Title & Introduction

  • Paper Title: Safety in Treatment: Classical Pharmacotherapeutics and New Avenues for Addressing Maternal Depression and Anxiety During Pregnancy
  • Published In: Pharmacological Reviews
  • Publish date: February 4, 2025 (Pre-proof)
  • Authors: Merel Dagher, Catherine M. Cahill, Anne M. Andrews
  • Objective: To evaluate the safety profiles of antidepressant drugs used during pregnancy and discuss emerging therapies, including psychedelics and kappa opioid receptor antagonists.
  • Importance: Maternal depression and anxiety during pregnancy are common yet poorly understood conditions. This study assesses the risks and benefits of pharmacological treatment during pregnancy and identifies new therapeutic options.

Summary & Takeaways

Key Takeaway: While SSRIs and SNRIs remain the most prescribed antidepressants during pregnancy, newer treatments, such as ketamine and kappa opioid receptor antagonists, show promise. The safety of antidepressant use remains a concern due to limited clinical trials in pregnant individuals.

Practical Application: This study informs clinical guidelines on treating maternal depression and anxiety, weighing the risks of untreated mood disorders against potential drug-related fetal effects.

Key Background Information

  • Context: The safety of antidepressant use during pregnancy remains a subject of debate, with concerns over fetal development, birth outcomes, and long-term neurobehavioral effects.
  • Hypothesis: Current pharmacological treatments for maternal depression are generally safe but require better evaluation, and new treatment avenues may offer superior safety and efficacy.

Methodology

  • Study Design: Literature review and analysis of pharmacological and clinical data
  • Participants: Review of clinical studies involving pregnant individuals and neonates
  • Intervention/Exposure: Examination of classical pharmacotherapeutics (SSRIs, SNRIs, MAOIs, TCAs) and emerging treatments (psychedelics, ketamine, kappa opioid receptor antagonists)
  • Controls: Comparisons between medicated and non-medicated pregnant individuals
  • Duration: Analysis of longitudinal studies tracking perinatal and neonatal outcomes

Key Findings

Primary Outcomes:

  • SSRIs and SNRIs cross the placental barrier, leading to potential fetal exposure, but evidence of significant long-term harm remains inconclusive.
  • Persistent Pulmonary Hypertension of the Newborn (PPHN) and Neonatal Adaptation Syndrome (NAS) are associated with SSRI exposure but occur infrequently.
  • Psychedelics and kappa opioid receptor antagonists are emerging as novel treatments with promising antidepressant effects, though their safety in pregnancy remains unverified.

Secondary Outcomes:

  • Pregnancy alters drug metabolism, affecting antidepressant efficacy and maternal dosage requirements.
  • Maternal depression, if left untreated, poses significant risks, including preterm birth, low birth weight, and adverse neurodevelopmental outcomes.
  • Psychotherapy remains the first-line treatment for mild to moderate maternal depression, but pharmacotherapy is necessary for severe cases.

Interpretation & Implications

  • Conclusion: SSRIs and SNRIs remain the most commonly used antidepressants during pregnancy, with generally favorable safety profiles. New therapeutic options, such as psychedelics, may offer alternative treatments but require further research.
  • Implications: Clinicians must balance the risks of untreated maternal depression with the potential effects of antidepressant exposure. Personalized treatment approaches are needed.
  • Limitations: The study relies on existing literature, which lacks randomized controlled trials involving pregnant participants. Further research is required to assess emerging treatments.

Researchers & Publication

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