Antepartum depression: Prevalence, diagnosis and treatment

Introduction. - The occurrence of depression during pregnancy is a frequent situation that must be distinguished from postpartum depression. It raises many questions regarding its complications and therapeutic options. Objectives. - To provide a systematic review of available data on prevalence, risk factors, and adverse outcomes of antepartum depression, as well as on screening tools and treatments currently available. Methods. - Studies, reviews, and meta-analyses were searched through the Pubmed and Embase databases. Articles related to postpartum depression or specifically focusing on bipolar disorder were excluded. Results. - Epidemiology: Prevalence is estimated between 5 and 15%. Risk factors, in addition to those of any depression, are an ambivalent attitude towards pregnancy, previous miscarriages, and medically-assisted or complicated pregnancies. Diagnosis and screening: No specific tool has yet been designed to diagnose or screen antepartum depression, but some scales (EPDS, PRIME-MD PHQ) have been validated. Adverse outcomes: For the mother, adverse outcomes are those of any depression, in addition to an increased risk of delivery complications and of postpartum depression. For the child, there is an increased risk for preterm birth, low birth-weight, and possibly sudden death. Treatments: - Tricyclic antidepressants are widely described as safe during pregnancy. SSRIs show much reassuring data, even though recent studies have raised concerns about cardiac malformations and persistent pulmonary hypertension of the newborn. Electroconvulsive therapy is only indicated in the most severe cases but appears secure under specific safety measures. Most psychotherapies have not been specifically assessed during pregnancy. Other treatments (bright light therapy, rTMS ... ) have shown some promising but not robust results. Conclusion. - Antepartum depression is frequent, and potentially severe if not treated. Validation of specific screening tools is warranted. Pharmacological treatment should not be postponed in cases of severe depression. Regarding moderate depressions, it appears reasonable to turn to non-pharmacological treatments, primarily psychotherapies, which therefore should be more thoroughly studied. (C) L'Encephale, Paris, 2010.