title: The use of antidepressant medication in pregnancy.
abstract: The use of antidepressant medications during pregnancy has stimulated much professional and public debate. As a consequence, considerable data on the reproductive safety of antidepressants has been generated that exceeds the available information for most, if not all, other classes of medications that may be used in the perinatal period. Despite progress to date, definitive conclusions are limited by the methodological issues inherent to clinical research involving illness versus treatment effects in pregnancy. A notable shortcoming is the limited discussion of statistically significant (a mathematical determination) versus clinically significant (incorporation of incidence and effect sizes into practical relevance). Research emphasises completing an individualised 'risk-benefit' assessment, which is a laudable goal but falls short in providing succinct practical guidelines that includes the key educational points for patients. In this chapter, we focus on areas in which the preponderance of data are consistent, and there is concordance with the preclinical literature to generate a practical approach for antidepressant use in pregnancy.
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Shona
authors.initials: S
authors.lastname: Ray
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Pediatrics and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street 843, Little Rock, AR 72205-7199, USA. Electronic address: znstowe@uams.edu.
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Stowe
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use*; D001724:Birth Weight / Q000187:drug effects; D003863:Depression / Q000188:drug therapy*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D010547:Persistent Fetal Circulation Syndrome / Q000139:chemically induced; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000523:psychology; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced; D012127:Respiratory Distress Syndrome, Newborn / Q000139:chemically induced; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors
keywords: AD: antidepressant; SNRI: serotonin-norepinephrine reuptake inhibitor; SSRI: selective-serotonin reuptake inhibitor; TCA: tricyclic antidepressant; depression; pregnancy