Advertisement

Major Depression

  • Sonya Rasminsky
  • Erin Murphy Barzilay
  • Vivien K. BurtEmail author
Chapter

Abstract

Depression affects approximately 10% of pregnant women, and antenatal antidepressant use has been increasing over the last two decades. The decision about whether to take psychotropic medications during pregnancy requires a benefit-risk analysis, weighing the impact of untreated maternal depression against the risks of antidepressant exposure in utero. The treating clinician must sort through the most current data with the patient, acknowledging that most existing studies have not determined whether small increases in adverse outcomes are associated with antenatal psychotropic medications or with the condition for which the medications have been prescribed. Although choice about medication use during pregnancy is individualized, if a woman is experiencing severe depression and is functionally impaired, or has a history of psychosis, suicide attempts, chronic depression, or relapses following medication discontinuation, treatment with antidepressants is advisable. Serotonin reuptake inhibitors (SSRIs) are the best-studied antidepressants and therefore are generally preferred. However, if a woman has previously responded well to a particular medication, that medication is often the best starting point for treatment. A general principle of reproductive psychiatry is to treat perinatal patients with the fewest number of medications at the lowest effective dose. Caution should be exercised not to underdose pregnant women, exposing them to the risks of medication without the benefits of treating the disease. For postpartum depression, SSRIs are the best-studied medications and are considered first line in medication-naïve patients. For women who were treated during pregnancy, treatment should continue with previously effective medications. Most antidepressants are compatible with breastfeeding; however, attention should be paid to the mental health impact of sleep deprivation often associated with nursing and pumping breast milk.

Keywords

Perinatal depression Antenatal depression Postpartum depression Antidepressants Pregnancy Lactation 

References

  1. 1.
    Pratt LA, Brody DJ, Gu Q. Antidepressant use among persons aged 12 and over: United States, 2011–2014. NCHS data brief no. 283. 2017. https://www.cdc.gov/nchs/products/databriefs/db283.htm.
  2. 2.
    Andrade SE, Raebel MA, Brown J, Lane K, Livingston J, Boudreau D, Rolnick SJ, Roblin D, Smith DH, Willy ME, Staffa JA, Platt R. Use of antidepressant medications during pregnancy: a multisite study. Am J Obstet Gynecol. 2008;198(2):194.e1–5.CrossRefGoogle Scholar
  3. 3.
    Huybrechts KP, Pamsten K, Mogun H, Kowal M, Avorn J, Setoguchi-Iwata S, Hernández-Díaz S. National trends in antidepressant medication treatment among publicly insured pregnant women. Gen Hosp Psychiatry. 2013;35:265–71.CrossRefGoogle Scholar
  4. 4.
    Mitchell A, Gilboa S, Wexler M, Kelley K, Louik C, Hernandez-Diaz S. Medication use during pregnancy, with particular focus on prescription drugs: 1976–2008. Am J Obstet Gynecol. 2011;205(1):51.E1–8.CrossRefGoogle Scholar
  5. 5.
    Cohen LS, Altshuler LL, Harlow BI, Nonacs R, Newport DJ, Viguera AC, Suri R, Burt VK, Hendrick V, Reminick AM, Loughead A, Vitonis AF, Stowe ZN. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295:499–507.CrossRefGoogle Scholar
  6. 6.
    Melville JL, Gavin A, Guo Y, Fan MY, Katon WJ. Depressive disorders during pregnancy: prevalence and risk factors in a large urban sample. Obstet Gynecol. 2010;116(5):1064–70.CrossRefGoogle Scholar
  7. 7.
    Grigoriadis S, VonderPorten EH, Mamisashvili L, Tomlinson G, Dennis CL, Koren G, Steiner M, Mousmanis P, Cheung A, Radford K, Martinovic J, Ross LE. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. 2013;74:e321–41.CrossRefGoogle Scholar
  8. 8.
    Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–24.CrossRefGoogle Scholar
  9. 9.
    Huang HC, Sung FC, Chen PC, Chang CY, Muo CH, Shiue HS, Huang JP, Li TC, Tzeng YL, Wu SI. Obstetric outcomes in pregnant women with and without depression: population-based comparison. Sci Rep. 2017;7(1):13937.CrossRefGoogle Scholar
  10. 10.
    Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L, Beyene J, Wang Y, McDonald SD. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiat. 2016;73(8):826–37.CrossRefGoogle Scholar
  11. 11.
    Reynolds RM, Labad J, Buss C, Ghaemmaghami P, Räikkönen K. Transmitting biological effects of stress in utero: implications for mother and offspring. Psychoneuroendocrinology. 2013;38(9):1843–9.CrossRefGoogle Scholar
  12. 12.
    Seth S, Lewis AJ, Galbally M. Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: a systematic literature review. BMC Pregnancy Childbirth. 2016;16(1):124.CrossRefGoogle Scholar
  13. 13.
    Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, Howard LM, Pariante CM. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384(9956):1800–19.CrossRefGoogle Scholar
  14. 14.
    Park M, Brain U, Grunau RE, Diamond A, Oberlander TF. Maternal depression trajectories from pregnancy to 3 years postpartum are associated with children’s behavior and executive functions at 3 and 6 years. Arch Womens Ment Health. 2018;21(3):353–63.CrossRefGoogle Scholar
  15. 15.
    López Seco F, Mundo-Cid P, Aguado-Gracia J, Gaviria-Gómez AM, Acosta-García S, Martí-Serrano S, Vilella E, Masana-Marín A. Insecure maternal attachment is associated with depression in ADHD children. Atten Defic Hyperact Disord. 2016;8(4):189–96.CrossRefGoogle Scholar
  16. 16.
    Wan MW, Green J. The impact of maternal psychopathology on child-mother attachment. Arch Womens Ment Health. 2009;12(3):123–34.CrossRefGoogle Scholar
  17. 17.
    Delavari M, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M. The relationship of maternal-fetal attachment and postpartum depression: a longitudinal study. Arch Psychiatr Nurs. 2018;32(2):263–7.CrossRefGoogle Scholar
  18. 18.
    Weissman MM, Pilowsky DJ, Wickramaratne PJ, Talati A, Wisniewski SR, Fava M, Hughes CW, Garber J, Malloy E, King CA, Cerda G, Sood AB, Alpert JE, Trivedi MH, Rush AJ, STAR*D-Child Team. Remissions in maternal depression and child psychopathology, a STAR*D-Child report. JAMA. 2006;295(12):1389–98.CrossRefGoogle Scholar
  19. 19.
    Hoffman C, Dunn DM, Njoroge WFM. Impact of postpartum mental illness upon infant development. Curr Psychiatry Rep. 2017;19(12):100.CrossRefGoogle Scholar
  20. 20.
    Sockol LE. A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord. 2015;177:7–21.CrossRefGoogle Scholar
  21. 21.
    Sockol LE. A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women. J Affect Disord. 2018;232:316–28.CrossRefGoogle Scholar
  22. 22.
    van Ravesteyn LM, Lambregtse-van den Berg MP, Hoogendijk WJ, Kamperman AM. Interventions to treat mental disorders during pregnancy: a systematic review and multiple treatment meta-analysis. PLoS One. 2017;12(3):e0173397.CrossRefGoogle Scholar
  23. 23.
    Oren DA, Wisner KL, Spinelli M, Epperson CN, Peindl KS, Terman JS, Terman M. An open trial of morning light therapy for treatment of antepartum depression. Am J Psychiatry. 2002;159(4):666–9.CrossRefGoogle Scholar
  24. 24.
    Hizli Sayar G, Ozten E, Tufan E, Cerit C, Kağan G, Dilbaz N, Tarhan N. Transcranial magnetic stimulation during pregnancy. Arch Womens Ment Health. 2014;17(4):311–5.CrossRefGoogle Scholar
  25. 25.
    Kim DR, Epperson N, Paré E, Gonzalez JM, Parry S, Thase ME, Cristancho P, Sammel MD, O'Reardon JP. An open label pilot study of transcranial magnetic stimulation for pregnant women with major depressive disorder. J Womens Health (Larchmt). 2011;20(2):255–61.CrossRefGoogle Scholar
  26. 26.
    Leiknes KA, Cooke MJ, Jarosch-von Schweder L, Harboe I, Høie B. Electroconvulsive therapy during pregnancy: a systematic review of case studies. Arch Womens Ment Health. 2015;18(1):1–39.CrossRefGoogle Scholar
  27. 27.
    Ray-Griffith SL, Coker JL, Rabie N, Eads LA, Golden KJ, Stowe ZN. Pregnancy and electroconvulsive therapy: a multidisciplinary approach. J ECT. 2016;32(2):104–12.CrossRefGoogle Scholar
  28. 28.
    Deligiannidis KM, Byatt N, Freeman MP. Pharmacotherapy for mood disorders in pregnancy: a review of pharmacokinetic changes and clinical recommendations for therapeutic drug monitoring. J Clin Psychopharmacol. 2014;34(2):244–55.CrossRefGoogle Scholar
  29. 29.
    McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, Gregoire A, Howard LM, Jones I, Khalifeh H, Lingford-Hughes A, McDonald E, Micali N, Pariante CM, Peters L, Roberts A, Smith NC, Taylor D, Wieck A, Yates LM, Young AH, Endorsed by the British Association for Psychopharmacology. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. 2017;31(5):519–52.CrossRefGoogle Scholar
  30. 30.
    NICE. NICE clinical guideline 192. Antenatal and postnatal mental health: clinical management and service guidance. 2014, updated August 2017. https://www.nice.org.uk/guidance/cg192/chapter/1-recommendations#treating-specific-mental-health-problems-in-pregnancy-and-the-postnatal-period.
  31. 31.
    Salisbury A, O’Grady K, Battle C, Wisner KL, Anderson GM, Stroud LR, Miller-Loncar CL, Young ME, Lester BM. The roles of maternal depression, serotonin reuptake inhibitor treatment, and concomitant benzodiazepine use on infant neurobehavioral functioning over the first postnatal month. Am J Psychiatry. 2016;173:147–57.CrossRefGoogle Scholar
  32. 32.
    Warburton W, Hertzman C, Oberlander TF. A register study of the impact of stopping third trimester selective serotonin reuptake inhibitor exposure on neonatal health. Acta Psychiatr Scand. 2010;121(6):471–9.CrossRefGoogle Scholar
  33. 33.
    Azorin JM, Angst J, Gamma A, Bowden CL, Perugi G, Vieta E, Young A. Identifying features of bipolarity in patients with first-episode postpartum depression: findings from the international BRIDGE study. J Affect Disord. 2012;136(3):710–5.CrossRefGoogle Scholar
  34. 34.
    Molyneaux E, Howard LM, McGeown HR, Karia AM, Trevillion K. Antidepressant treatment for postnatal depression. Cochrane Database Syst Rev. 2014;9:CD002018.Google Scholar
  35. 35.
    Orsolini L, Bellantuono C. Serotonin reuptake inhibitors and breastfeeding: a systematic review. Hum Psychopharmacol. 2015;30(1):4–20.CrossRefGoogle Scholar
  36. 36.
    Giallo R, Gartland D, Woolhouse H, Brown S. “I didn’t know it was possible to feel that tired”: exploring the complex bidirectional associations between maternal depressive symptoms and fatigue in a prospective pregnancy cohort study. Arch Womens Ment Health. 2016;19:25–34.CrossRefGoogle Scholar
  37. 37.
    Kanes S, Colquhoun H, Gunduz-Bruce H, Raines S, Arnold R, Schacterle A, Doherty J, Epperson CN, Deligiannidis KM, Riesenberg R, Hoffmann E, Rubinow D, Jonas J, Paul S, Meltzer-Brody S. Brexanolone (SAGE-547 injection) in post-partum depression: a randomised controlled trial. Lancet. 2017;390(10093):480–9.CrossRefGoogle Scholar
  38. 38.
    Meltzer-Brody S, Colquhoun H, Riesenberg R, Epperson CN, Deligiannidis KM, Rubinow DR, Li H, Sankoh AJ, Clemson C, Schacterle A, Jonas J, Kanes S. Brexanolone injection in post-partum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials. Lancet. 2018;392(10152):1058–70.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sonya Rasminsky
    • 1
  • Erin Murphy Barzilay
    • 1
  • Vivien K. Burt
    • 1
    Email author
  1. 1.Department of Psychiatry and Biobehavioral Sciences, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUSA

Personalised recommendations