Mental health articles

OF mental health care and mentally ill

Treatment of Depression during Pregnancy

Depressive disorders are common in women of childbearing age, and postpartum depression is a serious complication of childbearing. The possibility of pregnancy should be considered in any pre-menopausal woman for whom antidepressant treatment is contemplated.

As many pregnancies are unplanned and unintended, contraceptive advice should be given at the outset of treatment and reviewed often, and an antidepressant with little evidence of teratogenicity should be chosen. Where pregnancy is planned, the risks of depression should be weighed against those of ceasing treatment: if antidepressant medication is to be continued, fl uoxetine (a SSRI) or possibly imipramine (a TCA) are preferred. If an unplanned pregnancy occurs while the patient is taking an antidepressant, greatest risk of harm to the foetus occurs in the fi rst 60 days post-conception. During this period, the drug should be stopped or the dose should be reduced as far as practicable. After 60 days, antidepressant treatment may be restarted if thought necessary. Women with a history of depressive disorders may be at greater risk of developing postnatal depression.

Maternal depression has been linked to impaired cognitive and social development in the child. There is little evidence that antidepressants taken during pregnancy provide effective prophylaxis. Treatment involves a combination of antidepressant medication, psychological therapy (there is evidence for CBT), and social support (often involving local organisations for mothers and their children).

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