Conditions in Pregnancy: APA: Don't under-treat depression in pregnancy

By Karen Richarson

NEW YORK ? Only 13% of pregnant women with depressive symptoms reported use of medications for depression, according to a study presented here.

In addition, of the few women who were taking antidepressants, less than half were being given doses adequate to control their symptoms, reported study author Dr. Sheila Marcus, director of the Women's Mood Disorders Program at the University of Michigan in Ann Arbor, where she is also clinical assistant professor of medicine.

Researchers studied 275 pregnant women who were at risk for depression, using the Centre for Epidemiologic Studies depression scale. It asks patients to report the frequency with which each of 20 events was experienced during the previous week. A score of 16 or greater (scoring range 0 to 60) means the patient may have experienced some depression in the past week.

The patients (average age 27 years) then underwent diagnostic interviews to determine depression status, history and use of antidepressant medications.

One-quarter of the women met the criteria for major depressive disorder. Among women who reported using antidepressant medication during pregnancy, most (70%) continued to have elevated levels of depressive symptoms.

A total of 44% of the women taking antidepressants reported minimally adequate dosage?defined as receiving at least 20 mg fluoxetine, 50 mg sertraline, 150 mg venlafaxine (Effexor), or 150 mgbupropion (Wellbutrin) for at least 12 weeks daily.

"Full symptom remission should be the goal for antenatal and postnatal depression to minimize risk to mother and baby," the researchers said.

Dr. Gideon Koren, director of the Hospital for Sick Children's Motherisk program in Toronto, said the American experience is "sadly, but not surprisingly" identical to what has been described in Canada.

"Subtreatment, or lack of any treatment of depression in pregnancy, is common and can be life-threatening," he said, commenting on the study in an interview.

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