Background: It is difficult to find well-grounded advice about the pharmacotherapeutic treatment of anxiety and depression before, during and after pregnancy. Furthermore, in the literature pharmacotherapeutic advice relating to the various periods (pre-conception, pregnancy and lactation) is often contradictory.
Aim: By reviewing the literature, to arrive at a recommendation for the pharmacotherapeutic treatment of depression during and after pregnancy and to compare and weigh up the various risks involved in treatment.
Method: A literature search in PubMed and Embase with search terms 'antidepress*', 'anxiol*', 'pregnan*', 'depressi*', 'anxiet*', 'guideline', 'lactation', 'breastfeeding' and 'milk'. The National Guideline Clearinghouse database was used to find guidelines. results The literature reveals that the medical treatment of a depression during pregnancy and lactation is not without risks. However, there are also risks involved in not treating depression during these periods. These risks cannot be assessed at group-level but have to be weighed up for each individual separately. The patient needs to be informed about the risks she runs in connection with a particular treatment so that a well-considered decision can be made about whether to treat or not treat depression with antidepressants during pregnancy.
Conclusion: If the decision is made to treat depression during pregnancy and in the lactation period, it is advisable to choose an antidepressant from the safest category; in most countries this means opting for tricyclic antidepressants.