NEW YORK (Reuters Health) – New guidelines released by the American Psychiatric Association and the American College of Obstetricians and Gynecologists indicate that antidepressants and psychotherapy are possible treatment options for depression during pregnancy.

“Depression in pregnant women often goes unrecognized and untreated in part because of concerns about the safety of treating women during pregnancy,” lead author Dr. Kimberly Ann Yonkers, from Yale University, New Haven, Connecticut, said in a statement. “It is our hope that (the guidelines) will be a resource to clinicians who care for pregnant women who have or are at risk of developing major depressive disorder.”

The guidelines, which are based on an extensive review of prior research, are published in the September/October issue of General Hospital Psychiatry and in the September issue of Obstetrics of Gynecology.

According to the report, there are both pros and cons to using antidepressants during pregnancy. While the drugs can effectively treat maternal depression, which has been linked to reduced attentiveness in the newborn, there is also evidence tying them to fetal malformations and reduced birth weight.

The guidelines suggest that psychotherapy may be a suitable alternative to antidepressants for some women with mild-to-moderate depression. The report also emphasizes the importance of ongoing consultation between a woman’s obstetrician and psychiatrist during pregnancy.

According to the report, women thinking about becoming pregnant: –may possibly taper or discontinue their antidepressants if they have had mild or no symptoms for 6 months or longer. — may need to continue their medications if they have a history of severe, recurrent depression or other major psychiatric illness. –should be referred to a psychiatrist for aggressive treatment if suicidal or acute psychotic symptoms are present.

Pregnant women currently taking antidepressants: –may be able to remain on the medications if they discuss the pros and cons with their physicians. –may, depending on their mental health history, attempt tapering and discontinuation their medications if symptom-free. –may benefit from psychotherapy if symptoms are still apparent. –should continue on their medication if depression is severe.

Pregnant women not currently taking antidepressants: –may consider psychotherapy as alternative to antidepressants. –should be informed of the risks and benefits of these agents if they desire to use them.

All pregnant women: –should immediately be evaluated by a psychiatrist if suicidal or psychotic symptoms are present.

Reference:
Obstet Gynecol 2009. General Hospital Psychiatry 2009.