depression during pregnancy
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Epidemiology
- 14% of women[1]
- peak incidence at 32 weeks of gestation
- pregnancy NOT protective for women with depression[3]
Diagnostic procedures
- depression during pregnancy associated with enriched DNA methylation patterns in cord blood, lymphocytes, & hippocampi (post-mortem) of offspring involving genes that regulate immune function & stress reactivity[8]
Complications
- women with severe recurrent major depression who stop pharmacotherapy are at high risk for relapse
Management
- general
- adequate treatment of depression is essential, ideally beginning before conception
- clinicians & patients should make decisions about pharmacotherapy collaboratively
- psychiatric referral for patients with severe depression, acute suicidality, psychosis, or bipolar disorder[6]
- both maternal depression & prenatal antidepressants can affect offspring[8]
- psychotherapy (preferably cognitive-behavioral therapy or interpersonal psychotherapy) is recommended for treatment of mild-to-moderate depression during pregnancy[6]
- antidepressant use during pregnancy is safe[10]
- depression during pregnancy associated with preterm birth & low Apgar score regardless of antidepressant use[10]
- neither depression nor antidepressant use associated with low birth weight or small for gestational age delivery[10]
- pharmacologic agents (antidepressants)
- selective serotonin re-uptake inhibitor (SSRI)*[2][4]
- may be risk to fetus, but absolute risks are small[9]
- sertraline probably safest for fetus
- not associated with septal defects[9]
- citalopram may increase risk of
- septal heart defects when used early in pregnancy[5]
- probably not[9]
- marginal link with neural tube defects[9]
- septal heart defects when used early in pregnancy[5]
- fluoxetine (Prozac) is associated with
- ventricular septal defects
- right ventricular outflow tract obstruction cardiac defects
- craniosynostosis
- paroxetine (Paxil) is associated with
- anencephaly
- atrial septal defects
- right ventricular outflow tract obstruction cardiac defects
- gastroschisis
- omphalocele
- neonatal withdrawal, neonatal pulmonary hypertension[4]
- tricyclic antidepressants
- a few reports of irritability, respiratory problems & seizures in infants born to women taking SSRIs or Effexor[2]
- electroconvulsive therapy is an option in severe depression[6]
- selective serotonin re-uptake inhibitor (SSRI)*[2][4]
* preferred agents
More general terms
Additional terms
References
- ↑ 1.0 1.1 Journal Watch 21(19):156-7, 2001 Evans et al BMJ 323:257, 2001
- ↑ 2.0 2.1 2.2 Prescriber's Letter 11(8): 2004 Treatment of Antenatal and Postpartum Depression Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200810&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 3.0 3.1 Cohen LS et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 2006 Feb 1; 295:499-507. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16449615
- ↑ 4.0 4.1 4.2 Levinson-Castiel R et al, Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolisc Med 2006; 160:173 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16461873
Chambers CD et al, Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med 2006; 354:579 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16461545 - ↑ 5.0 5.1 Pedersen LH et al Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population based cohort study BMJ 2009;339:b3569 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19776103 <Internet> http://www.bmj.com/cgi/content/full/339/sep23_1/b3569
Chambers C Selective serotonin reuptake inhibitors and congenital malformations BMJ 2009;339:b3525 http://www.bmj.com/cgi/content/extract/339/sep23_1/b3525 - ↑ 6.0 6.1 6.2 6.3 Yonkers KA et al The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Gen Hosp Psychiatry. 2009 Sep-Oct;31(5):403-13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19703633
Yonkers KA et al The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists Obstet Gynecol. 2009 Sep;114(3):703-13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19701065
Yonkers KA et al Typical somatic symptoms of pregnancy and their impact on a diagnosis of major depressive disorder. Gen Hosp Psychiatry. 2009 Jul-Aug;31(4):327-33. Epub 2009 Apr 15. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19555792 - ↑ Prescriber's Letter 16(10): 2009 Treatment of Depression in Pregnancy Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=251006&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 8.0 8.1 8.2 Nemoda Z et al. Maternal depression is associated with DNA methylation changes in cord blood T lymphocytes and adult hippocampi. Transl Psychiatr 2015 Apr 7; 5:e545. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25849984 <Internet> http://www.nature.com/tp/journal/v5/n4/full/tp201532a.html
Brandlistuen RE et al. Behavioural effects of fetal antidepressant exposure in a Norwegian cohort of discordant siblings. Int J Epidemiol 2015 Apr 14 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25873178 <Internet> http://ije.oxfordjournals.org/content/early/2015/04/14/ije.dyv030 - ↑ 9.0 9.1 9.2 9.3 9.4 Reefhuis J et al Specific SSRIs and birth defects: bayesian analysis to interpret new data in the context of previous reports. BMJ 2015;351:h3190 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26156519 <Internet> http://www.bmj.com/content/351/bmj.h3190
- ↑ 10.0 10.1 10.2 10.3 Vlenterie R, van Gelder MMHJ, Anderson HR et al. Associations between maternal depression, antidepressant use during pregnancy, and adverse pregnancy outcomes: An individual participant data meta-analysis. Obstet Gynecol 2021 Oct; 138:633-646. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34623076 https://lww.com/pages/results.aspx?txtKeywords=10.1097%2fAOG.0000000000004538