The Journal of clinical psychiatry
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Review Meta Analysis
Antidepressant exposure during pregnancy and congenital malformations: is there an association? A systematic review and meta-analysis of the best evidence.
Depression is often not optimally treated during pregnancy, partially because of conflicting data regarding antidepressant medication risk. This meta-analysis was conducted to determine whether antenatal antidepressant exposure is associated with congenital malformations and to assess the effect of known methodological limitations. ⋯ Overall, antidepressants do not appear to be associated with an increased risk of congenital malformations, but statistical significance was found for cardiovascular malformations. Results were robust in several sensitivity analyses. Given that the RRs are marginal, they may be the result of uncontrolled confounders. Although the RRs were statistically significant, none reached clinically significant levels.
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Because patients often seek treatment for depression in primary care, primary care physicians need the tools and knowledge to properly assess and manage major depressive disorder. Effective management includes using guideline-based treatment, measurement-based assessment, collaboration, and comorbid disease treatment. ⋯ Collaboration among primary care clinicians, case managers, and mental health specialists can improve adherence and outcomes for patients with major depressive disorder, including those with comorbid medical or psychiatric conditions. These approaches to patient care provide individualized treatment to help patients with depression.