Pharmacologic treatment of depression during pregnancy

Depression is a common illness among women of childbearing years. Nevertheless, few data suggest treatment guidelines for depression during pregnancy. The prospective trials considered in this review were identified through MEDLINE and Health STAR searches for the terms antidepressant during pregnancy and depression during pregnancy. Additional articles were identified through manual searches of review bibliographies and queries of researchers for 4989-1999. Four studies published since 1993 compared health outcomes of mothers and infants exposed to antidepressants with those for unexposed controls and were chosen for analysis. Identifying subjects, comparison groups, pregnancy, and birth outcomes, the analysis focused on 5 elements of reproductive toxicity: intrauterine fetal death, morphologic teratogenicity, growth impairment, behavioral teratogenicity, and neonatal toxicity. The analysis yielded data for tricyclic antidepressants (TCAs) as a group, fluoxetine, and selective serotonin reuptake inhibitors) as a group, revealing that none of these medications increased the risk, of intrauterine death or major birth defects. One study found decreased birth weight in infants who were exposed to fluoxetine during the third trimester. Infants exposed to TCAs or fluoxetine during pregnancy developed at the same rate as controls. Direct-drug effects and withdrawal syndromes were found in some new borns whose mothers had been exposed to antidepressarits near term. Data gleaned from prospective trials, although scarceiface preferable to those from nonprospective sources. Patients witli: identified risks such as poor weight gain should be monitored and necessary interventions employed.