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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.

Drs Rifkin and Rifkin raise questions about those study participants who discontinued antidepressant use and then reintroduced therapy with these medications. We did not examine this as a clinical strategy per se . . . [Full Text of this Article]

Lee S. Cohen, MD
lcohen2@partners.org

Ruta Nonacs, MD, PhD; Adele C. Viguera, MD; Alison M. Reminick, BA
Perinatal and Reproductive Psychiatry Clinical Research Program
Department of Psychiatry
Massachusetts General Hospital
Boston

Lori L. Altshuler, MD; Rita Suri, MD; Vivien K. Burt, MD, PhD; Victoria Hendrick, MD
Women's Mood Disorders Research Program
University of California, Los Angeles School of Medicine

Bernard L. Harlow, PhD; Allison F. Vitonis, BA
Obstetrics and Gynecology Epidemiology Center
Brigham and Women's Hospital
Boston, Mass

D. Jeffrey Newport, MD; Ada Loughead, BA; Zachary N. Stowe, MD
Women's Mental Health Program
Emory University School of Medicine
Atlanta, Ga

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