The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists

Abstract

Objective To address the maternal and neonatal risks of both depression and antidepressant exposure and develop algorithms for periconceptional and antenatal management. Method Representatives from the American Psychiatric Association, the American College of Obstetricians and Gynecologists and a consulting developmental pediatrician collaborated to review English language articles on fetal and neonatal outcomes associated with depression and antidepressant treatment during childbearing. Articles were obtained from Medline searches and bibliographies. Search keywords included pregnancy, pregnancy complications, pregnancy outcomes, depressive disorder, depressive disorder/dt, abnormalities/drug-induced/epidemiology, abnormalities/drug-induced/et. Iterative draft manuscripts were reviewed until consensus was achieved. Results Both depressive symptoms and antidepressant exposure are associated with fetal growth changes and shorter gestations, but the majority of studies that evaluated antidepressant risks were unable to control for the possible effects of a depressive disorder. Short-term neonatal irritability and neurobehavioral changes are also linked with maternal depression and antidepressant treatment. Several studies report fetal malformations in association with first trimester antidepressant exposure but there is no specific pattern of defects for individual medications or class of agents. The association between paroxetine and cardiac defects is more often found in studies that included all malformations rather than clinically significant malformations. Late gestational use of selective serotonin reuptake inhibitor antidepressants is associated with transitory neonatal signs and a low risk for persistent pulmonary hypertension in the newborn. Psychotherapy alone is an appropriate treatment for some pregnant women; however, others prefer pharmacotherapy or may require pharmacological treatment. Conclusions Antidepressant use in pregnancy is well studied, but available research has not yet adequately controlled for other factors that may influence birth outcomes including maternal illness or problematic health behaviors that can adversely affect pregnancy.

Perinatal Selective Serotonin Reuptake Inhibitor Exposure: Impact on Brain Development and Neural Plasticity

“…Clinical and preclinical data clearly point to a pervasive impact of SSRI exposure on development [11,59]. It is possible that perinatal exposure to SSRIs protects against the effects of maternal depression.…”

Self-Objectification and Pregnancy: Are Body Functionality Dimensions Protective?

“…Women of childbearing age face a high risk of depression, and pregnancy can increase the risk of a depressive episode (Gaynes et al 2005). Between 14% and 23% of women will experience a depressive disorder while pregnant (Yonkers et al 2009), and depressive symptoms in a mother have been found to be associated with adverse reproductive outcomes in some studies, including low birth weight, shorter gestation, preterm delivery, increased risk for irritability and reduced activity and attentiveness (Yonkers et al 2009). Moreover, depression during pregnancy increases women's risk of postpartum depression (U.S. Department of Health & Human Services 2009), which can have consequences for both mother and child.…”

The Relationship Between Depression and Sleep Quality in Iranian Pregnant Women

“…Although, a history of depression is an important risk fac- tor for depression during pregnancy but half of women with no previous history of depression at pregnancy are affected (27). Psychosocial approaches including individual and group psychotherapy can be used for treatment of the most of patients with mild to moderate depression and these approaches are rather than drug therapy (28). Therefore, the identification and screening of women with depression in pregnancy can help their treatment and support strategies.…”