Clinical Review

Depression in pregnancy

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1547 (Published 24 March 2016) Cite this as: BMJ 2016;352:i1547
  1. Simone N Vigod, assistant professor, psychiatrist, and Shirley Brown clinician scientist1,
  2. Claire A Wilson, academic clinical fellow2,
  3. Louise M Howard, NIHR research professor, professor in women’s mental health, and consultant perinatal psychiatrist2
  1. 1Department of Psychiatry, Faculty of Medicine, University of Toronto; Women’s College Hospital and Women’s College Research Institute, Ontario, Canada M5S 2B1
  2. 2Section of Women’s Mental Health, King’s College London, London, UK
  1. Correspondence to: S N Vigod simone.vigod{at}wchospital.ca

What you need to know

  • Offer all women education about mental health problems in pregnancy, treatment options, and the effect on themselves and their offspring

  • Offer women with mild or moderate depression psychological treatments if they have access to them and can commit time to therapy

  • Consider antidepressant drugs such as selective serotonin reuptake inhibitors (SSRIs) for women with current or past severe or recurrent depression

  • For pregnant women who have not used antidepressants, any SSRI (with the exception of paroxetine) is a reasonable first choice

  • For former antidepressant users, information on efficacy and tolerability must be considered when selecting an antidepressant during pregnancy

  • Switching antidepressants during pregnancy or lactation is not recommended (even with paroxetine) as there is no clear evidence that the safety profile of one drug is superior to that of another. Switching away from an effective drug could increase the risk of relapse

Depression in pregnancy affects up to 10% of women, with higher rates in low and middle income countries, a rate only slightly lower than in the postpartum period.1 2 Yet, as few as 20% of pregnant women with depression receive adequate treatment.3 4 This is problematic because depression can profoundly affect a woman’s sense of wellbeing, relationships, and quality of life. Untreated or incompletely treated depression can also have adverse consequences for the offspring. Systematic reviews show an increase in markers of infant morbidity such as preterm birth, childhood emotional difficulties, behaviour problems, and, in some studies, poor cognitive development.5 6 Antenatal depression also is one of the strongest risk factors for postnatal depression, a condition linked to developmental problems in children.6 7 Severe depression can result in suicide, a major cause of maternal death.8 9 Perinatal suicides have been associated with lack of active treatment.10 Barriers to treatment include stigma, lack …

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