Depression is a common phenomenon during pregnancy with between 10-15 percent of pregnant women meeting criteria for major depression and up to 70 percent reporting some symptoms throughout the pregnancy term. Postpartum depression is the most prevalent complicating event, occurring in about 15 percent of women, on average.
Untreated or unrecognized depression is significantly associated with poor pregnancy outcomes. Premature birth rates are higher and the risks of low birth weight infants, as well as postnatal complications, are increased. Also a depression that goes unmanaged is linked to an increased tendency to self-medicate with tobacco and drugs with abuse potential, including alcohol.
Psychotherapy is the best initial step for addressing mild or moderate depression during pregnancy. And women reluctant to consent to antidepressants are prime candidates for any of the commonly employed psychosocial therapies utilized today.
When it comes to antidepressant or other psychotropic medication use during pregnancy, the best approach is to begin with conducting a thorough history. The key issue is determining the acuity of the pregnant woman’s risk for the occurrence of depressive episodes during childbearing. Fetal exposure to psychotropics and the possibility of depression relapse are vital considerations. If the risk of relapse is high, warranting the use of medication, discussing pros and cons with the pregnant woman is imperative. The goal of medication management is to establish and maintain a euthymic state throughout the duration of the pregnancy – utilizing the lowest possible effective medication dosing strategies.
Determining risk beckons that certain questions be asked. Some of these include: How serious were previous depressive events? Did treatment, if any, include antidepressants or other psychiatric medications? Was there evidence of postpartum depression, and if so, what were the ramifications? Is the woman currently using psychotropics and for how long? Do they seem to be working? If the medications were discontinued, what happened? Is suicide possibly an issue?
Lastly, the use of multiple medications during pregnancy is a risky proposition. More medications equals a more complicated and potentially more serious adverse events profile, so optimizing and maximizing the benefits of a single medication is the safest and most reasonable strategy. Pregnancy is not the time for testing the waters of experimentation. The best case scenario is that if a woman needs a psychotropic medication during pregnancy and is taking a drug that seems to be working, she should continue on it, until adverse circumstances signal a reevaluation.
