Managing depression in pregnancy

There is increasing awareness of depression in the community, and a realisation that it is common and of particular importance in pregnancy where the welfare of both the fetus and the child must also be considered.

This paper looks at the management dilemmas that face the general practitioner when someone diagnosed with depression either becomes, or is already pregnant. Teratogenicity, and effects of medication at term and in breast milk are discussed, as well as the risks of failing to treat.

Medication when required should be kept to the minimum dose needed to adequately treat the symptoms, and reduced where possible, towards term. Antidepressants have no apparent teratogenetic effects but subtle effects cannot be excluded. Mood stabilisers are more likely to have teratogenic effects and should in general be avoided in pregnancy. Management needs to involve both the woman and her partner in decisions and be ongoing; failure to adequately treat has significant ramifications for both mother and child.