Trajectories of Depressive and Anxiety Symptoms Across Pregnancy and Postpartum in Selective Serotonin Reuptake Inhibitor-Treated Women

Gabrielle A. Mesches, Jody D. Ciolino, Catherine S. Stika, Dorothy K. Sit, Katelyn Zumpf, Sheehan Fisher, Crystal T. Clark, Alfred L. George, Michael J. Avram, Laura J. Rasmussen-Torvik, Daniel L. Erickson, Steven Caritis, Dawn Fischer, Raman Venkataramanan, Maged Costantine, Holly West, Elizabeth Welch, Shannon Clark, Katherine L. Wisner, Jacqueline K. Gollan

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objective: Tracking perinatal mood and anxiety disorders is championed by the American Psychiatric Association and the International Marcé Society for Perinatal Mental Health. We conducted this study to examine trajectories of monthly depressive and anxiety symptoms through pregnancy and postpartum. Methods: This is a prospective longitudinal observational cohort study of pregnant women interviewed at baseline (≤18th gestational week), every four weeks through delivery and at 6 and 14 weeks postpartum at three urban academic medical centers (N = 85) and a single rural health center (N = 3) from 2016 to 2020. Pregnant women had at least one prior episode of major depressive disorder, were not in a current episode, and were treated with sertraline, fluoxetine, citalopram, or escitalopram. Of 192 women screened, 88 (46%) women enrolled, and 77 (88%) women completed the postpartum follow-up. Symptom trajectories were generated with scores from the Edinburgh Postnatal Depression Scale, the Quick Inventory of Depressive Symptoms, the Generalized Anxiety Disorder Scale, 7-item, and the Patient-Reported Outcomes Measurement Information System Global Health measure. A semi-parametric, group-based mixture model (trajectory analysis) was applied. Results: Three relatively stable depression trajectories emerged, described as Minimal, Mild, and Subthreshold, in each group across pregnancy. Two of the four anxiety trajectories were stable, including Asymptomatic and Minimal, while the third, termed Breakthrough, was ascending with increasing symptoms and the fourth trajectory, described as Mild, had descending symptoms. Conclusions: Screening for anxiety with depression for pregnant women will yield a comprehensive view of psychiatric symptoms and treatment targets in perinatal women.

Original languageEnglish (US)
Pages (from-to)32-41
Number of pages10
JournalPsychiatric Research and Clinical Practice
Issue number2
StatePublished - Jun 1 2022

ASJC Scopus subject areas

  • Psychiatry and Mental health


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