Optimal Treatment for Depression during Pregnancy and Lactation

Yong-Ku Kim

doi:10.4172/2376-127X.1000e113

ISSN: 2376-127X

Journal of Pregnancy and Child Health

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Optimal Treatment for Depression during Pregnancy and Lactation

Yong-Ku Kim^*
Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
Corresponding Author :	Yong-Ku Kim Department of Psychiatry College of Medicine, Korea University Seoul, Republic of Korea Tel: 82-31-412-5140 Fax: 82-31-412-5144 E-mail: Yongku@korea.ac.kr / yongku0304@gmail.com
Received May 23, 2015; Accepted May 25, 2015; Published May 29, 2015
Citation: Kim YK (2015) Optimal Treatment for Depression during Pregnancy and Lactation. J Preg Child Health 2:e113. doi: 10.4172/2376-127X.1000e113
Copyright: ©2015 Kim YK. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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About 70% of pregnant women experience depressive symptoms during their gestational period and the prevalence rates of major depressive disorders during pregnancy range from 10%-16%. When depression during pregnancy is not treated properly, various problems such as nutritional deficiency and sleep disorder occur. In addition, depressive mothers may not comply with medical instruction and their risks of smoking/drug addiction and of committing suicide may be increased. Moreover, problems such as fetal growth retardation, premature birth, low birth weight, difficult labor, mental retardation, and insufficient attachment with mother may develop. Thus, mothers have the important task of understanding depressive disorders during pregnancy, which cover the fields of obstetrics, internal medicine and psychiatry. On the one hand, after childbirth, the prevalence rate of major depressive disorder is also estimated as 10-15%. Major factors of depressive disorders that develop during the perinatal period include a history of postpartum depression, prepartum depression, and a family history of depression. Additional factors include low social support, negative life events, unstable marital relationship, motherhood at a young age, unexpected pregnancy, ambivalent emotions and newborn health problems and so on. In minor-age mothers, the prevalence rate of postpartum depression reaches as high as 26%.

In principle, medication is avoided during pregnancy. However, in a study that monitored pregnant women with a history of depression, since their pregnancy without depression, 43% of the subjects experienced recurrent depression during their gestational period. The recurrence rate (68%) in the women who stopped taking antidepressant medications was significantly higher than that (26%) in the women who continued taking the medications. So, clinicians are often caught in a situation that requires them to choose between discontinuing the prescription of antidepressant medications to pregnant women and prescribing such medications for new depressive pregnant women. Despite these concerns, many mothers had been reported to have been taking antidepressant medications. About 42% of mothers who stopped taking antidepressant medications due to pregnancy resumed their intake of such medications during their gestation period due to recurrence of depression. About half of them resumed their intake at the first trimester of their pregnancy.

I and my colleague have searched PUBMED and EMBSE using terms with regard to the treatment of depressive disorders during pregnancy and lactation. In results, the treatment option for depressive disorders during pregnancy and lactation depends on the severity of depression. For mild to moderate depression, the nonpharmacological treatment should be considered first. Psychosocial treatment such as cognitive behavior therapy, interpersonal therapy, couple therapy, psychoeducation, and supportive psychotherapy are recommended. For moderate to severe depression, pharmacotherapy should be administered in addition to the psychosocial treatment. When the risk of committing suicide is high, or if the patient cannot undergo pharmacology or does not respond to the aforesaid therapies, electroconvulsive therapy (ECT) can be considered. ECT is recommended for depressive disorder of severe intensity. Depression during pregnancy and lactation must be treated while balancing the risk of non-treatment and the effect of the treatment on the fetus or newborn baby. Pregnancy or lactation must be considered based on the following three categories of side effects- the risk of fetal abnormalities, the toxicity effects on the newborn baby during the perinatal period, and the effects on the behavior of the mother after childbirth. So, time is focal point of treatment of depression during pregnancy and lactation period, and the treatment is determined by the severity of the depressive symptoms.

Treatment plans for depression during pregnancy and lactation differ from those for general depression. Optimal treatment decisions must be made according to the timing and individual situations. The decisions must be based on the evaluation of the risks and benefits, which include the risk of pharmacotherapy, the severity of depression, alternative pharmacotherapy, delayed effect of psychotherapy, and the risk to the safety of the mothers. Early detection of the symptoms is very important, and once the treatment begins, efforts to prevent the recurrence of the symptoms must be continuously made even after childbirth. Medication must be used based on the available information, and the lowest dose that can produce treatment responses must be selected and changed according to the gestational period. Clinician must consider optimal treatment strategies for depression during pregnancy and lactation.