15 - Depression in the context of pregnancy

Summary

The detection and appropriate management of depression among women of reproductive age before or early in pregnancy is critical. The majority of studies have not found an association with major congenital malformations (MCMs) and first-trimester exposure to selective serotonin reuptake inhibitors (SSRIs). Non-SSRI and non-tricyclic antidepressants (TCA) antidepressants have been the focus of small studies. These medications include trazodone, mirtazapine, nefazodone, mianserin, and reboxetine. A neonatal behavioral syndrome (NBS) has been described in neonates exposed to antidepressants in utero. Lithium carbonate remains one of the mainstays for acute and maintenance treatment of bipolar disorder. There have been several registries that have collected information on the use of lamotrigine in the first trimester of pregnancy. A single case study found vagal nerve stimulation (VNS) to be safe during pregnancy in a woman receiving treatment throughout pregnancy, labor, and delivery.