Unipolar Depression During Pregnancy: Nonpharmacologic Treatment Options

Christopher Tjoa; Emmanuelle Pare; Deborah R Kim

Disclosures

Women's Health. 2010;6(4):565-576. 

In This Article

Conclusion

Depression during pregnancy is an important and prevalent health problem. The costs of untreated depression are shared by both mother and fetus, making safe treatment options invaluable. Our commonest remedies for MDD in the nonpregnant population lack conclusive safety and efficacy data in pregnancy. Practice guidelines lay the groundwork for establishing the importance of treating depression in this population, and have concluded that psychotherapy and antidepressant medications are first-line treatment recommendations. Treatment alternatives add to the clinician's armamentarium, specifically for women who chose to forego psychotherapy and/or antidepressant medications. Options such as exercise or light therapy may provide a treatment alternative with a more acceptable risk profile, although their efficacy remains in question. For severe depression, treatment alternatives such as ECT or TMS may be the most effective and appropriate options available, although neither is FDA approved specifically for treatment during pregnancy.

In considering treatment recommendations, the clinician should consider severity of depression, past psychiatric history, psychiatric comorbidity, patient treatment preferences and the risks of not treating or undertreating maternal depression. In addition, all women with depression should also be screened for bipolar disorder as this diagnosis requires different treatment recommendations. Choosing a treatment option in depression during pregnancy can be a demanding process and consultation with a behavioral health specialist with expertise in reproductive issues is strongly urged, especially in cases where suicidal ideation, mania, psychosis or other significant psychiatric comorbidity is present. Particular attention should be given to adequately attaining informed consent.

For patients with a milder depression, complementary/alternative treatments offer therapeutic alternatives that often have known generalized benefits for mother and fetus and are generally accepted as safe, although efficacy in severe depression remains in doubt. As Freeman concluded in her review, exercise, omega-3 fatty acids and folic acid are three such options that can be easily added to any regimen with few risks, with the potential to alleviate mild-to-moderate MDE symptoms, but no conclusive evidence as of yet.[49]

In specific situations, a patient's depressive symptoms may warrant targeted treatment options. In expecting mothers with a history of seasonal mood symptoms, bright light therapy may be the most appropriate treatment alternative available. Similarly, for catatonic and psychotic depression, ECT would be a conspicuous choice. Women with a proclivity for traditional medicine remedies may find acupuncture to be a suitable treatment alternative. TMS remains an exciting and potentially valuable tool for treating antepartum depression, but more data are needed before it can be recommended.

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