Question:
I have a 32 year old patient with ADHD who stopped her stimulant medication (Concerta 54 mg) during pregnancy. She is now 34 weeks pregnant and is wondering if she can resume the stimulant treatment. He feels that without it, it’s mostly okay and can work relatively well. However, she doesn’t feel like she’s at her best and is struggling a bit to keep up with life at work and at home. She feels less confident and worries about the risk of postpartum depression. He has no history of depression.
Answer:
Women with attention-deficit/hyperactivity disorder (ADHD) often stop their ADHD medication during pregnancy, especially if they have milder symptoms. In the postpartum period, we could conclude that most women with ADHD do not “need” their ADHD medication while on maternity leave because they do not have to deal with the demands of work or school.
Although this approach makes sense in terms of limiting unnecessary exposure to women with milder illness, we have often been surprised by the clinical outcomes in this population, especially when previously high-functioning women develop significant psychiatric morbidity during pregnancy. and the postpartum period after stopping the ADHD Medication.
In a research study from our program (Baker et al, 2022), we observed that women who discontinued ADHD medication during pregnancy were more likely to experience higher levels of depressive symptoms during pregnancy. Although ADHD symptoms remained relatively stable during pregnancy for women who discontinued psychostimulants, this group of women experienced a clinically significant increase in depressive symptoms compared with women who either maintained or adjusted their ADHD medication during pregnancy. of pregnancy.
In addition, women who discontinued psychostimulant therapy during pregnancy experienced a significant decline in family functioning. Specifically, they were more likely to experience conflict within the family, had more difficulty having fun as a family, rated parenting as more difficult, and described being more isolated from their family.
Another study from Sweden examined the risk of postpartum depression and anxiety in women diagnosed with ADHD. In this study, the researchers used registry-based data to identify women who gave birth to their first and/or second child (n = 773,047). The prevalence of postpartum depression in women with ADHD was approximately five times that observed in women without an ADHD diagnosis (prevalence ratio 5.09, 95% confidence interval, 4.68–5.54). In addition, approximately 25% of women diagnosed with ADHD were also diagnosed with an anxiety disorder during the postpartum period. The prevalence of anxiety in women with ADHD was approximately five times that observed in women without an ADHD diagnosis (prevalence ratio 5.41, CI 5.06–5.78).
Although a total of 59% of women diagnosed with ADHD had additional psychiatric diagnoses (compared to only 5% of women without ADHD), they found that ADHD was an independent risk factor for postpartum depression and anxiety.
What these studies tell us is that ADHD is a significant risk factor for mood and anxiety disorders during pregnancy and the postpartum period. Although it may make sense to stop ADHD medication in patients with milder disease, we must be alert for the development of depressive symptoms and anxiety during pregnancy and the postpartum period. We have a growing body of literature supporting the reproductive safety of stimulants in pregnant women, and these studies show that not treating them can have negative consequences for the mother and her child.
Ruta Nonacs, MD PhD
bibliographical references
Baker AS, Wales R, Noe O, Gaccione P, Freeman MP, Cohen LS. The course of ADHD during pregnancy. J Atten Disord. 2022 Jan. 26(2):143-148.
Andersson A, Garcia-Argibay M, Viktorin A, Ghirardi L, Butwicka A, Skoglund C, Madsen KB, D’onofrio BM, Lichtenstein P, Tuvblad C, Larsson H. Postpartum depression and anxiety disorders in women diagnosed with attention deficit hyperactivity disorder. J Affect Disord. 2023 Jan 18: S0165-0327(23)00085-X.
