CNS Spectrums

Review Articles

The management of mood disorders in pregnancy: alternatives to antidepressants

Erica M. Richardsa1 and Jennifer L. Paynea2 c1

a1 Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland, USA

a2 Department of Psychiatry and Women's Mood Disorders Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA

Abstract

The management of mood disorders during pregnancy is complex due to risks associated with medication use and risks associated with untreated depression. Antidepressant use during pregnancy is an exposure for the unborn child, and it currently remains unclear what long-term repercussions there might be from this exposure, though available data are reassuring. On the other hand, there are risks for both the mother and child of untreated depression during pregnancy. There is a real need for research into nonpharmacological strategies for the prevention of relapse of mood disorders in pregnant women who are off medications. We have reviewed a number of potential candidate interventions including psychotherapies, exercise, light box therapy (LBT), repetitive transcranial magnetic stimulation (rTMS), electroconvulsive therapy (ECT), holistic strategies, and nutritional and herbal supplements. Currently there is a lack of evidence supporting the use of such strategies in the prevention of depressive relapse during pregnancy, though most of these strategies have at least some support for their use in the treatment of a major depressive episode. Carefully conducted research using one or more of these strategies in women who want to discontinue antidepressants for pregnancy is sorely needed.

(Received December 11 2012)

(Accepted February 05 2013)

(Online publication April 10 2013)

Key words

  • Peripartum;
  • depression;
  • mood disorder;
  • persistent pulmonary hypertension;
  • holistic;
  • poor neonatal adaptation

Correspondence

c1 Address for correspondence: Jennifer L. Payne, MD, Associate Professor of Psychiatry, Johns Hopkins School of Medicine, Department of Psychiatry, 550 N. Broadway, Suite 305, Baltimore, MD 21205, USA. (Email jpayne5@jhmi.edu)

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