Journal Article

Trajectories of Depressive and Anxiety Symptoms Across Pregnancy and Postpartum in Selective Serotonin Reuptake Inhibitor‐Treated Women

Gollan, Jacqueline K., Caritis, Steven, George, Alfred L., Clark, Crystal T., Rasmussen‐Torvik, Laura J., Avram, Michael J., Erickson, Daniel L., Costantine, Maged, Wisner, Katherine L., Welch, Elizabeth, Stika, Catherine S., Venkataramanan, Raman, Fisher, Sheehan, Clark, Shannon, Ciolino, Jody D., Sit, Dorothy K., Fischer, Dawn, Zumpf, Katelyn, Mesches, Gabrielle A., West, Holly

2022

Overview

Objective Tracking perinatal mood and anxiety disorders is championed by the American Psychiatric Association and the International Marcé Society for Perinatal Mental Health. We conducted this study to examine trajectories of monthly depressive and anxiety symptoms through pregnancy and postpartum. Methods This is a prospective longitudinal observational cohort study of pregnant women interviewed at baseline (≤18th gestational week), every four weeks through delivery and at 6 and 14 weeks postpartum at three urban academic medical centers (N = 85) and a single rural health center (N = 3) from 2016 to 2020. Pregnant women 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. Of 192 women screened, 88 (46%) women enrolled, and 77 (88%) women completed the postpartum follow‐up. Symptom trajectories were generated with scores from the Edinburgh Postnatal Depression Scale, the Quick Inventory of Depressive Symptoms, the Generalized Anxiety Disorder Scale, 7‐item, and the Patient‐Reported Outcomes Measurement Information System Global Health measure. A semi‐parametric, group‐based mixture model (trajectory analysis) was applied. Results Three relatively stable depression trajectories emerged, described as Minimal, Mild, and Subthreshold, in each group across pregnancy. Two of the four anxiety trajectories were stable, including Asymptomatic and Minimal, while the third, termed Breakthrough, was ascending with increasing symptoms and the fourth trajectory, described as Mild, had descending symptoms. Conclusions Screening for anxiety with depression for pregnant women will yield a comprehensive view of psychiatric symptoms and treatment targets in perinatal women. Highlights Question: What are the trajectories of depression and anxiety symptoms across pregnancy and postpartum in women who continue to take Selective serotonin reuptake inhibitor (SSRI) antidepressants? Findings: In this prospective longitudinal observational cohort study of pregnant women with antidepressant‐treated remitted depression (N = 88), a substantive proportion of women had mild depression (32%) or anxiety (23%). Three trajectories were observed for depression, all relatively stable across time, and four were observed for anxiety, three stable and one increasing across time. Meaning: There is a relative stability of mild symptoms at study entry and across gestation in depression and anxiety symptom course, with three depression and four anxiety trajectories. There was one unique trajectory in anxiety symptom course with one group with ascending symptoms. Clinicians may use measures that are already part of perinatal visits to track and treat those women who fall into these trajectories to improve their mental health.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: Antidepressants / Body mass index / Cohort analysis / Enrollments / Generalized anxiety disorder / Gestational age / Mental depression / Non-binary gender / Pregnancy / Sample size / Serotonin / Statistics / Variables / Womens health