Treating depression in pregnancy

Depression is not uncommon in pregnant women. Between 14 and 23% of pregnant women will experience a depressive disorder while pregnant. In 2003, approximately 13% of pregnant women took an anti-depressant at some point during their pregnancy. This rate has doubled since 1999. Many women go untreated due to concerns regarding the safety of treating pregnant women.

“The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists” describes results from an unusual collaboration of authors from the American Psychiatric Association and American College of Obstetricians and Gynecologists, as well as a consulting developmental pediatrician. These authors reviewed the world's English-language literature and reported results describing the association of depressive symptoms and anti-depressant treatment on fetal and neonatal outcomes.

Both depressive symptoms and anti-depressant exposure were found to be associated with fetal growth changes and shorter gestations. Short-term neonatal irritability and neurobehavioral changes were also linked with both maternal depression and anti-depressant treatment. Some, but not all, studies reported low rates of fetal malformations with first trimester exposure, but there was no specific pattern of defects for individual medications or class of agents.

“This timely article by Yonkers and colleagues reviews the data on the potential effects of both anti-depressant medications and depressive symptoms on birth and fetal outcomes,” said Wayne J. Katon, MD, Editor-in-Chief of General Hospital Psychiatry.

This article is also published in the September 2009 issue of Obstetrics & Gynecology.