Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Dr Terao describes some consistency in rates of relapse of depression and bipolar illness among patients who either maintain or discontinue antidepressants or lithium therapy. He cites the findings of Viguera et al1 that suggest that rapid vs gradual discontinuation of mood stabilizer use among pregnant women with bipolar disease who are euthymic is associated with risk for relapse. This may have important implications for the patients with histories of major depression described in our article since abrupt discontinuation of maintenance psychotropic medications immediately after documentation of pregnancy is a common clinical scenario. In subsequent analyses, we plan to evaluate the extent to which slow vs rapid antidepressant discontinuation predicts risk for depressive relapse during pregnancy.
Cohen LS, Nonacs R, Viguera AC, Reminick AM, Altshuler LL, Suri R, Burt VK, Hendrick V, Harlow BL, Vitonis AF, Newport DJ, Loughead A, Stowe ZN. Antidepressant Treatment and Relapse of Depression During Pregnancy—Reply. JAMA. 2006;296(2):165-167. doi:10.1001/jama.296.2.166-b