COMMENTARY

December 2004: The Year in Review -- Ob/Gyn & Women's Health

Ursula Snyder, PhD

Disclosures

January 24, 2005

Pregnancy - Depression During Pregnancy

The Medscape Psychiatry & Mental Health Web site contains a wealth of information on primary prevention of depression. Here I would like to summarize briefly some of the research published in 2004 in relation to depression and pregnancy.

Although postpartum depression is now a well-known phenomenon, what is also becoming increasingly clear is that depression during pregnancy, especially during the second and third trimesters, is common. The results of meta-analysis published in 2004 indicate prevalences of 7.4%, 12.8%, and 12.0% for the first, second, and third trimesters, respectively.[112] However, data presented at the annual meeting of the American Psychiatry Association suggest that pregnant women who are depressed are unlikely to receive any treatment for their condition, and those who do receive treatment often receive suboptimal dosages. (See Medscape Medical News story.) A review by Bennett and colleagues[113] provides an up-to-date overview of antenatal depression and its clinical issues, which the authors suggest will afford healthcare providers the necessary evidence to make informed decisions regarding the management of depression for the obstetric patient. Of course, treatment with antidepressants during pregnancy is a difficult issue because of the relative lack of information on possible adverse effects. The results of a prospective study on adverse birth outcomes for women who used antidepressants – especially tricyclic antidepressants -- late in pregnancy suggest that the drugs can have adverse effects.[114] These results also suggest that selective serotonin reuptake inhibitors (SSRIs) may be less harmful, and the authors state that perhaps SSRIs should be the drugs of choice for treatment of depression during pregnancy. (See Medscape Medical News story.) However, another study published this year shows that gestational exposure to SSRIs may have important physiologic effects on the fetus.[115] A nonpharmacologic therapy, light therapy, is a promising alternative.[116] (See Medscape Medical News story.)

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