In the best of all worlds, pregnancy and the postpartum period
would be times of joy, contentment, and peace of mind. In the
real world, pregnancy is not a protected state. Mild to moderate
symptoms of depression are common. At any one time, 7.4%–11% of
women are depressed in the first trimester, 8.9%–12.8% in the
second trimester, and 8.5%–12% in the third (1, 2). The
prevalence of depression over the 40-week course of a pregnancy
is 18.4% (12.7% for major depressive episodes) as opposed to
7%–9% in the general population (2). In the postpartum period
10%–15% (3) of women become depressed. One to 2 women per 1,000
develop a psychotic disorder. Indeed, the postpartum period is
the time during which women are most likely be admitted for
mental health problems. Given these facts, most physicians will
have to help a woman or couple decide how to manage a
psychiatric disorder during pregnancy or the postpartum. The
initial reaction will be to avoid any medication during these
periods. If the depression is mild to