CLASStime: Balancing emotions: Antidepressant use in pregnancy and breastfeeding

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CLASStime: Balancing emotions: Antidepressant use in pregnancy and breastfeeding

November 2023

By Lucy Broughton

Wednesday 1 November 2023, 12:40 AM

[Image: Fraser Williamson]

Perinatal depression is common and carries considerable risks, yet patients often receive contradictory information regarding the safety of antidepressant use during pregnancy and breastfeeding. In this article, Lucy Broughton sets the record straight and explains how pharmacists can support this important treatment decision

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References

Waldie KE, Peterson ER, D’Souza S, et al. Depression symptoms during pregnancy: Evidence from Growing Up in New Zealand. J Affect Disord 2015;186:66–73.
Jahan N, Went TR, Sultan W, et al. Untreated depression during pregnancy and its effect on pregnancy outcomes: A systematic review. Cureus 2021;13(8):e17251.
Stewart AL, Payne JL. Perinatal depression: A review and an update. Psychiatr Clin North Am 2023;46(3):447–61.
Perinatal and Maternal Mortality Review Committee. Te Pūrongo ā-Tau Tekau mā Toru o te Komiti Arotake Mate Pēpi, Mate Whaea Hokihe | Thirteenth Annual Report of the Perinatal and Maternal Mortality Review Committee. Wellington, NZ: Health Quality and Safety Commission; 2019.
Svardal CA, Waldie K, Milne B, et al. Prevalence of antidepressant use and unmedicated depression in pregnant New Zealand women. Aust N Z J Psychiatry 2022;56(5):489–99.
Broughton LC, Hughes-Medlicott N, Zeng J, Smith A. Perinatal psychotropic dispensing: A descriptive population-based study in New Zealand. Asia Pac Psychiatry 2023;15(2–3):e12539.
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Cohen LS, Altshuler LL, Harlow BL, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 2006;295(5):499–507.
Bayrampour H, Kapoor A, Bunka M, Ryan D. The risk of relapse of depression during pregnancy after discontinuation of antidepressants: A systematic review and meta-analysis. J Clin Psychiatry 2020;81(4):19r13134.
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Mulder E, Davis A, Gawley L, et al. Negative impact of non-evidence-based information received by women taking antidepressants during pregnancy from health care providers and others. J Obstet Gynaecol Can 2012;34(1):66–71.
Eakley R, Lyndon A. Antidepressant use during pregnancy: Knowledge, attitudes, and decision-making of patients and providers. J Midwifery Womens Health 2022;67(3):332–53.
BPACnz. Diagnosing and managing perinatal depression in primary care. November 2019.
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Grzeskowiak LE, Morrison JL, Henriksen TB, et al. Prenatal antidepressant exposure and child behavioural outcomes at 7 years of age: a study within the Danish National Birth Cohort. BJOG 2016;123(12):1919–28.
Nulman I, Rovet J, Stewart DE, et al. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: A prospective, controlled study. Am J Psychiatry 2002;159(11):1889–95.
Medsafe. Small increased risk of postpartum haemorrhage with use of serotonergic antidepressants close to delivery. Prescriber Update 2021;42(2):23–24.
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UK Teratology Information Service. Use of mirtazapine in pregnancy. September 2020.
Drugs and Lactation Database (LactMed). Bethesda, MD: National Institute of Child Health and Human Development; 2006–.
Briggs GG, Freeman RK, Tower CV, et al. Brigg's Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 12th edition. Lippincott Williams & Wilkins, US; 2021.

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CLASStime: Balancing emotions: Antidepressant use in pregnancy and breastfeeding