Janssen Research and Development, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA.
Johnson & Johnson Women's Health, New Brunswick, NJ, Canada.
BMC Pregnancy Childbirth. 2019 Sep 2;19(1):323. doi: 10.1186/s12884-019-2462-9.
Peripartum depression is a leading cause of disease burden for women and yet there is little evidence as to how often peripartum depression does not respond to treatment and becomes treatment resistant depression. We sought to determine the incidence of treatment resistant depression (TRD) in women with peripartum depression.
Population based retrospective cohort study using a large US claims database. Peripartum depression was defined as having a depression diagnosis during pregnancy or up to 6 months after the end of pregnancy. We included women with prevalent or incident depression. The outcome was the development of TRD within 1 year after the diagnosis of peripartum depression. TRD was defined as having 3 distinct antidepressants or 1 antidepressant and 1 antipsychotic in 1 year. Women with peripartum depression may not be exposed to pharmacological treatments early in pregnancy, therefore we created two groups: 1. women with peripartum depression, and 2. women with peripartum depression diagnosed 3 months before a live birth delivery or within 6 months after that delivery.
There were 3,207,684 pregnant women, of whom 2.5% had peripartum depression. Of these women half had incident depression during pregnancy. Five percent of women with peripartum depression developed TRD within 1 year of the depression diagnosis. The risk of developing TRD was 50% higher in women with prevalent depression than in women with incident peripartum depression (P < 0.0001). Results were similar in women with peripartum depression diagnosed later in their pregnancy. Women who went on to develop TRD had more substance use disorders, anxiety, insomnia and painful conditions.
TRD occurs in approximately 5% of women with peripartum depression. The risk of TRD is higher in pregnant women with a history of depression. Women who went on to develop TRD had more psychiatric comorbidities and painful conditions than women who did not.
围产期抑郁症是导致女性疾病负担的主要原因，但对于围产期抑郁症有多少比例未对治疗产生反应并发展为治疗抵抗性抑郁症，目前几乎没有证据。我们旨在确定患有围产期抑郁症的女性中治疗抵抗性抑郁症（TRD）的发生率。
采用美国大型索赔数据库进行基于人群的回顾性队列研究。围产期抑郁症定义为在妊娠期间或妊娠结束后 6 个月内存在抑郁症诊断。我们纳入了患有现患或新发抑郁症的女性。结局为在围产期抑郁症诊断后 1 年内发生 TRD。TRD 的定义为在 1 年内使用了 3 种不同的抗抑郁药或 1 种抗抑郁药和 1 种抗精神病药。患有围产期抑郁症的女性可能在妊娠早期未接受药物治疗，因此我们创建了两个组：1.患有围产期抑郁症的女性；2.在活产分娩前 3 个月或分娩后 6 个月内被诊断为围产期抑郁症的女性。
共有 3207684 名孕妇，其中 2.5%患有围产期抑郁症。其中一半女性在妊娠期间新发抑郁症。在围产期抑郁症诊断后 1 年内，有 5%的女性发生 TRD。与新发围产期抑郁症的女性相比，有围产期抑郁症病史的女性发生 TRD 的风险高 50%（P<0.0001）。在妊娠后期被诊断为围产期抑郁症的女性中结果相似。发展为 TRD 的女性有更多的物质使用障碍、焦虑、失眠和疼痛性疾病。
约 5%的围产期抑郁症女性发生 TRD。有抑郁症病史的孕妇发生 TRD 的风险更高。与未发展为 TRD 的女性相比，发展为 TRD 的女性有更多的精神共病和疼痛性疾病。
