Skip to main content Accessibility help
×
Home
Hostname: page-component-768dbb666b-9hf5z Total loading time: 0.541 Render date: 2023-02-05T09:03:47.568Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Diagnosis and Treatment of Depression During Pregnancy

Published online by Cambridge University Press:  07 November 2014

Abstract

Pregnancy has frequently been described as a time of affective well-being. However, a growing literature suggests that women are neither “protected” against new-onset or recurrence of depression during this time. Diagnosis and effective treatment of depression during pregnancy requires a careful weighing of risk of treatment which may include psychotropic medications against the risks associated with failure to adequately manage affective distress and its potential impact of maternal and fetal well-being. Treatment options during pregnancy are reviewed in the context of developing the most appropriate risk/benefit decision for individual patients with past or current depression who either anticipate pregnancy or who become pregnant.

Type
Review Articles
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Zajicek, E. Psychiatric problems during pregnancy. In: Wolkind, S, Zajicek, E, eds. Pregnancy: A Psychological and Social Study. London, England: Academic Press; 1981:5773.Google Scholar
2.Evans, J, Heron, J, Francomb, H, Oke, S, Golding, J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323:257260.CrossRefGoogle ScholarPubMed
3.Cohen, LS, Sichel, DA, Dimmock, JA, Rosenbaum, JF. Impact of pregnancy on panic disorder: a case series. J Clin Psychiatry. 1994;55:284288.Google ScholarPubMed
4.Cohen, LS, Sichel, DA, Faraone, SV, Robertson, LM, Dimmock, JA, Rosenbaum, JF. Course of panic disorder during pregnancy and the puerperium: a preliminary study. Biol Psychiatry. 1996;39:950954.CrossRefGoogle ScholarPubMed
5.Northcott, CJ, Stein, MB. Panic disorder in pregnancy. J Clin Psychiatry. 1994;55:539542.Google ScholarPubMed
6.O'Hara, MW. Social support, life events, and depression during pregnancy and the pueperium. Arch Gen Psychiatry. 1986;43:569573.CrossRefGoogle Scholar
7.Frank, E, Kupfer, DJ, Jacob, M, Blumenthal, SJ, Jarrett, DB. Pregnancy-related affective episodes among women with recurrent depression. Am J Psychiatry. 1987;144:288293.Google ScholarPubMed
8.Kessler, RC, McGonagle, KA, Swartz, M, Blazer, DG, Nelson, CB. Sex and depression in the National Comorbidity Survey. I: Lifetime prevalence, chronicity and recurrence. J Affect Disord. 1993;29:8596.CrossRefGoogle ScholarPubMed
9.Eaton, WW, Kessler, RC, Wittchen, HU, Magee, WJ. Panic and panic disorder in the United States. Am J Psychiatry. 1994;151:413420.Google ScholarPubMed
10.Kupfer, D, Frank, E, Perel, J, et al.Five-year outcome for maintenance therapies in recurrent depression. Arch Gen Psychiatry. 1992;49:769773.CrossRefGoogle ScholarPubMed
11.Orr, ST, Miller, C. Maternal depressive symptoms and the risk of poor pregnancy outcome. Review of the literature and preliminary findings. Epidemiol Rev. 1995;17:165171.CrossRefGoogle ScholarPubMed
12.Steer, RA, Scholl, TO, Hediger, ML, Fischer, RL. Self-reported depression and negative pregnancy outcomes. J Ciin Epidemiol. 1992;45:10931099.CrossRefGoogle ScholarPubMed
13.Kendell, RE, Wainwright, S, Hailey, A, Shannon, B. The influence of childbirth on psychiatric morbidity. Psychol Med. 1976;6:297302.CrossRefGoogle ScholarPubMed
14.Kendell, RE, Chalmers, JC, Platz, C. Epidemiology of puerperal psychoses. Br J Psychiatry. 1987;150:662673.CrossRefGoogle ScholarPubMed
15.Kumar, R, Robson, KM. A prospective study of emotional disorders in childbearing women. Br J Psychiatry. 1984;144:3547.CrossRefGoogle ScholarPubMed
16.O'Hara, MW. Postpartum Depression: Causes and Consequences. New York, NY: Springer-Verlag; 1995.Google Scholar
17.O'Hara, MW, Schlechte, JA, Lewis, DA, et al.Controlled prospective study of postpartum mood disorders: psychological, environmental, and hormonal factors. J Abnorm Psychol. 1991;100:6373.CrossRefGoogle Scholar
18.Gotlib, IH, Whiffen, VE, Mount, JH, Milne, K, Cordy, NI. Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum period. J Consult Clin Psychol. 1989;57:269274.CrossRefGoogle Scholar
19.Moline, M, Altshuler, L, Cohen, L, Kahn, D, Carpenter, D, Docherty, J. Expert Consensus Guideline Series: Treatment of Depression in Women 2001. Postgrad Med. 2001(spec no): 1107.Google Scholar
20.Altshuler, L, Cohen, L, Moline, M, Kahn, D, Carpenter, D, Docherty, J. Expert Consensus Guideline Series: treatment of depression in women. Postgrad Med. 2001:1116.Google Scholar
21.Frautschi, S, Maine, D. Suicide during pregnancy and its neglect as a component of maternal mortality. Int J Gynoecol Obstet. 1994;47:275284.CrossRefGoogle ScholarPubMed
22.Appleby, L. Suicide during pregnancy and in the first postnatal year. BMJ. 1991;302:137140.CrossRefGoogle ScholarPubMed
23.Marzuk, M, Tardiff, K, Leon, AC, et al.Lower risk of suicide during pregnancy. Am J Psychiatry. 1997;154:122123.Google ScholarPubMed
24.Beck, AT, Rush, AJ, Shaw, BF, Emery, G. Cognitive Therapy of Depression. New York, NY: Guilford; 1979.Google Scholar
25.Klerman, GL, Weissman, MM, Rounsaville, BJ, et al.Interpersonal Psychotherapy of Depression. New York, NY: Basic Books; 1984.Google Scholar
26.Spinelli, M. Interpersonal psychotherapy for depressed antepartum women: a pilot study. Am J Psychiatry. 1997;154:10281030.Google ScholarPubMed
27.Orr, S, James, SA, Blackmore Prince, C. Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, Maryland. Am J Epidemiol. 2002;156:797802.CrossRefGoogle ScholarPubMed
28.Nonacs, R, Viguera, AC, LS., C. Psychiatric aspects of pregnancy. In: Kornstein, SC, Clayton, AH, ed. Women's Mental Health. New York, NY: Guilford; 2001.Google Scholar
29.Cohen, LS, JF, R. Psychotropic drug use during pregnancy: weighing the risks. J Clin Psychiatry. 1998;59(suppl 2):1828.Google ScholarPubMed
30.Cohen, L, Altshuler, L, Heller, V, Rosenbaum, J. Psychotropic drug use in pregnancy. In: Bassuk, Ga, ed. The Practitioner's Guide to Psychoactive Draugs. vol. 4. New York: Plenum Publishing Corporation; 1998:417440.CrossRefGoogle Scholar
31.Cott, Wisner. Psychiatric disorders during pregnancy. Int Rev Psychiatry. 2003;15:217230.CrossRefGoogle ScholarPubMed
32.Altshuler, LL, Cohen, LS, Szuba, MP, Burt, VK, Gitlin, M, Mintz, J. Pharmacologic management of psychiatric illness in pregnancy: dilemmas and guidelines. Am J Psychiatry. 1996;153:592606.Google ScholarPubMed
33.Cohen, L, Altshuler, L. Pharmacologic management of psychiatric illness during pregnancy and the postpartum period. In: Dunner, D, Rosenbaum, J, eds. The Psychiatric Clinics of North America Annual of Drug Therapy. Philadelphia, Penn: WB Saunders Company; 1997:2160.Google Scholar
34.Wisner, KL, Gelenberg, AJ, Leonard, H, Zarin, D, Frank, E. Pharmacologic treatment of depression during pregnancy. JAMA. 1999;282:12641269.CrossRefGoogle ScholarPubMed
35.Pastuszak, A, Schick-Boschetto, B, Zuber, C, et al.Pregnancy outcome following first-trimester exposure to fluoxetine (Prozac). JAMA. 1993;269:22462248.CrossRefGoogle Scholar
36.Altshuler, LL, Hendrick, VC. Pregnancy and psychotropic medication: changes in blood levels. J Clin Psychopharmacol. 1996;16:7880.CrossRefGoogle ScholarPubMed
37.Chambers, C, Johnson, K, Dick, L, Felix, R, Jones, KL. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med. 1996;335:10101015.CrossRefGoogle ScholarPubMed
38.Nulman, I, Rovet, J, Stewart, D, et al.Neurodevelopment of children exposed in utero to antidepressant drugs. N Engl J Med. 1997;336:258262.CrossRefGoogle ScholarPubMed
39.Kulin, N, Pastuszak, A, Sage, S, et al.Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA. 1998;279:609610.CrossRefGoogle ScholarPubMed
40.Einarson, AFB, Sarkar, M, Lavigne, SV, et al.Pregnancy outcome following gestational exposure to venlafaxine: a multicenter prospective controlled study. Am J Psychiatry. 2001;158:17281730.CrossRefGoogle ScholarPubMed
41.Nulman, IRJ, Stewart, DE, Wolpin, J, Pace-Asciak, P, Shuhaiber, S, Koren, G. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry. 2002;159:18891895.CrossRefGoogle ScholarPubMed
42.Einarson, A, Bonari, L, Voyer-Lavigne, S, Addis, AMD, Johnson, YKG. A multicentre prospective controlled study to determine the safety of trazodone and nefazodone use during pregnancy. Can J Psychiatry. 2003;48:106110.CrossRefGoogle ScholarPubMed
43.Ericson, AKB, Wilhom, B. Delivery outcome after the use of antidepressants in early pregnancy. Eur J Clin Psychopharmacol. 1999;55:503508.CrossRefGoogle ScholarPubMed
44.Tennis, P, Eldridge, RR; International Lamotrigine Pregnancy Registry Scientific Advisory Committee. Preliminary results on pregnancy outcome in women using lamotrigine. Epilepsia. 2002;43:11611167.CrossRefGoogle ScholarPubMed
45.Dicke, JM. Teratology: principles and practice. Med Clin North Am. 1989;73:567581.CrossRefGoogle ScholarPubMed
46.McElhatton, P, Garbis, H, Elefant, E, et al.The outcome of pregnancy in 689 women exposed to therapeutic doses of antidepressants: a collaborative study of the European Network of Teratology Information Services (ENTIS). Reprod Toxicol. 1996;10:285294.CrossRefGoogle Scholar
47.Loebstein, R, Koren, G. Pregnancy outcome and neurodevelopment of children exposed in utero to psychoactive drugs: the Motherisk experience. J Psychiatry Neurosci. 1997;22:192196.Google ScholarPubMed
48.Nulman, I, Koren, G. The safety of fluoxetine during pregnancy and lactation. Teratology. 1996;53:304308.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
49.Goldstein, DJ, Williams, ML, Pearson, DK. Fluoxetine-exposed pregnancies. Clin Res. 1991;39:768A.Google Scholar
50.Goldstein, DJ. Effects of third trimester fluoxetine exposure on the newborn. J Clin Psychopharmacol. 1995;15:417420.CrossRefGoogle ScholarPubMed
51.Cohen, LS, Heller, VL, Bailey, JW, Grush, L, Ablon, JS, Bouffard, SM. Birth outcomes following prenatal exposure to fluoxetine. Biol Psychiatry. 2000;48:9961000.CrossRefGoogle ScholarPubMed
52.Goldstein, DJ, Sundell, KL, Corbin, LA. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med. 1997;336:872873.Google ScholarPubMed
53.Simon, G, Korff, MV, Heiligenstein, J, et al.Initial antidepressant choice in primary care. Effectiveness and cost of fluoxetine vs. tricyclic antidepressants. JAMA. 1996;275:18971902.CrossRefGoogle ScholarPubMed
54.Inman, W, Kobotu, K, Pearce, G, et al.Prescription event monitoring of paroxetine. PEM Reports. 1993;PXL1206:144.Google Scholar
55.Simon, GE, Cunningham, ML, Davis, RL. Outcomes of prenatal antidepressant exposure. Am J Psychiatry. 2002;159:20552061.CrossRefGoogle ScholarPubMed
56.Henshaw, S. Unintended pregnancy in the United States. Fam Plain Perspect. 1998;30:24-29, 46.Google ScholarPubMed
57.Heinonen, O, Sloan, D, Shapiro, S. Birth Defects and Drugs in Pregnancy. Littleton, Mass: Publishing Services Group; 1977.Google Scholar
58.Nordeng, H, Lindemann, R, Perminov, KV, Reikvam, A. Neonatal withdrawal syndrome after in utero exposure to selective serotonin reuptake inhibitors. Acta Paediatr. 2001;90:288–91.CrossRefGoogle ScholarPubMed
59.Cowe, L, Lloyd, D, Dawling, S. Neonatal convulsions caused by withdrawal from maternal clomipramine. Br Med J (Clin Res Ed). 1982;284:18371838.CrossRefGoogle ScholarPubMed
60.Eggermont, E. Withdrawal symptoms in neonates associated with maternal imipramine therapy. Lancet. 1973;2:680.CrossRefGoogle ScholarPubMed
61.Schimmell, MS, Katz, EZ, Shaag, Y, Pastuszak, A, Koren, G. Toxic neonatal effects following maternal clomipramine therapy. J Toxicol Clin Toxicol. 1991;29:479484.CrossRefGoogle ScholarPubMed
62.Webster, PA. Withdrawal symptoms in neonates associated with maternal antidepressant therapy. Lancet. 1973;2:318319.CrossRefGoogle ScholarPubMed
63.Bromiker, R, Kaplan, M. Apparent intrauterine fetal withdrawal from clomipramine hydrochloride. JAMA. 1994;272:17221723.CrossRefGoogle ScholarPubMed
64.Falterman, LG, Richardson, DJ. Small left colon syndrome associated with maternal ingestion of psychotropics. J Pediatr. 1980;97:300310.CrossRefGoogle Scholar
65.Shearer, WT, Schreiner, RL, Marshall, RE. Urinary retention in a neonate secondary to maternal ingestion of nortriptyline. J Pediatr. 1972;81:570572.CrossRefGoogle Scholar
66.Spencer, MJ. Fluoxetine hydrochloride (Prozac) toxicity in the neonate. Pediatrics. 1993;92:721722.Google ScholarPubMed
67.Casper, RC, Fleisher, BE, Lee-Ancajas, JC, et al.Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy. J Pediatr. 2003;142:402408.CrossRefGoogle ScholarPubMed
68.Costei, AM, Kozer, E, Ho, T, Ito, S, Koren, G. Perinatal outcome following third trimester exposure to paroxetine. Arch Pediarr Adolesc Med. 2002;156:1129–32.CrossRefGoogle ScholarPubMed
69.Dahl, ML, Olhager, E, Ahlner, J. Paroxetine withdrawal syndrome in a neonate [letter]. Br J Psychiatry. 1997;171:391392.CrossRefGoogle Scholar
70.Stiskal, JAKN, Koren, G, Ho, T, Ito, S. Neonatal paroxetine withdrawal syndrome. Arch Dis Child Fetal Neonatal Ed. 2001;84:F134F135.CrossRefGoogle ScholarPubMed
71.Laine, K, Heikkinen, T, Ekblad, U, Kero, P. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations. Arch Gen Psychiatry. 2003;60:720726.CrossRefGoogle ScholarPubMed
72.Coyle, I, Wayner, M, Singer, G. Behavioral teratogenesis: a critical evaluation. Pharmacol Biochem Behav. 1976;4:191200.CrossRefGoogle ScholarPubMed
73.Vorhees, C, Brunner, R, Butcher, R. Psychotropic drugs as behavioral teratogens. Science. 1979;205:12201225.CrossRefGoogle ScholarPubMed
74.Vernadakis, A, Parker, K. Drugs and the developing central nervous system. Pharmacol Ther. 1980;11:593647.CrossRefGoogle ScholarPubMed
75.Montero, D, DeCeballos, M, DelRio, J. Down-regulation of 3H-Imipramine binding sites in rat cerebral cortex after prenatal exposure to antidepressants. Life Sciences. 1990;46:16191626.CrossRefGoogle Scholar
76.Krauer, . Pharmacotherapy during pregnancy: emphasis on pharmacokinetics. In: MF, London, ed. Drag Therapy During Pregnancy. London, England: Butterworths; 1985:931.CrossRefGoogle Scholar
77.Jeffries, WS, Bochner, F. The effect of pregnancy on drug pharmacokinetics. Med J Aust. 1988;149:675677.Google ScholarPubMed
78.Wisner, K, Perel, J, Wheeler, S. Tricyclic dose requirements across pregnancy. Am J Psychiatry. 1993;150:15411542.Google ScholarPubMed
79.Hostetter, A, Stowe, ZN, Strader, JR Jr, McLaughlin, E, Llewellyn, A. Dose of selective serotonin uptake inhibitors across pregnancy: clinical implications. Depress Anxiety. 2000;11:5157.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
80.Eggermont, E, Raveschat, J, Deneve, V. The adverse influence of imipramine on the adaptation of the newborn infant to extrauterine life. Acta Paediatr Belg. 1972;26:197204.Google ScholarPubMed
81.Cooper, GL. The safety of fluoxetine: an update. Br J Psychiatry Suppl. 1988:7786.Google Scholar
82.Geddes, JR, Carney, SM, Davies, C, et al.Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet. 2003;361:653661.CrossRefGoogle ScholarPubMed
83.Frank, E, Kupfer, DJ, Perel, JM, et al.Comparison of full-dose versus half-dose pharmacotherapy in the maintenance treatment of recurrent depression. J Affect Disord. 1993;27:139145.CrossRefGoogle ScholarPubMed
84.Ferrill, MJ, Kehoe, WA, Jacisin, JJ. ECT during pregnancy: Physiologic and pharmacologic considerations. Convul Ther. 1992;8:186200.Google ScholarPubMed
85.Miller, LJ. Use of electroconvulsive therapy during pregnancy. Hosp Comm Psychiatry. 1994;45:444450.Google ScholarPubMed
86.Sherer, DM, D'Amico, LD, Warshal, DP, Stern, RA, Grunert, HF, Abramowicz, JS. Recurrent mild abruption placentae occurring immediately after repeated electroconvulsive therapy in pregnancy. Am J Obstet Gynecol. 1991;165:652653.CrossRefGoogle Scholar
23
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Diagnosis and Treatment of Depression During Pregnancy
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Diagnosis and Treatment of Depression During Pregnancy
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Diagnosis and Treatment of Depression During Pregnancy
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *