O'Brien Lisa, Schachtschneider Anne-Marie, Koren Gideon, Walker John H, Einarson Adrienne
Hospital for Sick Children, Toronto and Institute of Medical Science, University of Toronto.
J Psychiatr Pract. 2007 Jan;13(1):33-9. doi: 10.1097/00131746-200701000-00005.
Pregnant women who suffer from clinical depression and use antidepressant medications may receive conflicting information about fetal safety. Little information exists on the effect of continuation of antidepressants on depressive symptoms during pregnancy.
To determine the effectiveness of maintaining antidepressants during pregnancy, as measured by changes in symptoms of depression, anxiety, irritability, and stress following reassuring evidence-based counseling.
Depressed women who were pregnant and taking antidepressants, and who called the Motherisk program for advice, participated in a study that involved reassuring evidence-based counseling on the risk of antidepressants in pregnancy, followed by four telephone interviews: one in each trimester and one in the postpartum period. Depression, anxiety, irritability, and stress scales were completed at each call.
Of the 58 women who enrolled in the study, 38 completed 75% of the follow-ups. Eight women (14%) discontinued their medication during the study. Depression scores were highest at enrollment in the first trimester and decreased as pregnancy progressed. When data from all women, regardless of dose adjustments, were analyzed, no statistically significant differences were seen between depression scores at any time point; mean depression scores were below the cut off for depression throughout the study period. Irritability, anxiety, and stress scores were not found to be statistically different at any time point during the study.
Evidence-based reassurance and continuous antidepressant pharmacotherapy during gestation can provide pregnant women with effective symptom control for their depression. Women should consult their healthcare provider to ensure that they are being treated effectively; a risk/benefit assessment should be conducted on a case-by-case basis.
患有临床抑郁症且使用抗抑郁药物的孕妇可能会收到关于胎儿安全性的相互矛盾的信息。关于孕期继续使用抗抑郁药物对抑郁症状的影响，目前几乎没有相关信息。
通过基于循证咨询后抑郁、焦虑、易怒和压力症状的变化，确定孕期维持使用抗抑郁药物的有效性。
怀孕且正在服用抗抑郁药物并致电母婴风险评估项目寻求建议的抑郁症女性参与了一项研究，该研究包括基于循证的关于孕期抗抑郁药物风险的咨询，随后进行四次电话访谈：在每个孕期各进行一次，产后再进行一次。每次通话时完成抑郁、焦虑、易怒和压力量表的填写。
在参与研究的58名女性中，38名完成了75%的随访。8名女性（14%）在研究期间停药。抑郁评分在孕早期入组时最高，并随着孕期进展而降低。当分析所有女性的数据，无论是否调整剂量时，在任何时间点的抑郁评分之间均未发现统计学上的显著差异；在整个研究期间，平均抑郁评分均低于抑郁的临界值。在研究期间的任何时间点，均未发现易怒、焦虑和压力评分在统计学上存在差异。
孕期基于循证的安抚和持续的抗抑郁药物治疗可以为孕妇提供有效的抑郁症状控制。女性应咨询其医疗保健提供者，以确保得到有效治疗；应根据具体情况进行风险/效益评估。
