Korean J Biol Psychiatry.  2007 May;14(2):91-98.

Treatment Strategies for Depression during Pregnancy and Lactation

• Lee SI
• Jung HY

Abstract

OBJECTIVES
Considering the impact of depressive illness on physical and mental health of both mother and fetus, specification of a treatment algorithm for depressive disorder during pregnancy is legitimated. This article provides a systemic review of treatments for depressive disorder during pregnancy and lactation.
METHODS
According to the search strategy of the Clinical Research Center for Depression of Korean Health 21 R & D Project, 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
Pharmacotherapy 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. 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
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. As the research knowledge is limited, the recommendations should based on the best judgement of psychiatrists.

Keyword

Depression; Pregnancy; Lactation; Treatment strategy

MeSH Terms

Antidepressive Agents
Depression*
Depressive Disorder
Drug Therapy
Electroconvulsive Therapy
Female
Fetus
Humans
Infant, Newborn
Lactation*
Mental Health
Mothers
Pregnancy*
Psychiatry
Risk Assessment
Serotonin Uptake Inhibitors
Antidepressive Agents
Serotonin Uptake Inhibitors