Although pregnancy is a joyful time for many women, others struggle
with depression and other mood disorders. The limited data
available suggest that 7.5% of women who become pregnant develop
major depression, and another 7% have minor depression, before
Consensus is growing that depression during pregnancy should be
treated, for the sake of both the mother and the developing fetus.
Among other risks, untreated depression during pregnancy increases
the likelihood that a woman will have postpartum depression and
give birth to a lethargic, irritable baby whose weight is lower
Medication is one option for treating prenatal depression (see
"Medications for prenatal depression"). In 2003, 13% of pregnant
women used antidepressants at some point during pregnancy. But
anecdotal reports from clinicians suggest that many women prefer
not to take antidepressants during pregnancy, mostly because of
concern about exposing the developing fetus to any type of drug.
Guidelines issued jointly in 2009 by the American Psychiatric
Association (APA) and the American College of Obstetricians and
Gynecologists (ACOG) offer detailed advice for clinicians. In
general, the APA-ACOG guidelines recommend psychotherapy for
pregnant women with mild to moderate depression, and medication for
patients with severe depression, psychosis, bipolar disorder, a
history of suicide attempts, or a co-occurring psychiatric disorder
that requires drug treatment.
Unfortunately, scant research exists on alternatives to medication
— whether psychotherapy or other modalities. As such, a decision
about how best to proceed is an individual one and depends on
clinical experience and the patient's preference.
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