Download PDF
PSYCH up2date 2023; 17(05): 417-435
DOI: 10.1055/a-2044-8033
Affektive Störungen

Depressionen in der Schwangerschaft

Freya Lanczik
,
Katrin Fiedler
,
Sarah Kittel-Schneider
› Further Information
Also available at
    Permissions and Reprints All articles of this category

Depressionen kommen auch bei schwangeren Frauen häufig vor, die besondere Situation erfordert allerdings auch eine besondere Herangehensweise. Risiko-Nutzen-Abwägung und der Einbezug der ganzen Familie sowie Zusammenarbeit in einem multiprofessionellen, interdisziplinären und auch sektorenübergreifenden Hilfesystem sind hier von großer Bedeutung. Dieser Beitrag verschafft einen Überblick.
Kernaussaugen

  • Depressionen in der Schwangerschaft sind ähnlich häufig bei Frauen wie in anderen Lebensphasen und betreffen ca. 8–12% aller Schwangeren.

  • Über die Folgen einer Schwangerschaftsdepression für die Entwicklung der Kinder ist weniger bekannt als bei postpartalen Depressionen. Dennoch spricht alles dafür, dass es wichtig ist, auch Depressionen in der Schwangerschaft frühzeitig und suffizient zu behandeln, um negative langfristige Konsequenzen für die exponierten Kinder zu verhindern.

  • Psychotherapie ist die erste Wahl bei leichten bis moderaten Schwangerschaftsdepressionen.

  • Kognitive Verhaltenstherapie hat die robusteste Evidenz zur Behandlung einer Schwangerschaftsdepression.

  • Bei schwerer ausgeprägten Depressionen ist auch eine medikamentöse Behandlung in der Schwangerschaft nach individueller Nutzen-Risiko-Analyse sinnvoll.

  • Psychosoziale und familiäre Unterstützung ist äußert wichtig – bereits in der Schwangerschaft, und umso mehr nach der Geburt.

  • Eine gute Geburts- und Wochenbettplanung ist wichtig zur Rezidivprophylaxe und sollte schriftlich fixiert werden, damit diese Informationen auch alle beteiligten Berufsgruppen erreichen.

  • Alle Psychopharmaka erhöhen das Risiko für Anpassungsstörungen beim Kind nach der Geburt, daher sollte die Geburt in einer Klinik mit Perinatalzentrum erfolgen.

Schlüsselwörter

Depression - Psychosoziale Unterstützung - Pharmakotherapie - Psychotherapie - Schwangerschaft


Publication History

Article published online:
18 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Bennett HA, Einarson A, Taddio A. et al. Depression during pregnancy : Overview of clinical factors. Clin Drug Investig 2004; 24: 157-179
    CrossrefPubMedSearch in Google Scholar
  • 2 Field T, Diego M, Hernandez-Reif M. Prenatal depression effects on the fetus and newborn: A review. Infant Behav Dev 2006; 29: 445-455
    CrossrefPubMedSearch in Google Scholar
  • 3 Field T. Prenatal depression risk factors, developmental effects and interventions: A review. J Pregn Child Health 2017; 4: 301
    CrossrefPubMedSearch in Google Scholar
  • 4 Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008; 371: 261-269
    CrossrefPubMedSearch in Google Scholar
  • 5 Beck CT. Predictors of postpartum depression: An update. Nurs Res 2001; 50: 275-285
    CrossrefPubMedSearch in Google Scholar
  • 6 Friedman LE, Gelaye B, Sanchez SE. et al. Association of social support and antepartum depression among pregnant women. J Affect Disord 2020; 264: 201-205
    CrossrefPubMedSearch in Google Scholar
  • 7 Ludermir AB, Lewis G, Valongueiro SA. et al. Violence against women by their intimate partner during pregnancy and postnatal depression: A prospective cohort study. Lancet 2010; 376: 903-910
    CrossrefPubMedSearch in Google Scholar
  • 8 Salehi-Pourmehr H, Mohammad-Alizadeh S, Jafarilar-Agdam N. et al. The association between pre-pregnancy obesity and screening results of depression for all trimesters of pregnancy, postpartum and 1 year after birth: A cohort study. J Perinat Med 2018; 46: 87-95
    CrossrefPubMedSearch in Google Scholar
  • 9 Molyneaux E, Pasupathy D, Kenny LC. et al. Socio-economic status influences the relationship between obesity and antenatal depression: Data from a prospective cohort study. J Affect Disord 2016; 202: 124-127
    CrossrefPubMedSearch in Google Scholar
  • 10 Lancaster CA, Gold KJ, Flynn HA. et al. Risk factors for depressive symptoms during pregnancy: A systematic review. Am J Obstet Gynecol 2010; 202: 5-14
    CrossrefPubMedSearch in Google Scholar
  • 11 Gelabert E, Subirà S, García-Esteve L. et al. Perfectionism dimensions in major postpartum depression. J Affect Disord 2012; 136: 17-25
    CrossrefPubMedSearch in Google Scholar
  • 12 Forty L, Jones L, Macgregor S. et al. Familiality of postpartum depression in unipolar disorder: Results of a family study. Am J Psych 2006; 163: 1549-1553
    CrossrefPubMedSearch in Google Scholar
  • 13 Kiewa J, Meltzer-Brody S, Milgrom J. et al. Perinatal depression is associated with a higher polygenic risk for major depressive disorder than non-perinatal depression. Depress Anx 2022; 39: 182-191
    CrossrefPubMedSearch in Google Scholar
  • 14 Sacher J, Chechko N, Dannlowski U. et al. The peripartum human brain: Current understanding and future perspectives. Front Neuroendocrinol 2020; 59: 100859
    CrossrefPubMedSearch in Google Scholar
  • 15 Galea LAM, Frokjaer VG. Perinatal depression: Embracing variability toward better treatment and outcomes. Neuron 2019; 102: 13-16
    CrossrefPubMedSearch in Google Scholar
  • 16 Taka-Eilola Nee Riekki T, Veijola J, Miettunen J. et al. Antisocial and borderline personality disorders in the offspring of antenatally depressed mothers – a follow-up until mid-adulthood in the Northern Finland 1966 birth cohort. Nord J Psych 2020; 74: 138-146
    CrossrefPubMedSearch in Google Scholar
  • 17 Waters CS, Hay DF, Simmonds JR. et al. Antenatal depression and childrenʼs developmental outcomes: Potential mechanisms and treatment options. Eur Child Adolesc Psych 2014; 23: 957-971
    CrossrefPubMedSearch in Google Scholar
  • 18 Kelly RH, Russo J, Katon W. Somatic complaints among pregnant women cared for in obstetrics: Normal pregnancy or depressive and anxiety symptom amplification revisited?. Gen Hosp Psych 2001; 23: 107-113
    CrossrefPubMedSearch in Google Scholar
  • 19 Tabb KM, Dalton VK, Tilea A. et al. Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008–2018. J Affect Disord 2023; 320: 263-267
    CrossrefPubMedSearch in Google Scholar
  • 20 Levis B, Negeri Z, Sun Y. et al. Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: Systematic review and meta-analysis of individual participant data. BMJ 2020; 371: m4022
    CrossrefPubMedSearch in Google Scholar
  • 21 Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. Br J Psych 2017; 210: 315-323
    CrossrefPubMedSearch in Google Scholar
  • 22 Fairbrother N, Collardeau F, Albert AYK. et al. High prevalence and incidence of obsessive-compulsive disorder among women across pregnancy and the postpartum. J Clin Psych 2021; 82: 20m13398
    Search in Google Scholar
  • 23 Stephens S, Ford E, Paudyal P. et al. Effectiveness of psychological interventions for postnatal depression in primary care: A meta-analysis. Ann Fam Med 2016; 14: 463-472
    CrossrefPubMedSearch in Google Scholar
  • 24 Shortis E, Warrington D, Whittaker P. The efficacy of cognitive behavioral therapy for the treatment of antenatal depression: A systematic review. J Affect Disord 2020; 272: 485-495
    CrossrefPubMedSearch in Google Scholar
  • 25 Sockol LE, Epperson CN, Barber JP. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev 2011; 31: 839-849
    CrossrefPubMedSearch in Google Scholar
  • 26 Sockol LE, Epperson CN, Barber JP. Preventing postpartum depression: A meta-analytic review. Clin Psychol Rev 2013; 33: 1205-1217
    CrossrefPubMedSearch in Google Scholar
  • 27 Sockol LE. A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord 2015; 177: 7-21
    CrossrefPubMedSearch in Google Scholar
  • 28 Bright KS, Charrois EM, Mughal MK. et al. Interpersonal psychotherapy to reduce psychological distress in perinatal women: A systematic review. Int J Environ Res Public Health 2020; 17: 8421
    CrossrefPubMedSearch in Google Scholar
  • 29 Schiepek G. Systemic therapies – a contribution to psychotherapy integration. Psychother Psychosom Med Psychol 2012; 62: 204-213
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Li C, Sun X, Qing L. et al. Role of psychotherapy on antenatal depression, anxiety, and maternal quality of life: A meta-analysis. Medicine (Balt) 2020; 99: e20947
    CrossrefPubMedSearch in Google Scholar
  • 31 Ziegenhain U. Promoting sensitivity and parenting competencies in teenage mothers. Prax Kinderpsychol Kinderpsychiatr 2007; 56: 660-675
    CrossrefPubMedSearch in Google Scholar
  • 32 Bayrampour H, Kapoor A, Bunka M. et al. The risk of relapse of depression during pregnancy after discontinuation of antidepressants: A systematic review and meta-analysis. J Clin Psych 2020; 81: 19r13134
    Search in Google Scholar
  • 33 Ding J, Wang L, Wang C. et al. Is vagal-nerve stimulation safe during pregnancy? A mini review. Epileps Res 2021; 174: 106671
    CrossrefPubMedSearch in Google Scholar
  • 34 Anderson EL, Reti IM. ECT in pregnancy: A review of the literature from 1941 to 2007. Psychosom Med 2009; 71: 235-242
    CrossrefPubMedSearch in Google Scholar
  • 35 Lee HJ, Kim SM, Kwon JY. Repetitive transcranial magnetic stimulation treatment for peripartum depression: Systematic review & meta-analysis. BMC Pregn Childbir 2021; 21: 118
    CrossrefPubMedSearch in Google Scholar
  • 36 Eryilmaz G, Sayar GH, Özten E. et al. Follow-up study of children whose mothers were treated with transcranial magnetic stimulation during pregnancy: preliminary results. Neuromodulation 2015; 18: 255-260
    CrossrefPubMedSearch in Google Scholar
  • 37 Vigod SN, Murphy KE, Dennis C-L. et al. Transcranial direct current stimulation (tDCS) for depression in pregnancy: A pilot randomized controlled trial. Brain Stimul 2019; 12: 1475-1483
    CrossrefPubMedSearch in Google Scholar
  • 38 Konstantinou GN, Vigod SN, Mehta S. et al. A systematic review of non-invasive neurostimulation for the treatment of depression during pregnancy. J Affect Disord 2020; 272: 259-268
    CrossrefPubMedSearch in Google Scholar
  • 39 Donmez M, Yorguner N, Kora K. et al. Efficacy of bright light therapy in perinatal depression: A randomized, double-blind, placebo-controlled study. J Psychiatr Res 2022; 149: 315-322
    CrossrefPubMedSearch in Google Scholar
  • 40 Garbazza C, Cirignotta F, DʼAgostino A. et al. Sustained remission from perinatal depression after bright light therapy: A pilot randomised, placebo-controlled trial. Acta Psychiatr Scand 2022; 146: 350-356
    CrossrefPubMedSearch in Google Scholar
  • 41 Bais B, Kamperman AM, Bijma HH. et al. Effects of bright light therapy for depression during pregnancy: A randomised, double-blind controlled trial. BMJ Open 2020; 10: e038030
    CrossrefPubMedSearch in Google Scholar
  • 42 Daley AJ, Foster L, Long G. et al. The effectiveness of exercise for the prevention and treatment of antenatal depression: Systematic review with meta-analysis. BJOG 2015; 122: 57-62
    CrossrefPubMedSearch in Google Scholar
  • 43 Smith CA, Shewamene Z, Galbally M. et al. The effect of complementary medicines and therapies on maternal anxiety and depression in pregnancy: A systematic review and meta-analysis. J Affect Disord 2019; 245: 428-439
    CrossrefPubMedSearch in Google Scholar
  • 44 Yasuma N, Narita Z, Sasaki N. et al. Antenatal psychological intervention for universal prevention of antenatal and postnatal depression: A systematic review and meta-analysis. J Affect Disord 2020; 273: 231-239
    CrossrefPubMedSearch in Google Scholar
  • 45 Scope A, Booth A, Morrell CJ. et al. Perceptions and experiences of interventions to prevent postnatal depression. A systematic review and qualitative evidence synthesis. J Affect Disord 2017; 210: 100-110
    CrossrefPubMedSearch in Google Scholar
  • 46 Molyneaux E, Telesia LA, Henshaw C. et al. Antidepressants for preventing postnatal depression. Coch Data Syst Rev 2018; 4: CD004363
    CrossrefPubMedSearch in Google Scholar
  • 47 Kittel-Schneider S, Davidova P, Kalok M. et al. A pilot study of multilevel analysis of BDNF in paternal and maternal perinatal depression. Arch Womens Ment Health 2022; 25: 237-249
    CrossrefPubMedSearch in Google Scholar
  • 48 Treatment and management of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 5. Obstet Gyn [Anonym]. 2023; 141: 1262-1288
    CrossrefPubMedSearch in Google Scholar