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Other Considerations

Pregnancy

• Postpartum depression is experienced by 8% to 20% of women following delivery.
• The safety of SSRIs and tricyclic antidepressant medications during pregnancy remains uncertain. The physician will provide guidance regarding use or avoidance of antidepressants during pregnancy. The risks and benefits to the mother and the fetus must be weighed in each individual case in order to determine the most appropriate regimen during pregnancy. MAOIs cause birth defects and should be avoided during pregnancy.
• The dietary supplements and herbs mentioned here have not been tested for safety during pregnancy, and should therefore be avoided.

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Warnings and Precautions

• All antidepressants may cause suicidal thinking and behavior in children and adolescents, especially in the early phases of treatment.
• SSRIs should be avoided in people with Parkinson's disease.
• Tricyclic antidepressants should be avoided in people with coronary artery disease.
• Several herbal remedies and supplements should not be combined with antidepressant medications. Be sure to inform your healthcare provider of all herbs and supplements you take to avoid adverse interactions.

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Prognosis and Complications

Depression is a serious condition that can have a devastating effect on people's lives. It can directly and indirectly contribute to chronic medical conditions, such as heart disease and stroke, because depressed people with these conditions are less likely to engage in healthy behaviors (such as exercise) and more likely to engage in unhealthy behaviors (such as smoking). Suicide is a significant factor in depression; about 15% of people with major depressive disorder commit suicide. Depression also significantly shortens the life-span of the elderly and is associated with the development of memory impairment and dementia.

When left untreated, depression can last up to 2 years. Rates of recurrence are variable: 50% of people who have had one depressive episode will have a second major depressive disorder; 70% will have a third and 90% will have a fourth. Symptoms of depression usually disappear after menopause in women with premenstrual dysphoric disorder or seasonal affective disorder. Fortunately, there are several treatment options available for people with depression and the prognosis improves tremendously for those who seek treatment and comply with their regimen.

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Reviewed: 03/2006