Expert Commentary

Prenatal and Postpartum Depression

Ellen Haller, MD

Professor of Clinical Psychiatry
University of California, San Francisco
San Francisco, CA

 

Depression is not uncommon among pregnant women. Many women with a history of depression will choose to discontinue antidepressant medication during pregnancy, which puts them at an elevated risk of depressive relapse. It should be noted that while antidepressant medication can have negative effects on the developing fetus, depression in the mother has also been shown to have adverse effects, including premature birth, low birth weight, and an increased risk of future depression. Treatment of pregnant women with depression requires individualized decision making, carefully weighing the risks and benefits of initiating or continuing compared to not starting or discontinuing antidepressant treatment. Psychotherapy, particularly interpersonal psychotherapy and cognitive behavioral therapy can be very effective in treating mild to moderate depression in pregnant women.


Postpartum depression may occur in women with and without a history of depression. Diagnosis may be challenging because many women, particularly first-time mothers, may not realize that their feelings go above and beyond the stresses of having a new child. Simple screening tools – such as the Edinburgh Postnatal Depression Scale, available here can be used to help identify women with postpartum depression by gynecologists, pediatricians, and other health care practitioners who come into frequent contact with postpartum women. Women who are treated with antidepressants should also be advised regarding the potential for these medications to pass through the breast milk; available evidence suggests that in the case of most antidepressants, concentration in the breast milk is low.

 

In rare cases, women who have recently had a child may develop postpartum psychosis. This is a psychiatric emergency which must be treated aggressively, often with psychiatric hospitalization, as the woman may be a danger to herself or her child.


 

References

  1. Goedhart G, Snijders AC, Hesselink AE, van Poppel MN, Bonsel GJ, Vrijkotte TG. Maternal depressive symptoms in relation to perinatal mortality and morbidity: results from a large multiethnic cohort study. Psychosom Med. 2010 ;72(8):769-776.
  2. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-786.
  3. Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant Drugs and Breastfeeding: A Review of the Literature. Breastfeed Med. 2010 Oct 19. [Epub ahead of print]

 

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