Recurrence Rates High for Depression, Even During and After Pregnancy

The risk of depressive episodes increases significantly with each occurrence, and even individuals who successfully manage the condition can experience relapse due to factors like major life stressors, according to medical experts.

The National Institutes of Health reports that after a first depressive episode, the risk of recurrence is 50%, rising to 70% after a second and 90% after a third. Maintaining treatment, even during pregnancy, is often recommended due to the potential dangers of untreated depression. “The benefits of treating depression almost always outweigh the risks,” says Veronica Gillispie-Bell, MD, MAS, FACOG, an OB-GYN and system medical director of health outcomes at Ochsner Health. While some antidepressants carry small risks – such as a slight chance of persistent pulmonary hypertension in newborns or increased risk of preeclampsia or miscarriage – these are rare and carefully weighed against the consequences of untreated maternal depression.

A phenomenon known as “antidepressant tachyphylaxis” can occur, where a medication that previously provided relief gradually loses its effectiveness. This can happen even after periods of stability, as experienced by one individual during the COVID-19 pandemic. The added stress of being a new mother in Brooklyn, working for a crisis hotline, and navigating remote work and childcare led to a relapse of depression in 2021, despite previously successful management with SSRI medication. Understanding the complexities of depression is crucial for both patients and healthcare providers.

The American College of Obstetricians and Gynecologists (ACOG) recommends the use of medications for depression or anxiety disorders during the perinatal period – from pregnancy up to a year after childbirth – when appropriate, recognizing the severe risks associated with untreated depression, including substance use and, in extreme cases, suicide. ACOG’s guidelines emphasize a patient-centered approach to mental health care during this vulnerable time.

Healthcare professionals emphasize the importance of ongoing monitoring and potential adjustments to treatment plans for individuals with a history of depression, particularly during times of significant life change or stress.