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Treatment of nonpsychotic major depression during pregnancy: patient safety and challenges

Authors Epstein R, Moore K, Bobo W

Received 13 April 2014

Accepted for publication 4 July 2014

Published 18 September 2014 Volume 2014:6 Pages 109—129


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Richard A Epstein,1 Katherine M Moore,2 William V Bobo2

1Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, 2Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA

Abstract: In pregnant women with major depression, the overarching goal of treatment is to achieve or maintain maternal euthymia, thus limiting both maternal and fetal exposure to the harmful effects of untreated or incompletely treated depression. However, the absence of uniformly effective therapies with guaranteed obstetric and fetal safety makes the treatment of major depression during pregnancy among the most formidable of clinical challenges. Clinicians and patients are still faced with conflicting data and expert opinion regarding the reproductive safety of antidepressants in pregnancy, as well as large gaps in our understanding of the effectiveness of most antidepressants and nonpharmacological alternatives for treating antenatal depression. In this paper, we provide a clinically focused review of the available information on potential maternal and fetal risks of untreated maternal depression during pregnancy, the effectiveness of interventions for maternal depression during pregnancy, and potential obstetric, fetal, and neonatal risks associated with antenatal antidepressant use.

Keywords: depression, major depressive disorder, pregnancy, antidepressants, safety

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