ACOG & APA Issue Guidelines For Treatment of Depression During Pregnancy

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The American College of Obstetricians and Gynecologists, in partnership with the American Psychiatric Association,hasjust issued specific direction and guidelines on the use of antidepressants during pregnancy.

They must be congratulated for their clear understanding of the nuances of treatment for depression during pregnancy, and for acknowledging that there is no one right answer to this situation as some would have you believe.

"This is a report intended to reach out to psychiatrists as well as obstetrician-gynecologists," said Dr. Kimberly Yonkers [the report's author, who is from both the Department of Psychiatry and the Department of OB/GYN at Yale University]. "We developed algorithms which I think reflect the fact that there are multiple issues to consider and [that] there should be no knee-jerk response in managing a woman who is depressed and pregnant or contemplating pregnancy. Psychiatric history and a woman's preference are among the important features that should be taken into consideration."

In a nutshell,ACOG and the APArecommend that those with mild depression who are pregnant may be better served trying psychotherapy and seeing if that will relieve their symptoms. Women with severe depression or those who have a history of depression or psychosis, however, should remain on their medication during pregnancy. And of course, all pregnant women or those who are thinking about becoming pregnant should discuss their specific situation with their doctors. Here are just a couple of the common scenarios the reportoffers along with recommendations to doctors and patients as to how to proceed:

Pregnant Women Currently on Medication for Depression

  • After a consultation between their psychiatrist and obstetrician/gynecologist (to discuss risks), psychiatrically stable women who prefer to stay on medication may be able to do so.
  • For those who want to discontinue medication and are not experiencing symptoms, tapering and discontinuation may be attempted. However, women with a history of recurrent depression are at a high risk for relapse.
  • Those with recurrent depression or symptoms despite their medication may benefit from psychotherapy to replace or augment medication.
  • Women with severe depression should remain on medication. If a patient refuses, alternative treatment and monitoring should be in place, preferably before discontinuation.

Pregnant Women Not Currently on Medication for Depression

  • For those who want to avoid antidepressant medication, psychotherapy may be beneficial.
  • For those who prefer taking medication, risks and benefits of treatment choices should be evaluated and discussed.

If you have access to the September issue of the journal Obstetrics & Gynecology, you can read the entire report here. It will also appear in the September/October issue of General Hospital Psychiatry.

Surprisingly, this report has been covered fairly well thus far by the mainstream media. ABCNews.com did a good piece that included quotes from Dr. Lucy Puryear and Dr. Ruta Nonacs. Nice job by ABC with a story on Good Morning America as well. And here is coverage from Medscapeand Medical News Today. The Wall Street Journal Health Blog chose to go with a storyangle aboutECT for some odd reason. Will keep you posted if I see more on this …

For more from Postpartum Progress on depression during pregnancy, also called antepartum depression, click here.

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About Katherine Stone

is the founder & editor of Postpartum Progress. She was named one of the ten most influential mom bloggers of 2011, a WebMD Health Hero and one of the top 25 parent bloggers using social media for social good. She also writes the Fierce Blog, and a parenting column for Disney's Babble.com.

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Comments

  1. Thank you, Katherine, for your continuing mission to provide highly informative, helpful, well-researched posts. It's so good to see perinatal mood disorders getting the attention it deserves by researchers, national orgs such as the APA & ACOG, and mainstream media, as well as the progress that's being made with respect to providing those who treat women (both medical and mental health practitioners) with guidelines for treating each patient in a highly individualized and consultative fashion.

  2. I agree, Ivy! I work as a maternal-newborn clinical nurse specialist, and much of the work I do with other clinicians is developing guidelines and algorithms that are grounded in sound, evidence-based practice. So, you can imagine how excited I was to see the collaborative efforts from the APA and ACOG on management of depression in pregnancy! We have MANY such recommendations, care pathways, etc, for a multitude of other "medical diagnoses", so it is about time that psych and OB have joined forces to establish some standards.
    I see too many women who are often "under-treated" or make decisions about proceeding with medication/therapy without the appropriate information from their providers. Clinicians LOVE algorithms. These recommendations will help steer providers to counsel their obstetric patients with sound evidence, which will allow women to make a more informed decision on their mental health care and the potential risks/benefits to them and their fetus. Great info, Katherine!

  3. This is so interesting, and also really encouraging to see that they've outlined some specific guidelines, and woo hoo for some more positive press on the subject. Thanks again for the info!