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
pregnant or breastfeeding women who have a new episode of depression
for a woman who develops mild or moderate depression during pregnancy or the postnatal period, the following should be considered:
self-help strategies (guided self-help, computerised CBT (C-CBT) or exercise)
non-directive counselling delivered at home (listening visits)
brief CBT or interpersonal psychotherapy (IPT)
antidepressant drugs should be considered for women with mild depression during pregnancy or the postnatal period if they have a history of severe depression and they decline, or their symptoms do not respond to, psychological treatments
for a woman with a moderate depressive episode and a history of depression, or with a severe depressive episode during pregnancy or the postnatal period, the following should be considered: · structured psychological treatment specifically for depression (CBT or IPT)
antidepressant treatment if the woman has expressed a preference for it
combination treatment if there is no response, or a limited response to psychological or drug treatment alone, provided the woman understands the risks associated with antidepressant medication
treatment-resistant depression
for pregnant women with treatment-resistant depression, a trial of a different single drug or ECT should be considered before combination drug treatment. Lithium augmentation should be avoided
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