Pharmacological treatment of unipolar depression during pregnancy and breast-feeding—A clinical overview

Abstract

Background: This overview is aimed at clinicians working with patients in the fertile age who suffer from depressive disorders. The study of adverse effects of antidepressants on the foetus is hampered by difficulty in distinguishing between the behavioural changes that are related to the disorder itself and changes that accompany its treatment with antidepressants. The current lack of solid scientific knowledge and the implications, mainly emotional, of treating pregnant or breast-feeding women often raise anxiety and cause concern among patients and clinicians. Methods: Currently available data are evaluated and clinical recommendations given. Results and Conclusions: Citalopram and sertraline can be used during pregnancy, while some controversy remains over in utero exposure to paroxetine and fluoxetine, which might be associated with an increased risk of foetal cardiovascular malformation. Less data is available concerning fluvoxamine and escitalopram use but current data does not indicate a specific risk. Citalopram, paroxetine and sertraline can be used during breast-feeding, while fluoxetine probably should be avoided. Nortriptyline, amitriptyline and clomipramine can be used during pregnancy and lactation, although data are more abundant for SSRI treatment. Venlafaxine can be used during pregnancy, while caution is advised during breast-feeding. Other antidepressants should be avoided because of lack of data on their effect. A strongly indicated lithium therapy should be continued. Close monitoring of lithium levels throughout pregnancy is mandatory, as is detailed foetal echocardiography in weeks 18–22 of gestation. Lithium should not be used during breast-feeding. Electroconvulsive therapy (ECT) is a valid option if indicated, both during pregnancy and breast-feeding.

• Abnormalities
• Antidepressive agents
• Breast-feeding
• Depression
• Pregnancy

Acknowledgements

The authors would like to acknowledge Professor Morten Pilegaard for his editorial assistance.

Disclosure of interests: Nielsen has received research grants from H. Lundbeck for clinical trials, received speaking fees from Bristol-Myers Squibb, Astra Zeneca, Janssen & Cilag, Lundbeck and has been an advisor to Astra Zeneca.

Damkier has received grants from Novatis and speaking fees from Pfizer, H. Lundbeck, Janssen Cilag, Astra Zeneca, Bristol-Myers Squibb, Baxter and Novo Nordisk. Damkier has served as an advisor for Fertin A/S. The authors alone are responsible for the content and writing of the paper.