If the patient does refuse treatment, how can the physician manage that pregnancy safely?

One step you can take to help a pregnant women manage her depression without medication is to focus on lifestyle issues that can affect her condition. One factor that can make depression worse is a lack of sleep. Women often have trouble sleeping during pregnancy, so advise patients to focus on comfort to reduce sleep problems. A pregnant women should make sure that she is able to stay cool, that she has something to support her abdomen, and that she avoids drinking too much at night so she doesn’t have to use the bathroom frequently.

Women with a history of depression also have a higher rate of post-partum depression, so plan ahead during pregnancy to reduce the risk. Help women make lifestyle plans, such as considering whether to exclusively breastfeed or use a bottle during the night so a partner can take over feedings. Another option is to split night feedings. One person takes the 9 p.m. to 3 a.m. shift, and the second person takes the 3 a.m. to 9 a.m. shift. When performing nighttime feedings, women should use dim or red lights to make it easier to fall back asleep. Getting adequate sunlight exposure during the day is also important to regulate the circadian rhythms for both mother and baby. Helping to manage these issues proactively can help head off or reduce the severity of post-partum depression.

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  1. Womenshealth.gov. Depression During and After Pregnancy. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/depression-pregnancy.cfm. Accessed May 7, 2012.
  2. Marroun HE, Jaddoe WVW, Hudziak JJ, et al. Maternal use of selective serotonin reuptake inhibitors, fetal growth, and risk of adverse birth outcomes. Arch Gen Psychiatry. Online First. March 5, 2012. Available at: http://archpsyc.ama-assn.org/cgi/content/short/archgenpsychiatry.2011.2333. Accessed May 7, 2012.
  3. Kieler H, Artama M, Engeland, A, et al. Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from five Nordic countries. BMJ. 2012;344.