@@include("../../includes/head.inc", {"p": "../../"})@@

Depression

Back
  • In all age groups, depression is more common among women than men.
  • Prior history of depression during pregnancy is a strong predictor of postpartum depression.
  • The PHQ-2 can be used as an initial screen for perinatal and postpartum depression, but a positive screen should be followed by a PHQ-9 or the Edinburgh Postpartum Depression Scale (EPDS, 10 questions) (See Resources for screening tools).
  • Discuss the risks of postpartum depression (onset within 4 weeks of delivery) and postpartum psychosis, which can be life threatening for mother and baby.
  • Some data support increased rates of obstetrical complications and poor neonatal outcome in depressed pregnant women including an increased risk of preterm birth and low birth weight.
  • Research supports adverse effects of depression during pregnancy on patient, infant and families.
  • Antidepressants are not major teratogens:
    • Selective serotonin reuptake inhibitors (SSRIs) have more study data about the relative risks of use during pregnancy than most other medicines. The absolute risks of congenital malformations with SSRI exposure during pregnancy are small.
    • Paroxetine use during the first trimester is associated with about a 2-fold increased risk for cardiac malformations (e.g. ventricular septal defects, right ventricular outflow tract obstruction).
    • Reproductive safety data are more limited for Selective Norepinephrine Reuptake Inhibitors (SNRI).
    • Tricyclic antidepressants (TCA) are not associated with an increased risk for congenital anomalies but may have some undesirable side effects.
    • Neonatal withdrawal syndrome can occur but is usually mild and easy to manage.
  • Safest medication to use across pregnancy is the one that is able to achieve euthymia.
  • Avoid monoamine oxidase inhibitors in women trying to conceive.
@@include("../../includes/footer.inc", {"p": "../../"})@@