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2. 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

3. 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),

4. 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),

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

6. 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),

7. 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),

8. 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

9. Psychiatric Admissions in the 2 Years Preceding and Following Childbirth70
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),

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

11. 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.

12. 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.

13. Next Presentation Treating Depression in Pregnancy: Guiding Principles