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New Recommendations for Treating Depression During Pregnancy
 Depression is common
during pregnancy-between
14 percent and 23 percent of pregnant women will experience depressive symptoms
while pregnant. In 2003, approximately 13 percent of women took an
antidepressant at some time during their pregnancy.
A new report from the American College of
Obstetricians and Gynecologists (ACOG) and the American Psychiatric Association
(APA), based on an extensive review of existing research, offer recommendations
for the treatment of women with depression during pregnancy.
Both depression symptoms and the use of
antidepressant medications during pregnancy have been associated with negative
consequences for the
newborn.
Infants born to women with depression have increased risk for
irritability, less activity and attentiveness, and fewer facial expressions
compared with those born to mothers without depression. Depression and its
symptoms are also associated with
fetal growth change and
shorter gestation periods. And while available research still leaves some
questions unanswered, some studies have linked fetal malformations, cardiac
defects, pulmonary hypertension, and reduced birth weight to antidepressant use
during pregnancy.
Identifying depression in pregnant women can be
difficult because its symptoms mimic those associated with pregnancy, such as
changes in mood, energy level, appetite, and cognition.
According to the report, some patients with
mild-to-moderate depression can be treated with psychotherapy (alone or in
combination with medication. In addition, the report discusses the need for
ongoing consultation between a patient's ob-gyn and psychiatrist during
pregnancy and presents algorithms for treating patients in common scenarios:
Women thinking about getting pregnant
-
 For women on
medication with mild or no symptoms for 6 months or longer, it may be
appropriate to taper and discontinue medication before becoming pregnant.
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Medication
discontinuation may not be appropriate in women with a history of severe,
recurrent depression (or who have psychosis, bipolar disorder, other psychiatric
illness requiring medication, or a history of suicide attempts).
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Women with suicidal or
acute psychotic symptoms should be referred to a psychiatrist for aggressive
treatment.
Pregnant women currently on medication for
depression
-
Psychiatrically
stable women who prefer to stay on medication may be able to do so after
consultation between their psychiatrist and ob-gyn to discuss risks and
benefits.
-
Women who would like
to discontinue medication may attempt medication tapering and discontinuation if
they are not experiencing symptoms, depending on their psychiatric history.
Women with a history of recurrent depression are at a high risk of relapse if
medication is discontinued.
-
Women with recurrent
depression or who have symptoms despite their medication may benefit from
psychotherapy to replace or augment medication.
-
Women with severe
depression (with suicide attempts, functional incapacitation, or
weight loss) should remain
on medication. If a patient refuses medication, alternative treatment and
monitoring should be in place, preferably before discontinuation.
Pregnant and not currently on medication for
depression
-
Psychotherapy may
be beneficial in women who prefer to avoid antidepressant medication.
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For women who prefer
taking medication, risks and benefits of treatment choices should be evaluated
and discussed, including factors such as stage of gestation, symptoms, history
of depression, and other conditions and circumstances (eg, a
smoker, difficulty
gaining weight).
All pregnant women
-
Regardless of
circumstances, a woman with suicidal or psychotic symptoms should immediately
see a psychiatrist for treatment.
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