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Ce blog est un lieu d'information sur les problèmes d'anxiété, de dépression et toutes autres difficultés psychologiques et les traitements existant pour ces troubles. Avec une volonté d'optimisme et de dédramatisation, dans l'optique de la psychiatrie positive.

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L'auteur

Antoine PELISSOLO, psychiatre

28 novembre 2005 1 28 /11 /novembre /2005 05:59

Pour les médecins :

Risque élevé de rechute dépressive durant la grossesse en cas d'arrêt du traitement.

JAMA. 2006 Feb 1;295(5):499-507.

Relapse of major depression during pregnancy in women who maintain or
discontinue antidepressant treatment.

Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, Suri R,
Burt VK, Hendrick V, Reminick AM, Loughead A, Vitonis AF, Stowe ZN.

Perinatal and Reproductive Psychiatry Clinical Research Program, Department of
Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
02114, USA. lcohen2@partners.org

CONTEXT: Pregnancy has historically been described as a time of emotional
well-being, providing "protection" against psychiatric disorder. However,
systematic delineation of risk of relapse in women who maintain or discontinue
pharmacological treatment during pregnancy is necessary. OBJECTIVE: To describe
risk of relapse in pregnant women who discontinued antidepressant medication
proximate to conception compared with those who maintained treatment with these
medications. DESIGN, SETTING, AND PATIENTS: A prospective naturalistic
investigation using longitudinal psychiatric assessments on a monthly basis
across pregnancy; a survival analysis was conducted to determine time to relapse
of depression during pregnancy. A total of 201 pregnant women were enrolled
between March 1999 and April 2003 from 3 centers with specific expertise in the
treatment of psychiatric illness during pregnancy. The cohort of women was
recruited from (1) within the hospital clinics, (2) self-referral via
advertisements and community outreach detailing the study, and (3) direct
referrals from the community. Participants were considered eligible if they (1)
had a history of major depression prior to pregnancy, (2) were less than 16
weeks' gestation, (3) were euthymic for at least 3 months prior to their last
menstrual period, and (4) were currently or recently (<12 weeks prior to last
menstrual period) receiving antidepressant treatment. Of the 201 participants,
13 miscarried, 5 electively terminated their pregnancy, 12 were lost to
follow-up prior to completion of pregnancy, and 8 chose to discontinue
participation in the study. MAIN OUTCOME MEASURE: Relapse of major depression
defined as fulfilling Structured Clinical Interview for DSM-IV [Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition] Diagnosis (SCID)
criteria. RESULTS: Among the 201 women in the sample, 86 (43%) experienced a
relapse of major depression during pregnancy. Among the 82 women who maintained
their medication throughout their pregnancy, 21 (26%) relapsed compared with 44
(68%) of the 65 women who discontinued medication.
Women who discontinued
medication relapsed significantly more frequently over the course of their
pregnancy compared with women who maintained their medication (hazard ratio,
5.0; 95% confidence interval, 2.8-9.1; P<.001). CONCLUSIONS: Pregnancy is not
"protective" with respect to risk of relapse of major depression. Women with
histories of depression who are euthymic in the context of ongoing
antidepressant therapy should be aware of the association of depressive relapse
during pregnancy with antidepressant discontinuation.

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