Evidence-based pharmacy practice (EBPP) : antidepressants in pregnancy

Abstract

Depression is a common chronic and recurrent illness that is the cause of significant morbidity that often requires long-term treatment. Depression is among the most common health disorders in women. The prevalence of depression is approximately twice as great in women as in men and it is more common in the childbearing years. Despite its common occurrence it is frequently undiagnosed and left untreated during pregnancy usually due to concerns about the safety of treating women during pregnancy. Depression itself can have a negative impact on the course of the pregnancy as well as the foetus. All antidepressants cross the placenta and expose the foetus to the effects of these medications. The decision on whether to treat a pregnant woman with depression with pharmacotherapy depends on the severity of the disease, the number and frequency of episodes and the history of response to medication. Whether or not the patient may breastfeed also needs to be taken into consideration when deciding on which antidepressant to prescribe. Psychotherapy may obviate the need for pharmacotherapy in mild to moderate depression and may also be beneficial in patients taking antidepressants. All pregnant patients with depression need to be assessed and treated on an individual basis. Pharmacists can provide patients with general counselling regarding depression and antidepressants and support by identifying any pharmaceutical issues such as interactions, persistent side effects, and adherence. Pharmacists may also identify potential suicide risk which may become apparent when talking with a patient which would require urgent referral.