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Antepartum Depression
Aka: Antepartum Depression, Depression in Pregnancy, Depression Management in Pregnancy
- See Also
- Peripartum Depression
- Major Depression
- Psychiatric Medications in Pregnancy
- Epidemiology
- Pregnancy is not protective against Major Depression
- Risk Factors
- See Peripartum Depression
- Adverse Effects: Untreated Depression
- Untreated Depression risks
- Suicide
- Adverse effects on family functioning
- Increased risk of Intrauterine Growth Retardation and low birth weight
- Increased risk of preterm birth
- Concurrent adverse habit risks
- Tobacco Abuse
- Alcohol Abuse
- Illicit Drug abuse
- Adverse Effects: Medications
- SSRIs appear to be safe as a class in pregnancy
- Persistent Pulmonary Hypertension
- Increased risk by 6 fold if SSRIs used after 20 weeks
- Number needed to harm: 286-351
- Grigoriadis (2014) BMJ 348:f6932 [PubMed]
- Paroxetine (Paxil)
- Made Category D in 2005
- See Paxil for details
- Associated with cardiac defects with first trimester exposure
- Fluoxetine
- Well studied in pregnancy, but data in 2015 showed association with cardiac defects
- Association with VSD, right ventricular outflow tract obstruction cardiac defects, and Craniosynostosis
- Avoid in Lactation due to increased Fluoxetine levels in Breast Milk
- Berard (2015) Br J Clin Pharmacol +PMID:26613360 [PubMed]
- Studies that show no longterm newborn effects
- Addis (2000) Psychol Med 30:89-94 [PubMed]
- Hendrick (2003) Am J Obstet Gynecol 188:812-5 [PubMed]
- Some reports of short-term neonatal withdrawal
- Weak cry, mild Tachypnea, jitteriness
- Wisner (1999) JAMA 282:1264-9 [PubMed]
- SSRIs that have shown mixed or weak associations with Autism (as one of many contributing factors)
- Boukhris (2016) JAMA Pediatr 170(2):117-2 +PMID:26660917 [PubMed]
- Harrington (2014) Pediatrics 133:e1241-8 +PMID:24733881 [PubMed]
- Hviid A (2013) N Engl J Med 369:2406-15 [PubMed]
- Rai (2013) BMJ 346:f2059 [PubMed]
- Management
- Treat Major Depression in Pregnancy
- Avoid medications during first trimester
- Consult mental health counseling
- Psychotherapy (esp. CBT) is preferred first-line therapy over medication
- However, untreated depression is associated with low birth weight, preterm-birth, C-Section
- Select SSRI Antidepressants with most safety data
- Sertraline (Zoloft)
- Most commonly used SSRI in pregnancy, and preferred agent
- May be continued into Lactation (poorly secreted into Breast Milk)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Avoid agents associated with adverse effects
- Avoid Fluoxetine (Prozac)
- Best studied in pregnancy, but see adverse effects above
- Avoid Paroxetine (Paxil) due to higher fetal risk
- Avoid agents with insufficient efficacy and safety data in pregnancy
- Avoid Docosahexaenoic Acid
- Avoid St. John's Wort
- Severe, refractory major Depression in Pregnancy
- Electroconvulsive Therapy for severe Depression
- Prevention
- See Peripartum Depression
- References
- Langan (2016) Am Fam Physician 93(10):852-8 [PubMed]