Pregnancy is a time of risk for women with histories of major depression. In a study where 201 women with histories of recurrent depression were followed prospectively through pregnancy, 43% experienced a relapse of major depression during pregnancy. Relapse rates were highest in the group of women who elected to discontinue antidepressant treatment proximate to conception (68% as compared to 26% in the group of women who maintained antidepressant treatment).
While there is data to support the reproductive safety of various antidepressants, many women chose to discontinue antidepressants (ADs) when trying to conceive. The odds of staying well after medication discontinuation are not high. Is there anything we can offer to these women in order to decrease their risk of relapse?
A recent study has explored the use cognitive behavioral therapy (CBT) specifically targeted to the prevention of depression recurrence (CBT-PR) in a group of women with histories of recurrent major depressive disorder (MDD) who were planning to discontinue maintenance antidepressant treatment for pregnancy.
This pilot study included 12 women. Participants received 12 sessions of CBT-PR during the acute phase and optional monthly booster sessions during follow-up. Participants were assessed monthly during the acute phase and then twice additionally during follow-up by an independent rater.
Over the 24 weeks of the trial, 75% (n = 9) of the participants did not restart antidepressant and did not relapse into depression. Of the 3 who reintroduced antidepressant, 2 experienced a depressive relapse, whereas one did not meet full criteria for MDD. Adherence to the intervention was very good with all participants completing all therapy sessions and assessments.
In this study, there was not a control group. However, if we compare relapse rates in this study to those observed in the study described above, where only 32% of the women who discontinued treatment remained well throughout the pregnancy, the CBT intervention looks promising with regard to its ability to reduce the risk of relapse in this population.
Cognitive behavioral therapy for the prevention of recurrence seems feasible and may provide protection for women with recurrent depression who wish to discontinue their medication while trying to conceive. Larger studies are needed to fully assess the efficacy of this intervention. Given the relatively high rates of relapse in women who maintain treatment with antidepressants, it would also be interesting to see if this form of CBT is affective for all women with histories of depression.
Ruta Nonacs, MD PhD
Psaros C, Freeman M, Safren SA, Barsky M, Cohen LS. Discontinuation of Antidepressants During Attempts to Conceive: A Pilot Trial of Cognitive Behavioral Therapy for the Prevention of Recurrent Depression. J Clin Psychopharmacol. 2014 Jun 6. [Epub ahead of print]