Perinatal depression: detection and treatment

Depression in women during their childbearing years is common. Routine depression screening coupled with multidisciplinary collaborative care models integrating case management is paramount. Risk factors for perinatal depression include previous history of depression, interpersonal conflict and limited social support. Antenatal depression may lead to poor pregnancy outcomes, such as pre-eclampsia, insufficient weight gain, decreased compliance with prenatal care and premature labor, and continue into postpartum depression, which in turn pose a risk for mother-infant bonding and subsequent child socioemotional development. Currently available literature suggests that overall, the risks of antidepressant use in pregnancy/lactation are small relative to the risks due to maternal untreated illness itself; however, for decision-making, careful individualized risk-benefit analysis and informed consent from the affected patient are crucial. Current guidelines suggest nonpharmacological treatments as first-line interventions for mild-to-moderate perinatal illness, while reserving pharmacological treatment for moderate-to-severe illness. Antidepressants, psychotherapies, alternative or complimentary approaches, and involving family in the supportive care of perinatal women are all effective strategies. More research is needed to determine the long-term and developmental effects in children exposed to antidepressants or untreated illness during pregnancy and lactation.