It may have become more difficult to decide whether or not to continue antidepressant therapy during pregnancy. In February, the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine (NEJM) published findings that, taken together, seem to be in conflict: continuing antidepressant therapy during pregnancy may be good for the mother, but not for her baby.

Cohen and colleagues compared the risk of depression relapse in pregnant women who discontinued antidepressant medication with that in women who maintained treatment during pregnancy. 1 The study, which appeared in JAMA, enrolled 201 pregnant women with a history of major depression prior to pregnancy. All participants were less than 16 weeks into pregnancy, were euthymic for at least three months prior to last menstrual period, and were currently or recently (less than 12 weeks prior to last menstrual period) receiving antidepressant treatment. Women were excluded if they were actively suicidal, had a positive urine screen for toxic substances, had hypothyroidism or another medical condition associated with depressive symptomatology, or if they met Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for psychological disorders such as schizophrenia or psychosis.

The study found that women who discontinued antidepressant therapy had more relapses than those who maintained their medication regimens. Of the former group, 68% experienced relapses of depression during pregnancy, while only 26% of the latter did the same. These findings show that pregnancy does not "provide 'protection' against psychiatric disorder."

In the study in NEJM, Chambers and colleagues identified an association between maternal use of selective serotonin-reuptake inhibitors (SSRIs) in late pregnancy and persistent pulmonary hypertension (PPH) in the newborn. 2 Fourteen infants of the 377 mothers who had used SSRIs after the 20th week of pregnancy had PPH, as oppsoed to six infants of the 836 control mothers (the adjusted odds ratio was 6.1). According to the authors, "Although our study cannot establish causality, several possible mechanisms suggest a casual association is possible." One possible mechanism is the accumulation of SSRIs in fetal lung tissue that has been shown to occur. Like the authors of the JAMA study, the researchers urged clinicians and their patients to consider both the benefits and the risks when making decisions regarding treatment of depression during pregnancy.-Joanna E. Cain, BSN, RN

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