Management of new episode of depression in a pregnant (or breastfeeding) woman

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
• 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

Reference:

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