Tuesday, January 12, 2010


This is an interesting article that was published in Medscape Medical News. If you are pregnant or considering attempting a pregnancy, please read this article and discuss it with your physician.

Depression and Pregnancy: New Report Weighs Treatment Options
Deborah Brauser From Medscape Medical News

At the end of the review, the investigators found that although both depressive symptoms and antidepressant exposure are associated with fetal growth changes and shorter gestation periods, the majority of the studies that evaluated antidepressant risks were unable to control for the possible effects of a depressive disorder.
The researchers also found that:
Neonates born to mothers with a depressive disorder have an increased risk for irritability, less activity and attentiveness, and fewer facial expressions compared with those born to mothers without depression.
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 (Paxil) 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 an increased risk for persistent pulmonary hypertension in the newborn.
Most of the studies did not show an association between tricyclic antidepressant use in pregnancy and structural malformations, but tricyclic antidepressants are associated with increased perinatal complications such as jitteriness, irritability, and convulsions in neonates.
The report also recommends several treatment algorithms. These common scenarios include the following.
Women Thinking About Getting Pregnant
Tapering and discontinuing medication for those with mild or no depressive symptoms for 6 months or longer.
This discontinuation may not be appropriate for women with a history of severe or recurrent depression (or who have psychosis, bipolar disorder, other psychiatric illness requiring medication, or a history of suicide attempts).
Pregnant Women Currently on Medication for Depression
After a consultation between their psychiatrist and obstetrician/gynecologist (to discuss risks), psychiatrically stable women who prefer to stay on medication may be able to do so.
For those who want to discontinue medication and are not experiencing symptoms, tapering and discontinuation may be attempted. However, women with a history of recurrent depression are at a high risk for relapse.
Those with recurrent depression or symptoms despite their medication may benefit from psychotherapy to replace or augment medication.
Women with severe depression should remain on medication. If a patient refuses, alternative treatment and monitoring should be in place, preferably before discontinuation.
Pregnant Women Not Currently on Medication for Depression
For those who want to avoid antidepressant medication, psychotherapy may be beneficial.
For those who prefer taking medication, risks and benefits of treatment choices should be evaluated and discussed.
In addition, regardless of circumstances, any pregnant woman with suicidal or psychotic symptoms should seek an immediate consultation with a psychiatrist for treatment.

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