Perinatal depression: What ob/gyns need to know

The screening tools previously mentioned both include a question related to self-harm. [...]it is imperative that the clinician review the responses before the patient leaves the office. Educating patients about risks of SSRIs When reviewing risks of SSRIs for treatment of perinatal depression, the following perinatal risks should be reviewed with the patient: congenital malformations, persistent pulmonary hypertension of the neonate (PPHN), neonatal adaptation syndrome and cognitive/behavioral issues.9 In the general population, 2% to 4% of neonates unexposed to prenatal antidepressants will be born with a congenital malformation versus 3% to 5% with such drug exposure. [...]exposure to antidepressants does not significantly increase the risk of congenital malformation.14'15 Risk of PPHN has been investigated in several studies. Previously, recommendations were made to discontinue antidepressants in the third trimester to decrease risk of neonatal adaptation syndrome, however, women were found to have relapses in their mood and thus this is no longer recommended.21 With regards to cognitive and behavioral issues in children exposed to antidepressants in pregnancy, data show no increased risk of behavioral issues such as attention deficit hyperactivity disorder, oppositional defiant disorder, or mood disorders. [...]care should be given to adolescent and young adult women when beginning antidepressants due to the black box warning showing possible increased risk of suicidality in this age group with initiation of SSRIs.28 It is imperative that all women- especially younger women-be seen within 1 to 2 weeks of medication initiation for follow-up.