OB
Antepartum Depression
search
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
SSRI
s appear to be safe as a class in pregnancy
Persistent
Pulmonary Hypertension
Increased risk by 6 fold if
SSRI
s 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]
SSRI
s 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
Antidepressant
s 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]
Type your search phrase here