Diagnosis and
Treatment of Perinatal Mood Disorders
by Meir
Steiner, MD, PhD
Pregnancy does not confer a
protective effect against mood disorders and the prevalence of mood
disorders during the postpartum period is even higher. Treatment of
these women therefore cannot be ignored and the clinician is faced with
the decision-making dilemma: to prescribe or not to prescribe
antidepressants.
Since all psychotropics
diffuse readily across the placenta and pass on into breastmilk, they
have the potential for adverse effects on the fetus and on the newborn
infant. These risks must be weighed against the risks of withholding
medications.
The risks of teratogenicity,
behavioural teratogenicity, perinatal complications and the risks to the
breastfeeding baby while the mother is taking antidepressants will be
reviewed. Overall there does not seem to be an association between
antidepressants and congenital malformations and the neurobehavioural
evidence also does not suggest illeffects.
An overview of the
risk/benefit assessment, prophylactic measures and treatment decisions
will be provided.
The new information from
prospective studies about the management of mood disorders during
pregnancy and postpartum provides welcome relief from decades of
decision making under the duress of meager data.