Pregnancy and postpartum antidepressant use moderates the effects of sleep on depression

Abstract

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.

Keywords: Antidepressant medication; Depression; Postpartum; Pregnancy; Sleep.

Fig. 1

Schematic of study design. Women were classified as non-depressed or depressed during the current pregnancy according to the SCID. Antidepressant use, sleep quality, and depression severity were measured for each group at Trimester 2, Trimester 3, 1-month postpartum, and 6-month postpartum

Fig. 2

Pittsburgh Sleep Quality Index (PSQI) scores measured during Trimesters 2 and 3 in pregnancy, 1- and 6-month postpartum. a PSQI scores by concurrent antidepressant use for women without a depressive disorder during pregnancy. b PSQI scores by concurrent antidepressant use for women with a depressive disorder during pregnancy. Higher scores indicate worse sleep quality

Fig. 3

Regression coefficients for the change in Inventory of Depressive Symptomatology (IDS-C) scores per unit change in Pittsburgh Sleep Quality Index (PSQI) by concurrent antidepressant use for women with and without a depressive disorder during pregnancy

Fig. 4

Inventory of Depressive Symptomatology (IDS-C) scores measured during Trimesters 2 and 3 in pregnancy, 1- and 6-month postpartum. a IDS-C scores by concurrent antidepressant use for women without a depressive disorder during pregnancy. b IDS-C scores by concurrent antidepressant use for women with a depressive disorder during pregnancy. Higher scores indicate higher depression severity