Principles to be followed in Treatment of Depression in Pregnancy

Principles to be followed in Treatment of Depression in Pregnancy

Prevalence of depression during pregnancy ranges from 4% to 20%. Several risk factors predispose to depression during pregnancy including obstetric factors. Depression during pregnancy is not only the strongest risk factor for post-natal depression but also leads to adverse obstetric outcomes.

Depression during pregnancy is a matter of public health importance due to 3 prime reasons:

Firstly, rate of depression during pregnancy is high during antenatal period.

Secondly, it is the strongest risk factor for post-natal depression.

Thirdly, it leads to adverse maternal and fetal outcomes. Thus, makes depression during pregnancy a matter of great importance.

Women who currently suffer major depression and are treated with pharmacotherapy may present with an unplanned pregnancy, in which case the fetus has been exposed to the antidepressant. For these patients, it is suggested that they continue their antidepressant, especially if the depressive episode has been severe (eg, marked by suicide attempts, psychotic features, or functional incapacitation). However, if the depressive syndrome has been mild to moderate and the patient feels strongly about avoiding further exposure, pharmacotherapy can be discontinued for the first trimester (during organogenesis), and subsequently restarted. In addition, it is reasonable to switch the patient from pharmacotherapy to psychotherapy (eg, cognitive-behavioral therapy or interpersonal psychotherapy), while monitoring for deterioration. A gradual (eg, at least over one to two weeks) taper of antidepressants is preferred to avoid worsening of the depressive syndrome; patients may nevertheless insist upon abruptly stopping the drug due to concerns about teratogenicity.

Unplanned pregnancy may also arise in women who are currently euthymic and treated with antidepressants; these patients need to decide whether to continue treatment. The factors involved include the risks of recurrence and maternal depression, as well as the risks of using antidepressants during pregnancy.

Some of the principles are

Start low and go slow on medication
Avoid switching medicines
Do not stop medicine during child birth
Minimal effective dosage should be advised
Advocate psychotherapy
Combination of treatment is required in severe cases

Видео Principles to be followed in Treatment of Depression in Pregnancy канала Prof. Suresh Bada Math