management of new episode of depression in a pregnant (or breastfeeding) woman
Last reviewed 01/2023
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
- for a woman who develops mild or moderate
depression during pregnancy or the postnatal period, the following should be considered:
Reference: