A central question for patients and clinicians is whether potential benefits of pharmacologic treatments for perinatal mental health disorders outweigh potential harms. Given lack of consensus on best practices, we completed a robust systematic review of pharmacologic interventions for perinatal mental health disorders; full results have been published previously and will be summarized here. Unfortunately, many important clinical questions remain unanswered. This commentary aims to summarize and interpret the current state of evidence and provide expert guidance when data are lacking. The review found sparse evidence on benefits of pharmacotherapy and voluminous, low-quality evidence on harms. Confounding by indication was a notable limitation for most studies. We suggest several key points to share with clinicians and patients: 1) untreated perinatal mental health disorders have maternal and child risks; 2) research in nonpregnant populations shows that pharmacotherapy effectively treats many mental health disorders; 3) few high-quality studies in perinatal individuals have been conducted; 4) limited evidence suggests some benefit of pharmacologic treatment; and 5) some studies, primarily of low quality, indicate potential risks of pharmacologic treatment, although the absolute risk is often low. Given the complexities surrounding treatment of perinatal mental health disorders, shared decision making is important, and consultation with a mental health professional may be warranted in certain clinical scenarios.
SYSTEMATIC REVIEW REGISTRATION:
ACOG: Pharmacologic Treatment for Perinatal Mental Health Disorders