Depression and suicidal ideation in pregnancy

Depression mostly remains underdiagnosed during pregnancy and results in adverse outcomes for both mother and the fetus. Primary care physicians (PCPs) should be vigilant in recognizing nonspecific somatic symptoms, which could be the manifestation of underlying depression. Universal screening for depression should be done at least once during prenatal period by the PCP, using either Edinburgh Postnatal Depression scale or the nine-item Patient Health Questionnaire. If depression is diagnosed, the PCP should initially assess the suicide risk and need for hospitalization. With regards to the pharmacotherapy, no drug is deemed completely safe as all psychotropic drugs cross the placenta. SSRIs are preferred, but paroxetine should not be considered a first line drug. Other options include psychotherapy, and in severe cases of depression, electroconvulsive therapy.