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Depression in Women of Childbearing Age: Its Impact on the Next Generation Vivien Burt, MD, PhD The Women’s Life Center Resnick Neuropsychiatric Hospital at UCLA

The Age of Onset of Depression in Men and Women 0.0140 Women Men 0.0120 0.0100 Risk of first-episode depression 0.0080 Hazard Rate 0.0060 Risk for subsequent episodes 0.0040 0.0020 0.0000 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Age Category Kessler, R. C., McGonagle, K. A., Swartz, M., Blazer, D. G., & Nelson, C. B. (1993). Sex and depression in the National Comorbidity Survey I: Lifetime prevalence, chronicity and recurrence. Journal of affective disorders, 29(2-3), 85-96.

Depression Recurrence Episode Risk for subsequent episode 1 50% 2 70% 90% 3 Kessler, R. C., McGonagle, K. A., Swartz, M., Blazer, D. G., & Nelson, C. B. (1993). Sex and depression in the National Comorbidity Survey I: Lifetime prevalence, chronicity and recurrence. Journal of affective disorders, 29(2-3), 85-96.

Risk for depression at times of reproductive transitions Early initial episode of depression Premenstrual Postpartum Perimenopause Risk for recurrence Times of hormonal changes

A Three-Site Study 43% relapsed 26% maintained antidepressant History of major depression: Before pregnancy or 43% relapsed Less than 16 weeks pregnant Euthymic for at least 3 months before last menstrual period 26% maintained antidepressant   68% discontinued antidepressant  On antidepressants currently or within 12 weeks of last menstrual period Cohen, L. S., Altshuler, L. L., Harlow, B. L., Nonacs, R., Newport, D. J., Viguera, A. C., ... & Loughead, A. (2006). Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. Jama, 295(5), 499-507.

Women Who Discontinue Medication 5 X  more likely to relapse Pregnancy is not protective against risk of major depression relapse  Be aware of depressive relapse during pregnancy with antidepressant discontinuation  History of depression On antidepressants Doing well Cohen, L. S., Altshuler, L. L., Harlow, B. L., Nonacs, R., Newport, D. J., Viguera, A. C., & Loughead, A. (2006). Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. Jama, 295(5), 499-507.

No Decision is Risk Free Maternal stress and depression are associated with:  Serious maternal illness  Poor health behaviors Increased risk for postpartum illness Discontinuing antidepressants Relapse of depression

Psychiatric Admissions in the 2 Years Preceding and Following Childbirth 70 Increased vulnerability for psychiatric illness 60 50 40 Admissions / Month 30 Pregnancy 20 10 -2 Years -1 Years Childbirth +1 Year +2 Years Kendell, R. E., Chalmers, J. C., & Platz, C. (1987). Epidemiology of puerperal psychoses. The British Journal of Psychiatry, 150(5), 662-673.

Depressed in pregnancy Likelihood of remaining depressed New hormonal challenges Caring for infant Worsening of depressive illness Family responsibilities Depressed in pregnancy

Children (7-17 years) Mothers Depression Disruptive behaviors Remitted depression 24% Not remitted from depression Depression Anxiety Depressive behavior 43% Depression during pregnancy can be considered a child’s first adverse life event.

Key Points Beginning at puberty, women are at an increased risk for first-onset depression. Women with a history of depression who stop medication as they approach or are beginning pregnancy are at 5 times increased risk of relapsing. The postpartum period is a time of vulnerability for mood disorders for women with a history of depression, especially depression during pregnancy or during a prior postpartum period. Successful treatment of maternal depression has a positive impact for both mothers and their children.

Next Presentation Treating Depression in Pregnancy: Guiding Principles