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New Recommendations for Treating Depression During Pregnancy WASHINGTON, DC -- August 21, 2009 -- Pregnant women with depression face complicated treatment decisions because of the risks associated with both untreated depression and the use of antidepressants. A new report from the American College of Obstetricians and Gynecologists (ACOG) and the American Psychiatric Association (APA), based on an extensive review of existing research, offer recommendations for the treatment of women with depression during pregnancy. The report is published in the September issue of Obstetrics & Gynecology and in the September/October issue of General Hospital Psychiatry. "Depression in pregnant women often goes unrecognised and untreated in part because of concerns about the safety of treating women during pregnancy," said lead author Kimberly Ann Yonkers, MD, Yale University, New Haven, Connecticut. "It is our hope that this will be a resource to clinicians who care for pregnant women who have or are at risk of developing major depressive disorder." Both depression symptoms and the use of antidepressant medications during pregnancy have been associated with negative consequences for the newborn. Depression and its symptoms are also associated with foetal growth change and shorter gestation periods. Identifying depression in pregnant women can be difficult because its symptoms mimic those associated with pregnancy, such as changes in mood, energy level, appetite, and cognition. According to the report, some patients with mild-to-moderate depression can be treated with psychotherapy (alone or in combination with medication. In addition, the report discusses the need for ongoing consultation between a patient's ob-gyn and psychiatrist during pregnancy and presents algorithms for treating patients in common scenarios: Women thinking about getting pregnant · For women on medication with mild or no symptoms for 6 months or longer, it may be appropriate to taper and discontinue medication before becoming pregnant. · Medication discontinuation may not be appropriate in women with a history of severe, recurrent depression (or who have psychosis, bipolar disorder, other psychiatric illness requiring medication, or a history of suicide attempts). · Women with suicidal or acute psychotic symptoms should be referred to a psychiatrist for aggressive treatment. Pregnant women currently on medication for depression · Psychiatrically stable women who prefer to stay on medication may be able to do so after consultation between their psychiatrist and ob-gyn to discuss risks and benefits. · Women who would like to discontinue medication may attempt medication tapering and discontinuation if they are not experiencing symptoms, depending on their psychiatric history. Women with a history of recurrent depression are at a high risk of relapse if medication is discontinued. · Women with recurrent depression or who have symptoms despite their medication may benefit from psychotherapy to replace or augment medication. · Women with severe depression (with suicide attempts, functional incapacitation, or weight loss) should remain on medication. If a patient refuses medication, alternative treatment and monitoring should be in place, preferably before discontinuation. Pregnant and not currently on medication for depression · Psychotherapy may be beneficial in women who prefer to avoid antidepressant medication. · For women who prefer taking medication, risks and benefits of treatment choices should be evaluated and discussed, including factors such as stage of gestation, symptoms, history of depression, and other conditions and circumstances. All pregnant women · Regardless of circumstances, a woman with suicidal or psychotic symptoms should immediately see a psychiatrist for treatment. SOURCE: American College of Obstetricians and Gynecologists and the American Psychiatric Association E-mail this page to a friend or colleague! To print, use this version