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Aust N Z J Psychiatry. 2018 Apr;52(4):320-327. doi: 10.1177/0004867418762057. Epub 2018 Mar 5.

Guidelines on treatment of perinatal depression with antidepressants: An international review.

Author information

1
1 Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands.
2
2 Department of Psychiatry, Westmead Hospital, Westmead, NSW, Australia.
3
Current affiliation: Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Abstract

OBJECTIVE:

Several countries have developed Clinical Practice Guidelines regarding treatment of perinatal depressive symptoms and perinatal use of antidepressant. We aimed to compare guidelines to guide clinicians in best clinical practice.

METHODS:

An extensive search in guideline databases, MEDLINE and PsycINFO was performed. When no guidelines were (publicly) available online, we contacted psychiatric-, obstetric-, perinatal- and mood disorder societies of all first world countries and the five largest second world countries. Only Clinical Practice Guidelines adhering to quality criteria of the Appraisal of Guidelines for Research and Evaluation instrument and including a systematic review of evidence were included. Data extraction focussed on recommendations regarding continuation or withdrawal of antidepressants and preferred treatment in newly depressed patients.

RESULTS:

Our initial search resulted in 1094 articles. After first screening, 40 full-text articles were screened. Of these, 24 were excluded for not being an official Clinical Practice Guidelines. In total, 16 Clinical Practice Guidelines were included originating from 12 countries. Eight guidelines were perinatal specific and eight were general guidelines.

CONCLUSION:

During pregnancy, four guidelines advise to continue antidepressants, while there is a lack of evidence supporting this recommendation. Five guidelines do not specifically advise or discourage continuation. For new episodes, guidelines agree on psychotherapy (especially cognitive behavioural therapy) as initial treatment for mild to moderate depression and antidepressants for severe depression, with a preference for sertraline. Paroxetine is not preferred treatment for new episodes but switching antidepressants for ongoing treatment is discouraged (three guidelines). If mothers use antidepressants, observation of the neonate is generally recommended and breastfeeding encouraged.

KEYWORDS:

Clinical Practice Guideline; antidepressants; depressive disorder; perinatal depression; pregnancy

PMID:
29506399
PMCID:
PMC5871019
DOI:
10.1177/0004867418762057
[Indexed for MEDLINE]
Free PMC Article

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