Elsevier

Seizure

Volume 28, May 2015, Pages 39-45
Seizure

Review
Depression and anxiety during pregnancy and the postpartum period in women with epilepsy: A review of frequency, risks and recommendations for treatment

https://doi.org/10.1016/j.seizure.2015.02.016Get rights and content
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Highlights

  • Peripartum depression affects 16–35% of women with epilepsy.

  • Risks include frequent seizures, polytherapy, previous psychiatric disease and sexual/physical abuse.

  • Screen for depression, anxiety and risk factors before, during and after pregnancy.

  • Use non-pharmacological antidepressive treatment during pregnancy and breastfeeding.

  • Measure serum-concentrations of antiepileptic and antidepressive drugs.

Abstract

Purpose

To review available data and provide treatment recommendations concerning peripartum depression, anxiety and fear of birth in women with epilepsy (WWE).

Method

The PubMed, the LactMed, the DART and the Cochrane database were searched for original articles concerning psychiatric disease in the peripartum period in WWE.

Results

Point prevalence of depression from 2nd trimester to 6 months postpartum ranged from 16 to 35% in women with epilepsy compared to 9–12% in controls. The highest estimates were found early in pregnancy and in the perinatal period. Anxiety symptoms 6 months postpartum were reported by 10 and 5%, respectively. Fear of birth symptoms were increased in primiparous WWE compared to controls. Previous psychiatric disease, sexual/physical abuse, antiepileptic drug (AED) polytherapy, and high seizure frequency emerged as strong risk factors. Depressed WWE rarely used antidepressive medication during pregnancy. No evidence was available concerning treatment effects or impact on the developing child.

Conclusion

Peripartum depression is frequent in WWE and seldom medically treated. Health personnel should screen WWE for psychiatric disease and risk factors during pre-pregnancy planning, pregnancy and postpartum follow up. Treatment decisions should rely on efficacy and safety data in peripartum patients without epilepsy and non-pregnant people with epilepsy. Consequences of in utero exposure to AED therapy in combination with antidepressants are not known, and non-pharmacological treatment should be tried first.

Abbreviations

AED
antiepileptic drugs
CBT
cognitive behavioral therapy
CYP
cytochrome P450
MBRN
Medical Birth Registry of Norway
SSRI
selective serotonin reuptake inhibitor
SNRI
serotonin noradrenaline reuptake inhibitor
WWE
women with epilepsy

Keywords

Perinatal
Seizure
Psychiatry
Antiepileptic drugs
Antidepressants
Postnatal

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