Depression during pregnancy.

OBJECTIVE To review existing literature on depression during pregnancy and to provide information for family physicians in order to promote early detection and treatment.

QUALITY OF EVIDENCE MEDLINE was searched from January 1989 through August 2004 using the key words depression, pregnancy, prenatal, and antenatal. Articles focusing on depression during pregnancy were chosen for review; these articles were based on expert opinion (level III evidence) and prospective studies (level II evidence).

MAIN MESSAGE Pregnancy does not safeguard women against depressive illness. The Edinburgh Postnatal Depression Scale is an effective screening tool for identifying women with depressive symptoms during pregnancy. Once diagnosed with major depression, these patients need to be monitored closely for up to a year after delivery. Patients with mild-to-moderate illness should be referred for psychotherapy. More severely ill patients might require additional treatment with antidepressants. The most commonly used antidepressants are selective serotonin reuptake inhibitors and the serotonin and norepinephrine reuptake inhibitor, venlafaxine. For each patient, risk of treatment with an antidepressant needs to be compared with risk of not treating her depressive illness.

CONCLUSION Early detection of depression during pregnancy is critical because depression can adversely affect birth outcomes and neonatal health and, if left untreated, can persist after the birth. Untreated postpartum depression can impair mother-infant attachments and have cognitive, emotional, and behavioural consequences for children.