Sanjog Kalra and Adrienne Einarson

Summary

Depression has been identified by the World Health Organization as a major cause of morbidity in the 21st century. As women between 25 and 44 yr represent the population at highest risk for depression, a substantial number are likely to become pregnant while suffering from this illness. In this chapter, we summarize the prevalence and clinical course of depression during pregnancy. We also document evidence-based information regarding the safety and efficacy of both pharmacological and nonpharmacological treatments of prenatal depression. In addition, we discuss other issues surrounding the treatment of depression, such as abrupt discontinuation syndrome, poor neonatal adaptability, and an increase in the rate of spontaneous abortions, associated with the use of certain antidepressant drugs. Of equal importance, we also review the emerging literature on the potential adverse effects of untreated depression during pregnancy.

Depression is an important issue that must be addressed when women become pregnant. A variety of pharmacological and nonpharmacological treatment options are available, the vast majority of which appear to be relatively safe. Women suffering from depression during pregnancy must be treated individually, and the benefits and/or risks of treatment or nontreatment should be weighed carefully using evidence-based information. This approach will ensure the best possible outcomes for the mothers and their babies.

Key Words: Depression; pregnancy; risks; prevalence; course; treatment; safety.

Depression has been identified by the World Health Organization as a major cause of morbidity in the 21st century (1). The Global Burden

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