Talk, drug therapy may ease depression in pregnancy

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Women who are depressed during pregnancy can take hope that antidepressants and/or “talk therapy” may be safe and appropriate treatment options, according to new professional guidelines made public this week.

“Depression in pregnant women often goes unrecognized and untreated in part because of concerns about the safety of treating women during pregnancy,” lead author of the guidelines, Dr. Kimberly Ann Yonkers, from Yale University, New Haven, Connecticut, said in a statement.

The guidelines on depression in pregnancy, which are based on an extensive review of prior research, were issued by the American Psychiatric Association and the American College of Obstetricians and Gynecologists. 

There are both pros and cons to using antidepressants during pregnancy, the report states. The drugs can effectively treat mom’s depression, which has been linked to problems in the newborn. However, there is also evidence tying them to birth defects and reduced birth weight.

Psychotherapy may be a suitable alternative to antidepressants for some women with mild-to-moderate depression, the report indicates.

According to the report, women thinking about becoming pregnant may possibly taper or discontinue their antidepressants if they have had mild or no symptoms for 6 months or longer.

However, they may need to continue their medications if they have a history of severe, recurrent depression or other major psychiatric illness.

The guidelines suggest that women see a psychiatrist for aggressive treatment if suicidal or acute psychotic symptoms are present.

Pregnant women currently taking antidepressants may be able to remain on the medications if they discuss the pros and cons with their doctors, the guidelines state.

Depending on their mental health history, these women may attempt tapering and going off their medications if symptom-free. Pregnant women taking antidepressants may benefit from psychotherapy if symptoms are still apparent, according to the document.

They should continue on their medication if depression is severe, the guidelines emphasize.

Pregnant women not currently taking antidepressants may consider psychotherapy as alternative to antidepressants, the report indicates. They should also be informed of the risks and benefits of antidepressants if they desire to use them.

SOURCE: Obstetrics and Gynecology, 2009 / General Hospital Psychiatry, 2009.

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