Bupropion Use During Pregnancy: A Systematic Review.

OBJECTIVE: To evaluate data on birth outcomes following bupropion use during pregnancy. DATA SOURCES: A systematic literature review of PubMed and PsycINFO was performed through June 2017 for clinical studies published in English. The following keywords were used: bupropion, pregnancy, depression, smoking cessation, birth outcomes, miscarriage, and spontaneous abortion. References and related articles were also searched to yield additional publications. With the exception of limiting the search to human subjects, no other limitations were applied in an effort to capture all relevant published studies. STUDY SELECTION/DATA EXTRACTION: No studies were excluded. A total of 8 studies were included in this review. RESULTS: Bupropion's use in the first trimester has been linked with a small elevation in the risk of cardiovascular defects, although the absolute risk was low and confounding by indication (eg, use for smoking cessation) cannot be excluded. While the risk of miscarriage following prenatal bupropion exposure was higher than that of a control group of women in one study, it remained within the general population rate. CONCLUSIONS: While more studies are needed, research to date suggests that bupropion may be a reasonable treatment option for depressed pregnant women who require pharmacotherapy, particularly when they also are attempting to reduce nicotine use during pregnancy.

Etiology and treatment of postpartum depression.

This article reviews the risk factors, pathogenesis, treatment, and prevention of postpartum depression. Postpartum depression is common and occurs in up to 18% of newly delivered mothers. Though the hormonal changes occurring after childbirth are believed to play a role in postpartum depression, no hormonal etiology has been identified. Estrogen appears somewhat helpful for postpartum depression, but its use is limited by problematic medical sequelae. Several antidepressants are effective for postpartum depression and appear safe for use by breastfeeding women. Psychosocial interventions and cultural rituals, which may prevent or ameliorate postpartum depression, have also been employed.