Current APA/ACOG Recommendations for Managing Depression during Pregnancy in Three Scenarios

November 1, 2010

  1. Considering pregnancy, taking ADs

    • If moderate to severe depressive symptoms, delay conceiving, continue and optimize meds until stable

    • If in early remission (started AD less than 6 months ago), delay conceiving, continue meds until stable

    • If in full remission, but history of both recurrence and non-response to psychotherapy, continue meds through pregnancy

    • If in full remission, no recurrent depression and/or positive prior response to therapy, taper off medication and refer for therapy



  2. Pregnant, depressed, taking ADs

    • If depression is severe, continue and optimize meds

    • If depression is not severe:

      • If pt has either responded to therapy before or has never had therapy, start therapy either in combination with meds or (if symptoms are relatively mild) with a med taper

      • If pt has failed therapy, continue meds





  3. Pregnant, depressed, not taking ADs

    • If depression is severe, start meds

    • If depression is not severe:

      • If pt has never failed a course of therapy, do therapy

      • If pt has failed therapy, start meds





General Psychiatry
KEYWORDS antidepressants depressive_disorder women's_issues_in_psychiatry
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