Management of depression in a woman who is planning a pregnancy or has an unplanned pregnancy

NICE state (1):

• risks associated with antidepressant treatment during pregnancy and breastfeeding lower the threshold for psychological treatments. In addition, risks are better established in older drugs and a cautious approach would be to avoid newer drugs
• women being treated for depression who are planning a pregnancy or have an unplanned pregnancy
• if a woman being treated for mild depression is taking an antidepressant, the medication should be withdrawn gradually and monitoring ('watchful waiting') considered. If intervention is then needed the following should be considered:
  • self-help approaches (guided self-help, computerised CBT [C-CBT], exercise) or
  • brief psychological treatments (including counselling, CBT and interpersonal psychotherapy (IPT))
• if a woman is taking an antidepressant and her latest presentation was a moderate depressive episode, the following options should be discussed with the woman, taking into account previous response to treatment, her preference, and risk:
  • switching to psychological therapy (CBT or IPT)
  • switching to an antidepressant with lower risk
• if a woman is taking an antidepressant and her latest presentation was a severe depressive episode, the following options should be discussed with the woman, taking into account previous response to treatment, her preference, and risk:
  • combining drug treatment with psychological treatment, but switching to an antidepressant with lower risk
  • switching to psychological treatment (CBT or IPT)

Reference:

1. NICE (2007). Antenatal and postnatal mental health.