Managing antidepressant treatment in pregnancy and puerperium. Careful with that axe, Eugene.

Until 2005, selective serotonin reuptake inhibitors (SSRIs), the class of antidepressants most frequently used in clinical practice, had been deemed devoid of any teratogenic effects. However, in recent years several concerns have been raised about their reproductive safety, including: disturbed fetal development, increased rates of congenital anomalies, increased risks of neonatal complications, neuro-motor delay and even autism. Specific concerns are also arising about the safety of SSRIs for infants breastfed by mothers who take such medications in puerperium. Such considerations have led to the 'bad reproductive reputation' of SSRIs, whose utilization during pregnancy and breastfeeding is deemed incautious. Specific reproductive problems also involve tricyclic antidepressants, especially clomipramine. Thus, any conclusion about what antidepressant should be considered the safest during pregnancy must be stated and read with great caution. However, the risks associated with pharmacological treatment must be balanced with the effects of untreated antenatal maternal depression on the mother-fetus dyad, which are likely to be devastating. During puerperium, it is mandatory to weigh the risks to the infant of antidepressant exposure through breast milk against the disadvantage of not receiving mother's milk and being exposed to a relapse of maternal mood symptoms (which may also have tragic consequences for the patient).