Diagnostic Interview administered twice in pregnancy and once after delivery. We used Cox Regression to model onset of a major depressive episode with a time-dependent predictor of antidepressant use.Results: There was no clear difference in risk of a major depressive episode between women who took antidepressants and women who did not (hazard ratio [HR] = 0.88; 95% CI = 0.51-1.50). After accounting for antidepressant use, clearly hazardous factors included 4 or more depressive episodes before pregnancy (HR = 1.97; 95% CI = 1.09-3.57), black race (HR = 3.69; 95% CI = 2.16-6.30), and Hispanic ethnicity (HR = 2.33; 95% CI = 1.47-3.69).Conclusions: Failure to use or discontinuation of antidepressants in pregnancy did not have a strong effect on the development of a major depressive episode. Women with 4 or more episodes before pregnancy were at high risk of a major depressive episode, independent of antidepressant use. Black and Hispanic women also were at high risk of a major depressive episode, but it is possible that this effect is attributable to unmeasured factors.