Women’s Health
Outcomes of treatment resistance among women with postpartum depression Yufeng Chen* Yufeng Chen Donghao Lu
Postpartum depression (PPD) affects millions of new mothers worldwide. While the conventional treatments are effective for many, emergence evidence indicates that treatment resistance (TR) in PPD is not uncommon. However, the clinical outcomes and health consequences in this venerable group are currently unknown. We conducted a nationwide register-based cohort study of all women who gave birth during 2006-2021 in Sweden and were diagnosed with PPD up to 12 months postpartum. TR is defined as use of either ≥3 distinct antidepressants, or add-on medications, or ECT, or rTMS in one year after PPD diagnosis. Information on demographics, pregnancy characteristics, treatments, and outcomes (included all-cause mortality, suicidal behavior, psychiatric disorder, and cardiovascular and autoimmune disease) were obtained from national registers. Associations between TRPPD and outcomes were assessed using multivariable Cox model. Of 58 618 patients with PPD (mean age 30.8, SD 5.3), 4 933 (8.5%) fulfilled the criteria for TRPPD. The all-cause mortality rate for patients with TRPPD was 1.6/1000 person-years (PYs), compared with 0.8/1000 PYs for patients without TRPPD (adjusted hazard ratio [HR] 1.87, 95% CI 1.42-2.47) over up to 16 years of follow-up. Compared with patients without TRPPD, patients with TRPPD were at a higher risk of suicidal behavior (incidence rate [IR]= 10.7/1000 vs. 3.7/1000 PYs; HR=2.41, 2.15-2.70) and psychiatric disorder (IR=244.0/1000 vs. 70.7/1000 PYs; HR=2.79, 2.69-2.89), cardiovascular disease (IR=8.3/1000 vs. 7.2/1000 PYs; HR=1.19, 1.05-1.34), and autoimmune disease (IR=19.0/1000 vs. 16.0/1000 PYs; HR=1.18, 1.09-1.28). This cohort study’s findings suggest that patients with TRPDD were associated with a higher risk of mortality, suicidal behavior, and mental and physical comorbidities. Better treatment and improved surveillance on comorbidities, particularly relapse of psychiatric episodes and suicidal behavior, are needed for these venerable patients.