Depression in women of reproductive age. Considerations in selecting safe, effective therapy.

The understanding of biologic and psychologic underpinnings of depression in women of reproductive age continues to grow. Overall, the news is good. Increased knowledge, safer treatments, and early identification have combined to reduce the morbidity of depression in this population. Many treatments appear to be safe and well tolerated by mother and infant alike. No matter how safe the treatment, however, a poor perinatal outcome will prompt both physician and patient to second-guess the intervention. Women who are pregnant or breast-feeding and have a history of depression or are currently experiencing symptoms need to be educated about the risks and benefits of treatment and nontreatment. Whenever possible, another family member should be involved in this discussion. Ultimately, the decision to medicate or not comes down to whether the risk of treatment outweighs the risk of no treatment. Untreated depression is not without its own risks and morbidity. Psychotherapy remains an important tool that can be used independent of or in addition to medication. It is especially helpful for the many women who refuse any and all medications when they are pregnant or breast-feeding.