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Antidepressant Use During Pregnancy: Current Controversies and Treatment Strategies


Clinical Obstetrics and Gynecology: September 2009 - Volume 52 - Issue 3 - p 469-482
doi: 10.1097/GRF.0b013e3181b52e20
Psychiatric Disorders in Pregnancy

The treatment of depression during pregnancy is both a common and complex clinical challenge. The decision to expose the fetus to antidepressant medication during pregnancy must be weighed against the risks of untreated maternal depression to both mother and fetus. Maternal depression during pregnancy has been associated with increased rates of preterm birth and maternal substance use. The safety of antidepressant use during pregnancy seems to be largely reassuring but there remain 2 areas of controversy including neonatal withdrawal syndrome and primary pulmonary hypertension of the newborn. Individualized treatment recommendations based on the patient's history are essential to optimize outcomes.

*Women's Mood Disorders Program, Johns Hopkins School of Medicine, Baltimore, Maryland

UNC Perinatal Psychiatry Program, UNC Center for Women's Mood Disorders, Chapel Hill, North Carolina

Dr Meltzer-Brody has received or currently receives research grant support from the NIH, Foundation of Hope, Astra Zeneca, and GlaxoSmithKline.

Dr Payne has received in the past year or currently receives research grant support from the NIH, The Stanley Medical Research Institute, Novartis Pharmaceuticals, and Repligen Corporation.

Dr Payne has also served as a consultant in the past year to Wyeth and Astra Zeneca Pharmaceutical Companies.

Correspondence: Jennifer L. Payne, MD, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.