Psychiatric outcomes following medical and surgical abortion
Department of Psychiatry
Medical Subject Headings
*Abortifacient Agents, Steroidal; Abortion, Induced; Adolescent; Adult; *Antidepressive Agents; Depression; Female; Humans; Hydrocortisone; *Mifepristone; Mood Disorders; Pregnancy; Saliva; Vacuum Curettage
BACKGROUND: Hypercortisolaemia is associated with certain depressive disorders. Mifepristone has possible antidepressant properties related to its anti-glucocorticoid activity. To explore the possible mood effects of mifepristone, we examined the mood outcomes after surgical and medical (mifepristone-misoprostol) abortion. The objectives were to determine post-abortion depression risk, evaluate risk factors for post-abortion depression and to explore the relationship between cortisol and depression.
METHODS: We enrolled 47 surgical and 31 medical abortion patients. Women were assessed pre-abortion and 1 month post-abortion with the Edinburgh Postnatal Depression Scale (EPDS) and salivary cortisol levels.
RESULTS: Pre-abortion, 36% (17/47) of surgical and 35% (11/31) of medical patients had high depression risk (EPDS > or = 10; (chi(2) = 0.31, df = 1, P = 0.58). At follow-up, 17% (7/42) of surgical and 21% (5/24) of medical patients had an EPDS > or = 10 (chi(2) = 0.18, df = 1, P = 0.67). The decline post-abortion in the women with EPDS > or = 10 was significant (P = 0.01). Women with past psychiatric history (Fisher's exact P = 0.05) or anxiety disorders (Fisher's exact P = 0.005) had elevated risk for post-abortion depression. Change in cortisol levels was not correlated with change in EPDS (r = 0.10, P = 0.28).
CONCLUSIONS: Most patients experienced post-abortion mood improvement. Mifepristone did not offer additional antidepressant effects. The lack of correlation between cortisol and depression could represent hypersuppression of the hypothalamic-pituitary-adrenal (HPA) axis or insufficient mifepristone dose to alter HPA axis activity.
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Citation: Hum Reprod. 2007 Mar;22(3):878-84. Epub 2006 Dec 13. Link to article on publisher's site
Sit, Dorothy; Rothschild, Anthony J.; Creinin, Mitchell D.; Hanusa, Barbara H.; and Wisner, Katherine L., "Psychiatric outcomes following medical and surgical abortion" (2006). Psychiatry Publications and Presentations. 64.