Response to Guille and Epperson Letter

To the Editor: I want to thank Dr. Guille and Dr. Epperson for the complimentary comments and the additional important reference they provided regarding the risk for recurrence of depression during the perinatal period related to antidepressant use. As they point out, the findings by Yonkers et al. (1) highlight the complicated nature of predicting who will or will not have a recurrence of depression and who may or may not require antidepressants during the perinatal period. Drs. Guille and Epperson note that, while controlling for antidepressant use, a history of four or more depressive episodes puts women at high risk for a major depressive episode. In addition, Yonkers et al. identify other risk factors, such as having a depressive episode in the 6 months before pregnancy and being of black race or Hispanic ethnicity. These additional variables, as well as the fact that 16% of the women in the study developed major depression during pregnancy or the postpartum period, underscore the need for further research to more fully understand who is at highest risk for recurrence in the perinatal period and therefore what the risks and benefits of antidepressant treatment are for individual patients with a range of depression severity.