In pregnant women with current major depression, what is the most effective and safest antidepressant for reducing depressive symptoms?
There is currently insufficient evidence to draw meaningful
conclusions about the effectiveness and safety of antidepressant
therapy in pregnant women with major depression.
Four systematic reviews, all with major methodological limitations,
reported results indicating that antidepressant use during
pregnancy may be associated with adverse outcomes, including
congenital cardiovascular abnormalities in the newborn, spontaneous
abortion, and major congenital abnormalities in the newborn.
However, it should be noted that all of these results were derived
from comparisons of pregnant women with depression who were exposed
to antidepressant treatments and un-exposed pregnant women who were
not depressed; this approach is fundamentally flawed in that it
takes no account of the possible effects of depression itself.
Further research is required to adequately explore the risks and
benefits associated with antidepressant use in pregnancy. If
randomised controlled trials are not considered appropriate a
large, prospective cohort study of pregnant women with depression,
including both women who are exposed to pharmacological
antidepressant therapy during pregnancy and women who are not
exposed, could be used as the basis for regression modelling. It is
important that all study participants should have a diagnosis of
depression and that other potential confounding factors are
adequately considered. Meta-analytic techniques could be used if
individual patient data (IPD) were available from existing studies.
Standard meta-analysis, as used by the studies included in this
summary, is not appropriate since each individual study is likely
to adjust for a different set of confounding factors. Hence
combining the results of these studies in a single model does not
produce a meaningful effect estimate.
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