The American Psychiatric Association and American College of Obstetricians and Gynecologists has released joint recommendations for weighing the risks and benefits of treatment options for women with perinatal depression. This summary report is intended in part to act as a guideline for Ob-Gyns and to encourage them to take an active role in diagnosing and treating depression in their patients. In short, the authors state that many patients with mild or moderate depression may be effectively treated using psychotherapy alone, but patients with severe mental illness (eg, bipolar disorder or a history of severe depression) should be referred to a psychiatrist for treatment during pregnancy. The authors also note that existing research on antidepressant exposure in pregnancy fails to control for adverse outcomes due to other health factors or pregnancy complications, including the effects of untreated depression.
For patients who need or prefer antidepressant therapy, scientists continue to plumb the data in search of information about the effects of antidepressants during pregnancy. The British Medical Journal recently published a paper by Danish researchers who looked at possible major teratogenic effects from exposure to SSRIs in pregnancy. Using birth and prescription data from Danish registries, they found a significant increase in septal heart defects when two types of SSRIs—sertraline and citalopram—were taken in the first trimester, with the highest prevalence in babies of women who were prescribed two or more SSRIs concurrently. Paroxetine and fluoxetine were not found to be associated with any major birth defects.
To learn more about SSRI use during pregnancy, please view Dr. Shari Lusskin's presentation, SSRIs and Pregnancy.
Identification of postpartum depression.
Sit DK, Wisner KL.
Clin Obstet Gynecol. 2009 Sep;52(3):456-68.
This study reviewed the diagnostic criteria, clinical risk factors, and screening tools for PPD as well as how to manage patients who screen positive for postpartum depressive disorders.
Antidepressant medication use during breastfeeding.
Lanza di Scalea T, Wisner KL. Clin Obstet Gynecol. 2009 Sep;52(3):483-97.
This review of 31 empirical papers identified the most evidence-based medications for use during breastfeeding.
The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists.
Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N, Ramin S, Chaudron L, Lockwood C. Gen Hosp Psychiatry. 2009 Sep-Oct;31(5):403-13.
Using Medline searches, researches evaluated studies of antidepressant exposure during pregnancy to determine the risks of depression and antidepressant exposure in pregnancy. Few of the studies controlled for possible effects of depressive disorder.
In The News
Margaret Trudeau speaks in Regina at the Unmasking Postpartum Depression conference
Regina Leader-Post, September 30, 2009
Canada's former first lady delivered the keynote address at the opening of the Unmasking Postpartum Depression conference, describing her experience with PPD and her lifelong struggle with bipolar disorder.
Antidepressants Linked to Heart Defects in Newborns
Atlanta Journal Constitution, September 24, 2009
Danish researchers found that septal heart defects were common among women taking antidepressants in the first trimester.
Predicting Postpartum Depression May Be Possible
US News and World Report, September 23, 2009
Spanish researchers have devised a method that they claim can detect or predict up to 80% of PPD cases within a few weeks postpartum.
Reproductive Health 2009
When: September 30-October 3 Where: Los Angeles, CA
12th Annual NPWH Premier Women's HealthCare Conference
When:October 14-October 17
Where: Providence, RI
9th Annual Social Work Conference: The Changing Face of Mental Health
When: October 22
Where: Charleston, SC
Med Ed Resources
American Psychiatric Association
The APA, which represents nearly 36,000 psychiatrists worldwide, supports the diagnosis, treatment, and prevention of mental illnesses.
Motherisk provides evidence-based information and guidance about the safety or risk to the developing fetus or infant of maternal exposure to drugs, chemicals, diseases, radiation, and environmental agents.
National Center for Complementary and Alternative Medicine
The National Institute on Alcohol Abuse and Alcoholism provides leadership in the national effort to reduce alcohol-related problems.
This Month's Poll
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