Resources for Professionals

California Health Collaborative, Nurture 2 Nurture Program Provides training to physicians and staff on the issue of perinatal mood and anxiety disorders, how to screen and refer
(559) 244-4580, fax (559) 244-4589
Maternal Depression Screening and Care Pathway
Edinburgh Postnatal Depression ScaleEnglish
Spanish
PHQ-9 Screening QuestionnaireEnglish
Spanish
Journal ArticleAntidepressant Use During Breastfeeding
Medication*Risk/Benefit
Fluoxetine (Prozac)Best studied, long half-life, high transfer into breast milk.
Sertraline (Zoloft)Suggested by ACOG. Considered first line especially if medication naive. Unlikely to increase birth defects.
Paroxetine (Paxil) Avoid prescribing in 1st trimester (associated with a rare but possible incidence of heart defects). If already on Paxil, continue and do not change.
Bupropion (Wellbutrin)Not as well-studied, good for women wanting to quit smoking.
TCAsSedating effects to treat insomnia, no shown association with congenital anomalies. NOT good for OCD or social phobias.
MAOIsNot recommended: shown to cause fetal growth restriction.
Escitalopram (Lexapro)Effective for comorbid depression/anxiety. Stronger than Celexa, safe but no study data yet.
Venlafaxine (Effexor) Small number of human pregnancies to date are insufficient to draw a general conclusion.

* All the medications listed here have “off label” indication. They reflect clinical and research experience of Dr. S. Misri and are free of industry bias.

Maurer-Spurej, E. Pittendreigh, C., & Misri, S. (2007). Platelet serotonin levels support depression scores for women with postpartum depression. Journal of Psychiatry and Neuroscience 32 (1): 23-29.

This page has been reviewed by Shawn Hersevoort, MD, of University Psychiatry Associates.

Last updated: 09-10-14

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