Peripartum Depression: Detection and Treatment

Peripartum depression is one of the most common disorders of pregnancy. It has a higher morbidity and mortality risk than any other condition affecting pregnant people. The American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the U.S. Preventive Services Task Force recommend that pregnant patients be screened for depression with one of several validated tools and offered treatment with psychotherapy and medication. There are no validated tools available to identify who is at increased risk of peripartum depression. Risk factors for peripartum depression include a history of depression, a history of physical or sexual abuse, carrying an unplanned or unwanted pregnancy, and traumatic birth. The U.S. Preventive Services Task Force recommends offering psychotherapy to patients at increased risk of depression because it can decrease the development of peripartum depression by up to 39%. Untreated peripartum depression increases the risk of adverse pregnancy outcomes and mortality for the patient, as well as negative outcomes for the newborn, including growth faltering, developmental delay, and attachment disorder. Cognitive behavior therapy and interpersonal psychotherapy are the mainstay of treatment for peripartum depression; physicians should consider selective serotonin reuptake inhibitors for those with moderate to severe depression. The benefits of selective serotonin reuptake inhibitors generally outweigh the risks; however, fluoxetine and paroxetine should be avoided during pregnancy because they can cause an increased risk of birth defects.