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2288 pages added, reviewed or updated during the last month (last updated: 19/4/2021)


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

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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

Last reviewed 03/2021

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