Reminick Alison, Cohen Stacy, Einarson Adrienne
Center for Women's Behavioral & Mental Health, Rush Medical Center, Chicago, IL, USA.
Womens Health (Lond). 2013 Nov;9(6):527-35. doi: 10.2217/whe.13.58.
Depression is a common illness during pregnancy, yet it often goes undetected and/or untreated. Untreated depression during pregnancy has been associated with increased rates of adverse maternal, obstetrical and fetal outcomes; consequently, it is crucial to manage these women effectively and adequately during this vulnerable time of their lives. The barriers to treatment include the stigma surrounding mental health and the challenges of navigating the constantly growing, and apparently conflicting, evidence regarding the safety of antidepressant use during pregnancy, as well as other concerns unique to pregnant women. In this paper, we suggest the management of women with depression during pregnancy, using evidence-based information, taking into account all of the aspects of treatment, including screening, risks of untreated depression and evaluation of the safety data regarding pharmaceutical treatments. In addition, we have designed a treatment algorithm to assist clinicians in making evidence-based decisions in this highly sensitive and complex clinical field. Finally, it is important to evaluate each woman on an individual, case-by-base basis, in order to ensure the best outcome for both the mother and her baby.
抑郁症是孕期常见疾病，但往往未被察觉和/或未得到治疗。孕期未治疗的抑郁症与孕产妇、产科和胎儿不良结局发生率增加有关；因此，在这些女性生命中的这一脆弱时期对其进行有效且充分的管理至关重要。治疗障碍包括围绕心理健康的污名化，以及在不断增加且明显相互矛盾的关于孕期使用抗抑郁药安全性的证据中进行抉择的挑战，还有孕妇特有的其他担忧。在本文中，我们建议利用循证信息对孕期抑郁症女性进行管理，考虑治疗的所有方面，包括筛查、未治疗抑郁症的风险以及药物治疗安全性数据的评估。此外，我们设计了一种治疗算法，以协助临床医生在这个高度敏感和复杂的临床领域做出循证决策。最后，重要的是对每位女性进行个体化、逐案评估，以确保母亲和她的宝宝都能获得最佳结果。
