Treatment of nonpsychotic major depression during pregnancy: patient safety and challenges

Abstract

In pregnant women with major depression, the overarching goal of treatment is to achieve or maintain maternal euthymia, thus limiting both maternal and fetal exposure to the harmful effects of untreated or incompletely treated depression. However, the absence of uniformly effective therapies with guaranteed obstetric and fetal safety makes the treatment of major depression during pregnancy among the most formidable of clinical challenges. Clinicians and patients are still faced with conflicting data and expert opinion regarding the reproductive safety of antidepressants in pregnancy, as well as large gaps in our understanding of the effectiveness of most antidepressants and nonpharmacological alternatives for treating antenatal depression. In this paper, we provide a clinically focused review of the available information on potential maternal and fetal risks of untreated maternal depression during pregnancy, the effectiveness of interventions for maternal depression during pregnancy, and potential obstetric, fetal, and neonatal risks associated with antenatal antidepressant use.

Chronobiology, sleep-related risk factors and light therapy in perinatal depression: the “Life-ON” project

“…With the exception of theoretical abnormalities in hypothalamic-pituitary-adrenal axis activity and possible genetic risk factors that are shared with a variety of psychiatric disorders, the etiopathogenesis of PND is still unknown. Once PND is recognized, no definitely safe pharmacologic treatments are available during pregnancy and breastfeeding [13], and the concurrent lack of preventive therapies exposes the health of women and children to the PND related risks. Placebo-controlled, randomized trials of antidepressant substances in this population are lacking, and the methodological flaws of available studies limit the generalizability of the findings.…”

Yoga for Chronic Depressive Symptoms in Pregnancy: A Commentary and Call to Action

“…Thus, many women remain under-or un-treated due to the actual and perceived risks involved in pharmacological therapy during pregnancy [5]. Even with UC, a majority of individuals do not achieve partial or full symptom remission [33][34][35][36][37].…”

“…Depressive symptoms are projected to be a leading cause of illness and disability in the world by 2030 [2,3].Nearly 20% of pregnant women experience depressive symptoms and 13% of pregnant women experience chronic, recurrent symptoms Of this large number of women experiencing depressive symptoms during pregnancy, the majority are experiencing depression as a chronic condition, rather than a new-onset occurrence [4][5][6][7]. Due to the often protracted, disabling nature of the symptom experience the adverse effects of depressive symptoms can significantly impact the mother as symptoms are associated with increased risk for poor adherence to prenatal care, preterm birth, suicide, substance abuse, and postpartum depression [4,[8][9][10][11][12][13][14][15].…”

“…Further, maternal depression can significantly alter maternal-fetal/child attachment, with potential future impact on emotional self-regulation of both mother and child [19][20][21]. In utero exposure to maternal depressive symptoms carries risks to the developing fetus; maternal symptoms are associated with poor infant outcomes including intrauterine growth restriction and child developmental delays [5,12,22,23]. Additionally, alterations in the intrauterine environment due to maternal depressive symptoms and the associated stress responses can affect the fetus via epigenetic pathways (environmentally-induced chemical modifications in DNA that affect gene functioning but not the underlying DNA sequence), which may increase the child's risk for the development of adult-onset chronic illnesses [24].…”

Prescribing in pregnancy - stop stopping and start planning

“…For example, successful treatment of women with antenatal depression is associated with reduced psychiatric symptoms and diagnoses in their children compared with an increase in those with ongoing depression. 3 …”