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Chemical Dependency

Depressive Disorders

Pharmacology

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Antepartum DepressionAka: Depression in Pregnancy

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  1. See Also
    1. Major Depression
  2. Epidemiology
    1. Pregnancy is not protective against Depression
  3. Adverse Effects: Untreated Depression
    1. Untreated Depression risks
      1. Suicide
      2. Adverse effects on family functioning
    2. Concurrent adverse habit risks
      1. Tobacco abuse
      2. Alcohol Abuse
      3. Illicit Drug abuse
  4. Adverse Effects
    1. SSRIs appear to be safe as a class
    2. Persistent Pulmonary Hypertension
      1. Increased risk by 6 fold if SSRIs used after 20 weeks
    3. Paroxetine (Paxil) has recently been made Category D
      1. Neonatal withdrawal risk
        1. Sanz (2005) Lancet 365:482
      2. Increased Atrial and Ventricular Septal Defects
        1. Associated with first trimester exposure
        2. Associated with a two fold increased risk
        3. (2006) Obstet Gynecol 108:1601
    4. Studies show no longterm newborn effects
      1. Addis (2000) Psychol Med 30:89
      2. Hendrick (2003) Am J Obstet Gynecol 188:812
    5. Some reports of short-term neonatal withdrawal
      1. Weak cry, mild Tachypnea, jitteriness
      2. Wisner (1999) JAMA 282:1264
  5. Management
    1. Treat Major Depression in Pregnancy
    2. Consult mental health counseling
    3. Select SSRI Antidepressants with most safety data
      1. Sertraline (Zoloft): Most commonly used
      2. Prozac (best studied)
    4. Avoid Paroxetine (Paxil) due to higher fetal risk
      1. See Above

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