Stone Kristen C, Salisbury Amy L, Miller-Loncar Cynthia L, Mattera Jennifer A, Battle Cynthia L, Johnsen Dawn M, O'Grady Kevin E
Alpert Medical School of Brown University, Box G-A1, Providence, RI, 02912, USA.
Women & Infants Hospital, 101 Dudley St., Providence, RI, 02905, USA.
Arch Womens Ment Health. 2017 Oct;20(5):621-632. doi: 10.1007/s00737-017-0726-9. Epub 2017 May 9.
This study examined the course of antidepressant use, sleep quality, and depression severity from pregnancy through 6-month postpartum in women with and without a depressive disorder during pregnancy. Women (N = 215) were interviewed during pregnancy, 1- and 6-month postpartum. Mixed linear models were used to examine the longitudinal course and inter-relationships for the time-varying variables of antidepressant use, subjective sleep quality, and depression severity. Pregnant women with a depressive disorder who did not use antidepressants had more variable depression severity over time with improvements in depression severity by 6-month postpartum. In contrast, the depression severity of their medicated counterparts remained stable and high throughout. Pregnant women without a depressive disorder had worse sleep quality when using antidepressants compared with when they were not. Antidepressant use significantly strengthened the magnitude of the effect of sleep quality on depression severity in women with a depressive disorder during pregnancy. When prenatally depressed women use antidepressants, their sleep disturbance is more highly linked to depression severity than when they do not. Furthermore, antidepressants are not adequately treating the sleep disturbance of these women or their remitted counterparts, leaving both groups vulnerable to significant negative mental and physical health outcomes.
本研究调查了孕期有或无抑郁症的女性从孕期到产后6个月期间抗抑郁药使用情况、睡眠质量和抑郁严重程度的变化过程。对215名女性在孕期、产后1个月和6个月时进行了访谈。采用混合线性模型来研究抗抑郁药使用、主观睡眠质量和抑郁严重程度等随时间变化的变量的纵向变化过程及相互关系。孕期患有抑郁症但未使用抗抑郁药的女性，其抑郁严重程度随时间变化更大，到产后6个月时抑郁严重程度有所改善。相比之下，使用药物治疗的同类女性的抑郁严重程度在整个过程中保持稳定且较高。未患抑郁症的孕妇在使用抗抑郁药时的睡眠质量比不使用时更差。在孕期患有抑郁症的女性中，使用抗抑郁药显著增强了睡眠质量对抑郁严重程度的影响程度。与不使用抗抑郁药时相比，产前抑郁的女性使用抗抑郁药时，其睡眠障碍与抑郁严重程度的关联更强。此外，抗抑郁药未能充分治疗这些女性及其已缓解的同类女性的睡眠障碍，使两组人群都容易出现显著的负面身心健康后果。
