Журнал беременности и здоровья детей

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Therapeutic Approaches for Depression During Pregnancy and Lactation

Sang Won Jeon and Yong-Ku Kim

Objectives: The pregnancy and postpartum period appear to be a time of heightened vulnerability for the development of major depression in some women. The treatment of depressive disorder during pregnancy is an important but complex clinical topic. This article provides a systemic review of treatments for depressive disorder during pregnancy and lactation: Psychotherapy, Pharmacotherapy, Electroconvulsive therapy and other effective treatments.

Methods: PubMed and EMBASE were searched using terms with regard to the treatment of depressive disorders during pregnancy and lactation. Reference lists of related reviews and studies were searched. In addition, relevant practice guidelines were searched using the PubMed. All identified clinical literatures were reviewed and summarized in a narrative manner.

Results: The treatment option for depressive disorders during pregnancy and lactation depends on the severity of depressive illnesses of the individual patient. For mild to moderate depression, the non-pharmacological treatment should be considered first. For moderate to severe depression, pharmacotherapy should be administered in addition to the psychosocial treatment. ECT is recommended for depressive disorder of severe intensity. Treatment strategies are described according to the point of time of pregnancy or lactation. FDA categories for antidepressants during pregnancy and lactation are described. In addition, issues regarding to the electroconvulsive therapy and psychosocial treatment are discussed.

Conclusion: Treatments during pregnancy and lactation requires a comprehensive assessment of the risks and benefits of treatment for both mother and fetus or neonate. Recently, there is growing evidence that the use of tricyclic and selective serotonin reuptake inhibitors during pregnancy and lactation does not result in increased risks of teratogenicity. As the research knowledge is limited, the recommendations should based on the best judgment of clinicians.