psiquiatría.com

Resumen

Una de cada cinco mujeres embarazadas pueden experimentar síntomas depresivos, pero pocas consiguen ayuda para ello, de acuerdo con los hallazgos de un nuevo estudio de la Universidad de Michigan.

Los resultados de la investigación demuestran que aquellas con un historial depresivo en cualquier momento previo al embarazo (aproximadamente una de cada cuatro mujeres) tienen alrededor de dos veces más probabilidades frente a otras mujeres de mostrar depresión mientras dura el embarazo.

El estudio conducido por investigadores del Centro de Depresión de la Universidad de Michigan incluyó a una muestra de 3.472 mujeres embarazadas y aparece publicado en la edición de Mayo del “Journal of Women's Health”.

Los resultados revelan la preocupación por el bajo diagnóstico y el bajo nivel de tratamiento de la depresión en el embarazo. El 20% de las mujeres obtuvieron marcadores altos en cuanto a los síntomas de la depresión, pero de estas, sólo el 13,8% recibieron ayuda mental de cualquier tipo, medicación u otros tratamientos. Solamente cerca del 24% de las mujeres que habían tenido depresión en los seis meses anteriores recibieron tratamiento durante el embarazo.

Las evidencias científicas cada vez mayores sugieren que los desequilibrios hormonales asociados a la depresión pueden afectar al feto o poner a la mujer en riesgo de depresión postparto. También se ha demostrado que los bebés de madres depresivas tienen peores nacimientos que los otros niños.

Según la doctora Sheila Marcus, autora del estudio, los años de maternidad en la mujer son también la etapa de mayor riesgo para la depresión. Ahora sabemos que las hormonas del cerebro implicadas en la depresión se ven afectadas por los cambios de otras hormonas relacionadas con el embarazo. Y esto puede afectar al feto.

Afortunadamente, los estudios recientes han demostrado que algunos tratamientos estándares para la depresión (incluyendo algunos fármacos antidepresivos) no aparecen aumentar el riesgo de defectos en el nacimiento. Algunos estudios más largo plazo sugieren que los bebés expuestos a algunos antidepresivos durante el embarazo parezcan muy similares a sus hermanos no expuestos, en términos de índices de inteligencia y de problemas de aprendizaje, cuando se comparan a los 5 años de edad. Aunque se necesita trabajar más en esta área.

Tanto la autora como sus colegas esperan que su estudio ayude a elevar el conocimiento entre las mujeres embarazadas, los especialistas médicos y comadronas, sobre la necesidad de reconocer los síntomas de la depresión y de buscar tratamiento.

Para acceder al texto completo es necesario suscribirse en la revista: www.liebertpub.com/JWH/default1.asp

Para poder visualizar el texto completo, necesita usted tener instalado el Adobe Acrobat, si usted no lo tiene puede bajárselo gratuitamente desde la dirección: www.psiquiatria.com/enlaces/652

Abstract

One in five pregnant women may be experiencing symptoms of depression, but few are getting help for it, a new University of Michigan study finds.

And those with a history of depression any time before their pregnancy -- about one in every four women -- are about twice as likely as other women to show signs of depression while pregnant, the study results show. The study of 3,472 pregnant women, conducted by researchers from the U-M Depression Center in the waiting rooms of 10 Michigan obstetrics clinics, is being published May 22 in the Journal of Women's Health.

The results reveal troubling under-diagnosis and under-treatment of depression in pregnancy. Twenty percent of the women scored high on a standard survey of depression symptoms, but of those, only 13.8 percent were receiving any mental health counseling, drugs or other treatment. Only about 24 percent of those who had had depression in the last six months were receiving treatment during pregnancy.

Growing scientific evidence suggests that hormone imbalances associated with depression can affect the fetus or put a woman at higher risk of post-partum depression. Population-based evidence has also shown that babies of depressed mothers do worse at birth, and beyond, than other infants.

"A woman's childbearing years are also her highest-risk time for depression. Doctors used to think of pregnancy as a 'honeymoon' away from depression risk, but this is turning out to be a myth," says lead author Sheila Marcus, M.D., a clinical assistant professor of psychiatry at the U-M Medical School. "We now know that the hormones and brain chemistry involved in depression are known to be affected by changes in other hormones related to pregnancy. And we know this may affect the fetus."

Fortunately, Marcus notes, recent studies have shown that some standard depression treatments -- including some antidepressant drugs -- do not appear to increase the risk of birth defects. A few longer-term studies suggest that infants exposed to some antidepressants in pregnancy look very similar to their siblings who are not exposed, both in terms of IQ and learning problems, when compared at age 5. But she notes that more work is necessary in this area.

She and her colleagues hope their study will help raise awareness among pregnant women, and their doctors and midwives, about the need to recognize depression symptoms and seek treatment.

Explains Marcus, "We need to educate women about the signs of depression, and encourage them to be open about how they're feeling during pregnancy and after delivery, rather than feeling guilty and embarrassed."

The U-M Depression Center, the nation's only comprehensive center for depression treatment, research and education, has launched a Web site about depression designed specifically for women, www.med.umich.edu/womensguide. The site recognizes that one in four women will experience depression sometime in her life, and that hormone-related life transitions such as puberty, pregnancy and menopause are strongly associated with an increased risk.

The team led by Marcus, who is also the clinical director of the psychiatry division of the U-M Depression Center, conducted the survey over a three-year period at a range of clinics where pregnant women were awaiting their prenatal doctor's visits. Ninety percent of the women who were approached agreed to complete the survey. Marcus notes that the high participation and completion rate show that screening for depression in the doctor's office waiting room may be feasible across the board. Such screening is becoming standard at U-M obstetrics clinics.

The survey included a standardized validated questionnaire of current distress and depressive feelings (CES-D), a standardized validated questionnaire about alcohol use (TWEAK), and questions about lifetime and recent depression history and treatment, overall health, use of prescription drugs and demographic information.

The women ranged in age from 18 to 46 years, with an average age of 28.6 years, and were from diverse racial and ethnic backgrounds with about 73 percent white. They were, on average, about 25 weeks into their pregnancies, but gestation ages ranged from 3 to 41 weeks.

The researchers used a cutoff score of 16 or above on the CES-D scale to indicate current minor depression. They also asked the women whether they had had a period of two or more weeks in the last six months, or in their lifetime, when they had consistently felt sad, blue or depressed, or lost all interest in things such as work -- an indication of major depression. Twenty-eight percent of the women reported a lifetime history of major depression, and 42 percent of them scored above 16 on the CES-D, indicating current minor or major depression.

This recurrence of depression during pregnancy, Marcus feels, is a significant issue that deserves special attention. Because of depression's cyclical nature, women who have had depression at any time in their lives may be symptom-free when they become pregnant. But the new data suggest that they can start experiencing a return of their symptoms during pregnancy -- and their increased risk of post-partum depression is already well known.

Women who reported being unemployed or without a partner, using alcohol and tobacco during pregnancy, or having lower levels of education were all more likely to score above 16 on the CES-D scale of distress and depression. The study also showed that the vast majority of currently or previously depressed women -- 86 percent of those with current symptoms, 88 percent of those with lifetime history of depression and 76 percent of those with depression in the last six months -- had not seen a counselor or received other treatment in recent months. In fact, about half of the women in the study who had been taking medications for depression before they got pregnant stopped once they conceived.

This under-treatment, and treatment stoppage, stem from a misconception that antidepressants are unsafe for pregnant women and fetuses, says Marcus.