title: Depression and anxiety during pregnancy and the postpartum period in women with epilepsy: A review of frequency, risks and recommendations for treatment.
abstract: OBJECTIVE
  To review available data and provide treatment recommendations concerning peripartum depression, anxiety and fear of birth in women with epilepsy (WWE).
  
  
  METHODS
  The PubMed, the LactMed, the DART and the Cochrane database were searched for original articles concerning psychiatric disease in the peripartum period in WWE.
  
  
  RESULTS
  Point prevalence of depression from 2nd trimester to 6 months postpartum ranged from 16 to 35% in women with epilepsy compared to 9-12% in controls. The highest estimates were found early in pregnancy and in the perinatal period. Anxiety symptoms 6 months postpartum were reported by 10 and 5%, respectively. Fear of birth symptoms were increased in primiparous WWE compared to controls. Previous psychiatric disease, sexual/physical abuse, antiepileptic drug (AED) polytherapy, and high seizure frequency emerged as strong risk factors. Depressed WWE rarely used antidepressive medication during pregnancy. No evidence was available concerning treatment effects or impact on the developing child.
  
  
  CONCLUSIONS
  Peripartum depression is frequent in WWE and seldom medically treated. Health personnel should screen WWE for psychiatric disease and risk factors during pre-pregnancy planning, pregnancy and postpartum follow up. Treatment decisions should rely on efficacy and safety data in peripartum patients without epilepsy and non-pregnant people with epilepsy. Consequences of in utero exposure to AED therapy in combination with antidepressants are not known, and non-pharmacological treatment should be tried first.
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Neurology, Haukeland University Hospital, Bergen, Norway. Electronic address: mebk@helse-bergen.no.
authors.forename: Marte
authors.initials: M
authors.lastname: H Bjørk
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Gyri
authors.initials: G
authors.lastname: Veiby
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Bernt
authors.initials: B
authors.lastname: A Engelsen
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Nils Erik
authors.initials: NE
authors.lastname: Gilhus
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001007:Anxiety / Q000453:epidemiology* / Q000628:therapy; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D003863:Depression / Q000453:epidemiology* / Q000628:therapy; D004827:Epilepsy / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005260:Female; D017408:Guidelines as Topic / Q000592:standards*; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents
keywords: Antidepressants; Antiepileptic drugs; Perinatal; Postnatal; Psychiatry; Seizure