The US Preventive Services Task Force (USPSTF) recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. The USPSTF reviewed the evidence on the benefits and harms of screening for depression in adult populations, including older adults and pregnant and postpartum women; the accuracy of depression screening instruments; and the benefits and harms of depression treatment in these populations. The USPSTF found that second-generation antidepressants (mostly selective serotonin reuptake inhibitors) are associated with some harms, such as an increase in suicidal behaviors in adults aged 18 to 29 years and an increased risk of upper gastrointestinal bleeding in adults older than 70 years, with risk increasing with age; however, the magnitude of these risks is, on average, small. The USPSTF found evidence of potential serious fetal harms from pharmacologic treatment of depression in pregnant women, but the likelihood of these serious harms is low. Effective treatment of depression in adults generally includes antidepressants or specific psychotherapy approaches, such as cognitive behavioral therapy (CBT) or brief psychosocial counseling, alone or in combination. Given the potential harms to the fetus and newborn child from certain pharmacologic agents, clinicians are encouraged to consider CBT or other evidence-based counseling interventions when managing depression in pregnant or breastfeeding women. Source: http://jama.jamanetwork.com/
美国预防医学工作组建议在普通成年人群中筛查抑郁症，包括孕妇和产后妇女。筛查应该在合适的系统条件下进行，以确保准确的诊断，有效的治疗和适当的随访。该工作组审查了在成年人群，包括老年人，孕妇和产后妇女中筛查抑郁症的利弊；抑郁症筛查手段的准确性；以及在这些人群中抑郁症治疗的利弊。该工作组发现第二代抗抑郁药（主要是选择性血清素再摄取抑制剂）与某些危害有关，如18至29岁成人的自杀行为增加和年龄超过70岁的成人上消化道出血的风险增加，且风险随着年龄的增大而增加；然而，平均而言，这些风险较小。该工作组发现了药物治疗孕妇的抑郁症可能严重危害胎儿的证据，但发生这些严重危害的可能性很小。成年人抑郁症的有效治疗手段通常包括单独或联合抗抑郁药及特定的心理治疗措施，如认知行为疗法或短暂的心理辅导。考虑到某些药物对胎儿和新生儿潜在的危害，鼓励临床医生在处理孕妇或哺乳期妇女抑郁症的时候考虑认知行为疗法或其他循证辅导措施。来源：http://jama.jamanetwork.com/.com/