Consensus Panel Recommendations for the Pharmacological Management of Pregnant Women with Depressive Disorders

Abstract

Introduction: The initiative of a consensus on the topic of antidepressant and anxiolytic drug use in pregnancy is developing in an area of clinical uncertainty. Although many studies have been published in recent years, there is still a paucity of authoritative evidence-based indications useful for guiding the prescription of these drugs during pregnancy, and the data from the literature are complex and require expert judgment to draw clear conclusions. Methods: For the elaboration of the consensus, we have involved the scientific societies of the sector, namely, the Italian Society of Toxicology, the Italian Society of Neuropsychopharmacology, the Italian Society of Psychiatry, the Italian Society of Obstetrics and Gynecology, the Italian Society of Drug Addiction and the Italian Society of Addiction Pathology. An interdisciplinary team of experts from different medical specialties (toxicologists, pharmacologists, psychiatrists, gynecologists, neonatologists) was first established to identify the needs underlying the consensus. The team, in its definitive structure, includes all the representatives of the aforementioned scientific societies; the task of the team was the evaluation of the most accredited international literature as well as using the methodology of the “Nominal Group Technique” with the help of a systematic review of the literature and with various discussion meetings, to arrive at the drafting and final approval of the document. Results: The following five areas of investigation were identified: (1) The importance of management of anxiety and depressive disorders in pregnancy, identifying the risks associated with untreated maternal depression in pregnancy. (2) The assessment of the overall risk of malformations with the antidepressant and anxiolytic drugs used in pregnancy. (3) The evaluation of neonatal adaptation disorders in the offspring of pregnant antidepressant/anxiolytic-treated women. (4) The long-term outcome of infants’ cognitive development or behavior after in utero exposure to antidepressant/anxiolytic medicines. (5) The evaluation of pharmacological treatment of opioid-abusing pregnant women with depressive disorders. Conclusions: Considering the state of the art, it is therefore necessary in the first instance to frame the issue of pharmacological choices in pregnant women who need treatment with antidepressant and anxiolytic drugs on the basis of data currently available in the literature. Particular attention must be paid to the evaluation of the risk/benefit ratio, understood both in terms of therapeutic benefit with respect to the potential risks of the treatment on the pregnancy and on the fetal outcome, and of the comparative risk between the treatment and the absence of treatment; in the choice prescription, the specialist needs to be aware of both the potential risks of pharmacological treatment and the equally important risks of an untreated or undertreated disorder.

Prescribing and deprescribing guidance for benzodiazepine and benzodiazepine receptor agonist use in adults with depression, anxiety, and insomnia: an international scoping review

“…BZD treatment specifications were provided more often in the context of perinatal/post-partum depressive disorders. 32 , 34 , 55 This could be explained by the emphasis on explicit safety considerations around medication use in pregnancy. For example, three guidelines offered explicit advice to use agents such as lorazepam, temazepam, oxazepam or brotizolam, which either undergo limited hepatic metabolism or have relatively shorter elimination half-lives to minimise theoretic fetal or lactational exposure.…”

“…For example, three guidelines offered explicit advice to use agents such as lorazepam, temazepam, oxazepam or brotizolam, which either undergo limited hepatic metabolism or have relatively shorter elimination half-lives to minimise theoretic fetal or lactational exposure. 32 , 34 , 55…”

Consensus Panel Recommendations for the Pharmacological Management of Breastfeeding Women with Postpartum Depression

“…On the other hand, a consensus statement and its recommendations are developed based on a collective opinion or consensus of the convened expert panel, and for this reason some authors excluded the consensus statements from their reviews [183,187]. But when the available evidence conflicts or is insufficient due to lack of high-quality evidence, the consensus is still a valid alternative and this is the case in the field of antidepressant treatment during breastfeeding, where the available data are very few, conflicting, and the clinical trials are lacking for ethical reasons [188].…”