Common Mental Disorders Depression - New Zealand Doctor

eastfeeding, or not breastfeeding, may be associated with an increased risk
of maternal postpartum depression. 471
In the opinion of the GDT, a practitioner should support breastfeeding in a woman
with postnatal depression who opts to take antidepressants, provided she is wellinformed
about known risks and benefits.
Principles of prescribing in this population
When prescribing an antidepessant for a woman with depression who is planning
a pregnancy, is pregnant or breastfeeding, the NICE guideline 101 recommends that
prescribers should:
• choose an antidepressant with the lowest possible risk profile
• start at the lowest possible dose and increase it slowly
• aim to use only one drug
• consider the possibility of neonatal complications.
The GDT notes that smoking, alcohol and recreational drugs are likely to have an
additive effect on the risk associated with antidepressants, and the practitioner should
discuss this when exploring treatment options.
Decisions about antidepressant use should take account of the stage of pregnancy in
which medication is being prescribed, as this determines the risk/benefit profile. 101
Preconception planning for women taking antidepressants
or mood stabilising drugs
A woman who is taking lithium or other mood stabilising drugs should be periodically
reminded of the need for preconception counselling about medication if she plans
a pregnancy. An increased incidence of congenital abnormalities has been noted
in infants of women given mood stabilising drugs (eg, lithium, 472 carbamazapine, 473
lamotrigine 474 ) in pregnancy.
If a woman on antidepressants is planning conception, she may wish to attempt slow
withdrawal from her medication before conception, provided the depression has
receded. She should be monitored carefully so that any relapse is detected early. 453
Conception while taking antidepressants
Unplanned conception for a woman on antidepressants may prompt her to abruptly
stop taking the medication, incurring high risk of recurrence of depression before
delivery. 475 Careful reassessment of risks will help women to decide whether
continuation of antidepressants is appropriate. 453
If a woman who is pregnant or planning pregnancy is being treated with an
antidepressant, her treatment preference, previous history and risk should be
reviewed. 101 If appropriate, attempts should be made to withdraw the antidepressant
102
Identification of Common Mental Disorders and Management of Depression in Primary Care