Depression in Pregnancy: To Treat or not to Treat?

The occurrence of depression in pregnancy poses a particular therapeutic challenge, since the benefits and risks of a pharmacotherapy have to be particularly carefully weighed against each other. If the indication is checked for an antidepressant pharmacotherapy during pregnancy, one tends to forget that not only the drug therapy is associated with risks, but also a potential non-treatment.Scientists from the University of Pittsburgh and Case Western Reserve University in Cleveland now report in the American Journal of Psychiatry about their observational study of 174 mothers and their children who were carefully assessed for one year after birth (Wisner et al., 2013). 97 of the mothers with their children represented the control group; they were not suffering from depression and were consequently not treated with an antidepressant. 46 mothers were treated with an antidepressant (SSRI) during pregnancy because of a depressive disorder, 30 of them for the entire duration of the pregnancy. 31 mothers were diagnosed, but not treated, eight of them for the entire duration of the pregnancy. Weight, height and head circumference were measured in all children at four time points after birth: 2, 12, 26 and 52 weeks.

The result of the study is summarized quickly: Neither the children of mothers who had received an antidepressant during pregnancy, nor the children of mothers whose depression had not been treated, differed in weight, height or head circumference at any time point from the healthy control group. However, the children of mothers treated with an SSRI presented with a significantly lower height at the time of birth than the two other groups. In addition, the children from mothers who had been treated with an SSRI or who had been exposed to an untreated depression, tended to be (not statistically significantly) more lightweight at time of birth. The mothers who had been treated with an SSRI had significantly more prematurity (gestational age < 37 weeks). In the group of children who were prenatally exposed to an SSRI there were also significantly less male infants.

Since the groups in the current publication are relatively small, it cannot be excluded that there are group differences that could not be detected. Moreover, this is an observational study. Randomization (treatment versus non-treatment) is extremely problematic for ethical reasons. Therefore, the groups in the present study differed with regard to major demographic parameters. In the group of mothers whose depression had not been treated there were significantly more women from ethnic minorities (non-whites). They also had a significantly lower level of education and were more often single.

In an accompanying editorial in the same issue of the journal Barbara Parry from the University of California in San Diego asks the question for parameters of child development in children whose mothers are prenatally diagnosed with depression and may have been treated with medication that go beyond purely physical dimensions, namely neurocognitive performance and social-emotional development. These data are to be expected with probability from Wisner and colleagues in the future.

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