Psychotherapy Recommended for Initial Depression in Pregnancy

As reviewed in Medscape Medical News:

A recent survey, it was reported that 65% of American practitioners recommend psychotherapy as a first line intervention for pregnant women with new, major depression. Interestingly, psychiatrists were particularly likely to recommend psychotherapy over pharmacology. The results were presented in a poster at the American Psychiatric Association (APA) meeting in San Diego.

Here’s the case scenario the practitioners were asked to review and comment on:

“You are performing an initial evaluation of a 29-year-old patient in her second trimester of pregnancy. She reports having signs and symptoms of a major depression for 2 months; she has no suicidal ideation and has no significant anxiety or any associated psychosis. She has never had similar symptoms and has never been in psychiatric treatment before. In your practice, which treatment are you most likely to recommend?”
The five treatment options were:
— Cognitive behavior therapy.
— Interpersonal therapy.
— A selective serotonin reuptake inhibitor (SSRI).
— A serotonin-norepinephrine reuptake inhibitor (SNRI).
— A tricyclic antidepressant.

Most clinicians recommended first-line treatment with psychotherapy. SSRIs were the most common type of medication chosen.

“The group acknowledges that their study is limited in that it was about an uncomplicated pregnancy and did not get information about specific drugs. They conclude that clinicians who are managing depression during pregnancy are opting for treatments with good safety profiles. They add that this study highlights the importance of disseminating rapidly changing research findings to front-line practitioners. Dr. Petersen observed: “We are trying to make sure people have a balanced view. When you are looking at risk/benefit ratios, in many cases there is more of a risk to not treat the depression with medication than to treat it with medication.” American Psychiatric Association 160th Annual Meeting: Abstract NR719. May 19-24, 2007.


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