Intervention and treatment in perinatal depression

Intervention in perinatal depression must follow fundamental principles that ensure the safety and well-being of both mother and baby. The approach must be individualized, considering the medical history, psychiatric background, family and social context, and stage of pregnancy or postpartum.

In addition, a multidisciplinary approach is required, including psychiatry, psychology, obstetrics, pediatrics, and social work, as maternal mental health directly impacts the health of the baby, the mother-child dyad, and family dynamics.

Pharmacological treatment during pregnancy and breastfeeding

Treatment with antidepressants for perinatal depression is based on a careful assessment of risks and benefits. Failure to treat perinatal depression can have significant consequences: poor attachment to the baby, obstetric complications, increased risk of maternal suicide, and adverse effects on infant development.

Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, are the first line of treatment due to their safety profile during both pregnancy and breastfeeding. It is essential to avoid abrupt changes in medication, especially if the woman has already had a favorable response to a specific drug.

Among mood stabilizers, lithium requires strict monitoring during pregnancy, while others such as valproic acid are contraindicated due to the high risk of congenital malformations.

Anxiolytics should be avoided during the first trimester due to the risk of cleft palate, and their use should be very limited around the time of delivery to avoid adverse neonatal effects. It is essential to avoid drugs such as clozapine during breastfeeding, unless breastfeeding is discontinued, due to the high transfer of the drug into breast milk.

Current guidelines always recommend planning pregnancy in women undergoing psychopharmacological treatment, selecting drugs with more evidence of safety, limiting the number of drugs used, and not interrupting effectively established treatments without a clear cause.

Psychotherapeutic treatment

Psychotherapy plays an essential role in all cases of perinatal depre