Dayan J, Yoshida K
Unité de psychiatrie périnatale, service de psychiatrie de l'enfant et de l'adolescent, CHU de Caen, avenue Clémenceau, 14033 Caen cedex, France.
J Gynecol Obstet Biol Reprod (Paris). 2007 Oct;36(6):530-48. doi: 10.1016/j.jgyn.2007.06.004. Epub 2007 Jul 5.
The aim of this article is to review the main methods of treatment of anxious and depressive disorders during pregnancy and the postpartum. To this end, we analyse recent publications about the use and efficacy of psychotherapy and psychosocial interventions (cognitive behavioural therapy, interpersonal psychotherapy, psychoanalytical therapy) in the perinatal period. We also review recent papers about the use of psychotropic medication during pregnancy and breast-feeding, with special emphasis on clinical trials. We particularly focus on the risk/benefit assessment of antidepressants, mood stabilisers, antipsychotics and benzodiazepines, in terms of teratogenicity, and impact on neonatal adaptation and neuropsychological development. Various treatment modalities are presented and discussed. It appears that psychotherapies have proved their efficiency on most pre- and postpartum anxious and depressive disorders and represent a first line treatment in most cases. Psychopharmacological treatment is indicated for severe anxious and depressive disorders. The risks of such medication, especially antidepressants, may have been overestimated in the past. Provided reasonable precautions are taken and mothers and future mothers receive clear information on the potential risks and benefits, psychotropic medication could be more broadly prescribed during pregnancy and the breast-feeding period.
本文旨在综述孕期及产后焦虑和抑郁障碍的主要治疗方法。为此，我们分析了近期有关围产期心理治疗和心理社会干预（认知行为疗法、人际心理治疗、精神分析疗法）的应用及疗效的出版物。我们还回顾了近期有关孕期及哺乳期使用精神药物的论文，特别强调了临床试验。我们尤其关注抗抑郁药、心境稳定剂、抗精神病药和苯二氮䓬类药物在致畸性方面的风险/获益评估，以及对新生儿适应和神经心理发育的影响。文中介绍并讨论了各种治疗方式。心理治疗似乎已在大多数产前和产后焦虑及抑郁障碍中证明了其有效性，并且在大多数情况下是一线治疗方法。对于严重的焦虑和抑郁障碍，需进行心理药物治疗。此类药物的风险，尤其是抗抑郁药的风险，在过去可能被高估了。只要采取合理的预防措施，并且母亲和准妈妈们能清楚了解潜在的风险和益处，那么在孕期和哺乳期就可以更广泛地开具精神药物。
