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Severe antenatal unipolar major depression: Treatment

Sophie Grigoriadis, MD, MA, PhD, FRCPC
Section Editors
Peter P Roy-Byrne, MD
Charles J Lockwood, MD, MHCM
Deputy Editor
David Solomon, MD


Unipolar major depression is common in pregnant women and is often not treated [1]. In a nationally representative survey in the United States that identified pregnant women with major depression, only 50 percent received treatment [2]. Untreated disease causes maternal suffering and is associated with poor nutrition, comorbid substance use disorders, poor adherence with prenatal care, postpartum depression, impaired relationships between the mother and her infant and other family members, and an increased risk of suicide [3,4].

Barriers to treatment of antenatal depression include cost, opposition to treatment (eg, fear of exposing the fetus to antidepressant medication or lack of interest in psychotherapy), unavailability of psychotherapy, and stigma [3,4]. In addition, many clinicians are reluctant to use pharmacotherapy because they lack sufficient expertise [5], and the large literature is often inconsistent [6].

This topic reviews choosing a specific treatment for severe antenatal unipolar major depression. Other topics discuss treatment of mild to moderate episodes of antenatal unipolar major depression; general principles of treatment; risks of antidepressants during pregnancy; and the epidemiology, clinical features, assessment, and diagnosis of antenatal depression.

(See "Mild to moderate antenatal unipolar depression: Treatment".)

(See "Unipolar major depression in pregnant women: General principles of treatment".)


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Literature review current through: Dec 2016. | This topic last updated: Mon Oct 31 00:00:00 GMT+00:00 2016.
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