Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety

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I applaud the workgroup for addressing the important issue of maternal mental health in pregnancy.1 Depression can be a devastating condition that can severely affect the pregnant mom, the family, the community, and the baby. In some cases it leads to suicide—the horror of which goes beyond words. Those who doubt the importance of depression should note the Centers for Disease Control and Prevention data, which show that suicide is the second leading cause of death in the United States among persons aged 15 to 34 years—with major depression implicated in the vast majority of cases.2 I was dismayed, however, to note that the workgroup recommends antidepressants in moderate-to-severe cases without any mention whatsoever (in the consensus statement) of the concerns regarding the use of these drugs in pregnancy. There are now too many studies to reference, both animal and human, that show the harmful effects of these drugs on pregnancy outcomes and the developing fetus.3 Aside from the research, simple common sense tells us that, of course, drugs that affect the chemistry of the human brain will alter the development of the fetal brain (as well as the many other fetal organ systems that rely on serotonin and other neurotransmitters). When it comes to drug exposures in pregnancy, the arc of history bends toward showing increasing harm over time. This was demonstrated tragically with diethylstilbestrol and thalidomide but continues today with valproic acid, acetaminophen, and other drugs that were considered safe. I cannot emphasize the following point enough: synthetic chemical compounds going into a developing fetus will have consequences—we can be certain of that. This, however, is not an argument to prohibit the use of these drugs in pregnancy or to make women feel guilty. A pregnant woman should make the decisions that are right for herself and she should be supported in those decisions. However, it is incumbent on us to correctly inform pregnant women and the public on the risks of these drugs. The failure of this document to even mention these concerns represents a significant shortcoming and does pregnant women and the public a disservice.
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