MDD (Perinatal)

Based on: CANMAT 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders

MDE

• Mild-to-Moderate Severity — 1st line — Psychotherapy — CBT
• Mild-to-Moderate Severity — 1st line — Psychotherapy — IPT
• Mild-to-Moderate Severity — 1st line — Psychotherapy — Mindfulness-based therapies
• Mild-to-Moderate Severity — 1st line — Psychotherapy — Behavioral Activation
• Mild-to-Moderate Severity — 1st line — Psychotherapy — Guided internet-based self-help including iCBT and iBA in pregnancy
• Mild-to-Moderate Severity — 2nd line — Psychotherapy — Guided internet-based self-help interventions including iCBT and iBA postpartum
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 1st line — Medication — Monotherapy — Citalopram — Most reassuring safety data of all antidepressants
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 1st line — Medication — Monotherapy — Escitalopram — Most reassuring safety data of all antidepressants
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 1st line — Medication — Monotherapy — Sertraline — Most reassuring safety data of all antidepressants
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 2nd line — Medication — Monotherapy — Bupropion — Less safety data than first-line agents, and rare case reports of infant seizure if continued in lactation
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 2nd line — Medication — Monotherapy — Desvenlafaxine — Less safety data than first-line agents
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 2nd line — Medication — Monotherapy — Duloxetine — Some uncertainty about spontaneous abortion risk
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 2nd line — Medication — Monotherapy — Fluoxetine — Possible higher PPHN and PNAS risk and longer half-life/higher passage into breastmilk if continued in lactation
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 2nd line — Medication — Monotherapy — Fluvoxamine — Maternal tolerability concerns at higher doses
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 2nd line — Medication — Monotherapy — Mirtazapine — Less safety data than first-line agents and some uncertainty about spontaneous abortion risk
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 2nd line — Medication — Monotherapy — Venlafaxine XR — Possible higher PNAS risk. Some uncertainty about spontaneous abortion risk
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 3rd line — Medication — Monotherapy — Paroxetine — Possible higher risk for CV malformations and PNAS
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 3rd line — Medication — Monotherapy — Quetiapine — Maternal and fetal metabolic impacts, sedation
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 3rd line — Medication — Monotherapy — Trazodone — Maternal tolerability concerns at high doses
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — 3rd line — Medication — Monotherapy — tricycline antidepressants (TCAs) — Maternal tolerability concerns
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — Insufficient evidence — Medication — Monotherapy — Agomelatine — Insufficient evidence
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — Insufficient evidence — Medication — Monotherapy — dextromethorphan/bupropion — Insufficient evidence
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — Insufficient evidence — Medication — Monotherapy — ketamine — Insufficient evidence
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — Insufficient evidence — Medication — Monotherapy — levomilnacipran — Insufficient evidence
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — Insufficient evidence — Medication — Monotherapy — mianserin — Insufficient evidence
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — Insufficient evidence — Medication — Monotherapy — milnacipran moclobemide — Insufficient evidence
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — Insufficient evidence — Medication — Monotherapy — phenelzine — Insufficient evidence
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — Insufficient evidence — Medication — Monotherapy — reboxetine — Insufficient evidence
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — Insufficient evidence — Medication — Monotherapy — tranylcypromine — Insufficient evidence: Case reports of malformations and of fetal death
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — Insufficient evidence — Medication — Monotherapy — vilazodone — Insufficient evidence
• Severe, high risk for relapse, unable to access PTx, OR inadequate response to PTx — Insufficient evidence — Medication — Monotherapy — vortioxetine — Insufficient evidence