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Diagnosis, Pathophysiology, and Management of Mood Disorders in Pregnant and Postpartum Women

Yonkers, Kimberly Ann MD; Vigod, Simone MD, FRCPC; Ross, Lori E. PhD

doi: 10.1097/AOG.0b013e31821187a7
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Mood disorders disproportionately affect women across the lifespan. Mood disorders in pregnancy and the postpartum period are common and have profound implications for women and their children. These include obstetric and neonatal complications, impaired mother–infant interactions, and, at the extreme, maternal suicide and infanticide. Because obstetrician–gynecologists are often the first (and sometimes the only) point of contact for young women in the health care system, familiarity with the presentation and treatment of depressive illness in the perinatal period is imperative. The goal of this review is to synthesize essential information on depressive illness in the perinatal period with a focus on its most common and severe presentations, major depressive disorder and bipolar disorder. Accurate diagnosis of unipolar major depressive disorder from bipolar disorder can facilitate the selection of the best possible treatment alternatives. Counseling may be sufficient for perinatal women who have mild to moderate depression, but women who are severely depressed are likely to require antidepressant treatment. Women with bipolar disorder are at high risk for relapse if mood stabilizer medication is discontinued, and they are vulnerable to relapse near the time of delivery. Comanagement of their care with psychiatrists will increase their chances of avoiding a recurrence of illness.

Mood disorders in perinatal women are common. Counseling can help with mild depression, but medication typically is required for women with severe depression or bipolar disorder.

From the Yale School of Medicine, New Haven, Connecticut; and the Women's College Hospital and Women's College Research Institute, and the Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.

Continuing medical education for this article is available at http://links.lww.com/AOG/A230.

Corresponding author: Kimberly Ann Yonkers, MD, 142 Temple Street, Suite 301, New Haven, CT 06510; e-mail: Kimberly.Yonkers@Yale.edu.

Financial Disclosure Dr. Yonkers has received funding for an investigator-initiated grant to treat postpartum depression. Funds were paid to Yale by Lilly. Pfizer provided medication (sertraline) for an ongoing study that is assessing the efficacy of sertraline used intermittently when symptoms begin as a treatment for premenstrual dysphoric disorder. The study is a three-site study funded by the National Institute of Mental Health. Dr. Yonkers has also received royalties from UpToDate for a chapter on premenstrual syndrome. The other authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.