summary
background It is difficult to find well-grounded advice about the pharmacotherapeutic treatment of anxiety and depression before, during and after pregnancy. Furthermore, in the literature pharmacotherapeutic advice relating to the various periods (pre-conception, pregnancy and lactation) is often contradictory.
aim By reviewing the literature, to arrive at a recommendation for the pharmacotherapeutic treatment of depression during and after pregnancy and to compare and weigh up the various risks involved in treatment.
method A literature search in PubMed and Embase with search terms 'antidepress*', 'anxiol*', 'pregnan*', 'depressi*', 'anxiet*', 'guideline', 'lactation', 'breastfeeding' and 'milk'. The National Guideline Clearinghouse database was used to find guidelines.
results The literature reveals that the medical treatment of a depression during pregnancy and lactation is not without risks. However, there are also risks involved in not treating depression during these periods. These risks cannot be assessed at group-level but have to be weighed up for each individual separately. The patient needs to be informed about the risks she runs in connection with a particular treatment so that a well-considered decision can be made about whether to treat or not treat depression with antidepressants during pregnancy.
conclusion If the decision is made to treat depression during pregnancy and in the lactation period, it is advisable to choose an antidepressant from the safest category; in most countries this means opting for tricyclic antidepressants.