Treatment of Mood Disorders During Pregnancy and Postpartum

Although pregnancy was once believed to be a time of emotional well-being for women, studies now suggest that pregnancy does not protect women from the emergence or persistence of mood disorders. Mood and anxiety disorders are prevalent in women during the childbearing years and, for many women, these mood disorders are chronic or recurrent. Maintenance antidepressant therapy is often indicated during the reproductive years and women face difficult treatment decisions regarding psychotropic medications and pregnancy. Treatment of psychiatric disorders during pregnancy involves a thoughtful weighing of the risks and benefits of proposed interventions (eg, pharmacological treatment) and the documented and theoretical risks associated with untreated psychiatric disorders such as depression. Collaborative decision making that incorporates patient treatment preferences is optimal for women trying to conceive or who are pregnant. With increasing evidence of high rates of relapse following discontinuation of psychotropic medications (eg, antidepressants, mood stabilizers, antipsychotics, and benzodiazepines) and other data that describe new-onset psychiatric illness during pregnancy, the value of psychiatric consultation during pregnancy and after delivery is intuitive. The risks of untreated mood disorders during pregnancy to the mother and the baby (eg, preterm delivery, poor nutrition, inadequate weight gain, poor prenatal care, inability to care for oneself, substance use, termination of the pregnancy, and postpartum depression) also deserve attention. Depression