Guidelines on treatment of perinatal depression with antidepressants: An international review
Open accessAbstract
Objective: Several countries have developed Clinical Practice Guidelines regarding treatment of perinatal depressive symptoms and perinatal use of antidepressant. We aimed to compare guidelines to guide clinicians in best clinical practice. Methods: An extensive search in guideline databases, MEDLINE and PsycINFO was performed. When no guidelines were (publicly) available online, we contacted psychiatric-, obstetric-, perinatal- and mood disorder societies of all first world countries and the five largest second world countries. Only Clinical Practice Guidelines adhering to quality criteria of the Appraisal of Guidelines for Research and Evaluation instrument and including a systematic review of evidence were included. Data extraction focussed on recommendations regarding continuation or withdrawal of antidepressants and preferred treatment in newly depressed patients. Results: Our initial search resulted in 1094 articles. After first screening, 40 full-text articles were screened. Of these, 24 were excluded for not being an official Clinical Practice Guidelines. In total, 16 Clinical Practice Guidelines were included originating from 12 countries. Eight guidelines were perinatal specific and eight were general guidelines. Conclusion: During pregnancy, four guidelines advise to continue antidepressants, while there is a lack of evidence supporting this recommendation. Five guidelines do not specifically advise or discourage continuation. For new episodes, guidelines agree on psychotherapy (especially cognitive behavioural therapy) as initial treatment for mild to moderate depression and antidepressants for severe depression, with a preference for sertraline. Paroxetine is not preferred treatment for new episodes but switching antidepressants for ongoing treatment is discouraged (three guidelines). If mothers use antidepressants, observation of the neonate is generally recommended and breastfeeding encouraged.
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- Authors
- Molenaar, N. M., Kamperman, A. M., Boyce, P., & Bergink, V.
- Affiliations
- Erasmus MC (NL)
- Westmead Hospital (AU)
- Corresponding author
- Molenaar, Nina M
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2018-03-05
- Volume
- 52
- Issue
- 4
- Pages
- 320-327
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- PMC
- PMC5871019
- OpenAlex
- W2792899182
- Cited by
- 156
- References
- 47
- Citations by year
- 2026: 11 · 2025: 20 · 2024: 11 · 2023: 34 · 2022: 23 · 2021: 22 · 2020: 18 · 2019: 14 · 2018: 3
- FWCI
- 2.59
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Australian & New Zealand Journal of Psychiatry (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- perinatal depression, antidepressants, pregnancy, breastfeeding, neonatal observation, sertraline, paroxetine, cognitive behavioral therapy, psychotherapy, guideline comparison, guideline quality assessment
- MeSH terms
- Antidepressive Agents, Depressive Disorder, Female, Humans, Pregnancy, Pregnancy Complications, Practice Guidelines as Topic
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