Women with epilepsy have higher rates of depression and anxiety during pregnancy and postpartum, compared with healthy pregnant or non-pregnant women with epilepsy, according to study findings published in Neurology.1
Prior research has found that women with epilepsy are more likely to have major depressive disorder, postpartum depression, and depression and anxiety during pregnancy compared with women without epilepsy. Analysis of data from the Norwegian Mother and Child Cohort Study2 indicated women with epilepsy who use antiseizure medication (ASM) during pregnancy are at higher risk for depression. Some studies have indicated that the type of ASM does not affect the connection with peripartum depression, while other studies suggest women report a better mood with lamotrigine compared with other ASMs.
In the present study, researchers assessed women with epilepsy’s self-reported maternal depression and anxiety.
The study included 331 pregnant women with epilepsy, 102 healthy pregnant women, and 102 non-pregnant women with epilepsy who participated in the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD; Clinicaltrials.gov Identifier: NCT01730170). MONEAD is a National Institutes of Health (NIH)-funded ongoing multicenter, prospective, observational, parallel-group cohort study of pregnant women with epilepsy and healthy women without epilepsy and their children, and a group of non-pregnant women with epilepsy. These women were recruited between December 2012 and January 2016.
During each trimester, at the time of delivery, and 3 through 9 months postpartum, the pregnant women would have study visits where they would be screened for depression, anxiety, and other psychiatric disorders. Women who were not pregnant would visit the clinic every 3 months to answer questions. Questions would relate to age, marital status, education level, household income, planned pregnancy, and antidepressant medication use or ASMs.
Pregnant women with epilepsy tended to have higher income level and rates of marriage/cohabitating and lower lifetime history of anxiety disorder and antidepressant use compared with non-pregnant women with epilepsy.
The researchers found an association between non-pregnant women with epilepsy and major depressive episodes. This group had a higher rate of lifetime history of mood disorders (22.2%) compared with pregnant women with epilepsy (17.5%) and healthy pregnant women (13.4%). Lifetime history of anxiety disorders occurred most frequently among non-pregnant women with epilepsy (25.3%) compared with pregnant women with epilepsy (16.2%) and healthy pregnant women (15.5%).
Perinatal rates of major depressive episodes were lower across the 3 groups: pregnant women with epilepsy (7.3%), non-pregnant women with epilepsy (6.9%), and healthy pregnant women (3.9%).
Polytherapy ASM, seizure frequency >1 during 90-days, lifetime history of mood disorder, and unplanned pregnancy were associated with major depressive episodes in pregnant women with epilepsy.
During pregnancy, pregnant women with epilepsy were more likely to experience depressive symptoms compared with non-pregnant women with epilepsy (37.2 vs 30.4%; adjusted odds ratio [aOR], 0.6; 95% CI, 0.3-1). During postpartum, depressive symptoms were more probable in pregnant women with epilepsy vs healthy pregnant women (8.9% vs 2.1%; aOR, 0.3; 95% CI, 0.1-1.2).
Anxiety symptoms tended to be worse among pregnant women with epilepsy compared with the other groups during pregnancy. Postpartum, anxiety symptoms were only worse in pregnant women with epilepsy compared with healthy pregnant women. The researchers noted that suicidal ideation was associated with anxiety symptoms and a lifetime history of mood disorder.
The researchers found that while the incidence of major depressive episodes didn’t vary among the populations, patients with epilepsy had higher rates of psychiatric symptoms during pregnancy and postpartum.
“Given the risks, PWWE [pregnant women with epilepsy] should be routinely assessed, and symptomatic patients should be offered treatment. … Maternal symptoms of anxiety enhance vulnerability to having thoughts of death/dying and anxiety should be included in perinatal assessments,” the researchers said. “WWE [women with epilepsy] are at increased risk for psychiatric symptoms during pregnancy and should be monitored more closely.”
Study limitations include a sample size, recall bias, timing of psychiatric symptoms, and any response to undocumented treatments.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
- Meador KJ, Stowe ZN, Brown CA, et al. A prospective cohort study of depression during pregnancy and the postpartum period in women with epilepsy vs control groups. Neurol. Published online August 17, 2022. doi:10.1212/WNL.0000000000200958
- Reiter SF, Veiby G, Daltveit AK, Engelsen BA, Gilhus NE. Psychiatric comorbidity and social aspects in pregnant women with epilepsy: the Norwegian Mother and Child Cohort Study. Epilepsy Behav. Published online September 26, 2013. doi:10.1016/j.yebeh.2013.08.016