Pharmakotherapie der Depression in Schwangerschaft und Stillzeit

Depressive episodes are as frequent in pregnancy and postpartum period as in other times in life of women. Psychopharmacological treatment may be indicated especially in severe depression but needs individual benefit-risk assessment together with the patient and her partner. Large studies show that most of the antidepressants and antipsychotics have no teratogenic effects when used in early pregnancy after adjusting for confounding factors. Medication with SSRI in the third trimester of pregnancy is associated with the rare but severe complication of persistent pulmonary hypertension (PPH) in the newborn. As well exposition to antidepressants as antipsychotics in late pregnancy may lead to poor neonatal adaptation syndrome (PNAS), characterized by amongst others apathy, tremor, sucking weakness. Studies describe this syndrome in up to 30% of the exposed newborns. Commonly PNAS is not lifethreatening and it is self-limiting in most cases. Less data is available on psychopharmacological medication in breast-feeding. However, several antidepressants and antipsychotics are considered as relatively safe for breast-fed children. Sertralin, Paroxetin and Nortriptyline are currently the antidepressant substances with the best evidence regarding safety. Olanzapin and Quetiapin should be used as first-line antipsychotic agents in breast-feeding women.