Antidepressants for mothers: what are psychiatrists prescribing?

Background and aims: Depressive illness in the perinatal period is common and can be associated with detrimental effects to both mother and child. The evolving evidence base on the safety of antidepressants in pregnancy and breastfeeding can make prescribing decisions challenging. This study aimed to investigate current prescribing practices and attitudes of hospital psychiatrists towards depression in pregnant and breastfeeding mothers. Methods and results: This qualitative survey was conducted by way of e-mail survey to 95 psychiatrists, of all grades and specialities, based within The Royal Edinburgh Hospital. A majority of psychiatrists are choosing and avoiding antidepressants in accordance with the National Institute for Health and Clinical Excellence guidelines. A minority of respondents are selecting classes of antidepressants, which raises concern about the safety of such prescribing decisions. The majority of psychiatrists expressed a lack of confidence when prescribing and expressed a wish for further training in this area. Conclusion: This study indicates a degree of uncertainty amongst psychiatrists of all grades when prescribing to these special groups. We would recommend increased training in this area to all psychiatrists and an increased emphasis placed upon incorporating perinatal psychiatry within the postgraduate psychiatric curriculum.