title: Antidepressants in pregnancy: a review of commonly prescribed medications.
abstract: Perinatal depression is an increasingly common comorbidity of pregnancy and is associated with adverse birth outcomes. Newer classes of antidepressants have been developed with a variety of mechanisms and improved side effect profiles. There is increasing use of these medications in reproductive-aged women. Medical providers have to balance the need to prevent relapse of maternal depressive symptoms with the need to minimize fetal exposure to medications. We review the literature on 10 of the most commonly used antidepressant medications: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, duloxetine, bupropion, and mirtazapine. The pharmacokinetic properties of the medications are detailed, as well as practical considerations for their use in pregnant and lactating women. Guidance on counseling and management of pregnancies complicated by perinatal depression is discussed.
  
  
  BACKGROUND
  Obstetricians & Gynecologists and Family Physicians.
  
  
  OBJECTIVE
  After completing this CME activity, physicians should be better able to differentiate the current classes of medications utilized commonly for perinatal depression, evaluate the reported adverse effects of antidepressant medications on the patient and developing fetus and choose the appropriate antidepressant medications for a depressed patient who is breast-feeding.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke Clinical Research Institute, Duke University, Durham, NC 27710, USA. avi.patil@duke.edu
authors.forename: Avinash S
authors.initials: AS
authors.lastname: Patil
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kuller
authors.forename: Eleanor H J
authors.initials: EH
authors.lastname: Rhee
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000517:prevention & control; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001942:Breast Feeding; D003863:Depression / Q000188:drug therapy*; D004348:Drug Labeling; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011295:Prenatal Care; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D018687:Antidepressive Agents, Second-Generation; D017367:Selective Serotonin Reuptake Inhibitors