Contemporary management of unipolar depression in the perinatal period

ABSTRACT

Introduction: There is increasing recognition that antenatal depression and postpartum depression are highly prevalent and have significant impact on maternal and child health.

Areas Covered: In the initial part of the manuscript, the authors review the epidemiology of antenatal and postpartum depression and its impact on maternal and child health. The later part of the manuscript reviews the current status of the medical management and psychosocial interventions targeting perinatal depression.

Expert Opinion: Perinatal depression is the focus of several studies with increasing interest in developing effective interventions. While several psychosocial interventions targeting maternal depressive symptoms during pregnancy and postpartum are available, more studies are needed to address the need for safe and efficacious strategies for the use of antidepressant medication during pregnancy and in the postpartum period.

KEYWORDS:

• Antenatal depression
• postpartum depression
• psychosocial interventions
• antidepressants
• treatment guidelines

Article highlights

•The authors briefly review the potential health effects of perinatal depression on maternal and child health.

•Comprehensive evaluation of perinatal depression includes assessment of severity of depression, associated suicidal risk, presence of vegetative symptoms, social support, and past history of depression, and resources available for treatment.

•The choice of antidepressant medication for the treatment of perinatal depression must be individualized and take into consideration patient related clinical factors and availability of resources.

•There is a need to integrate assessment and interventions targeting maternal depressive symptoms with antenatal services and child well- being clinics across the spectrum of health services.

•More research on the management of perinatal depression is needed from LMICs where the burden of perinatal depression is high and there is a scarcity of trained mental health professionals.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

S Thomas was supported by the Fogarty International Center of the National Institutes of Health under Award Number D43TW009343 and the University of California Global Health Institute.