Antidepressant Therapy (ADT)
depression
ADT was administered and monitored by nurses, beginning in the second trimester to balance benefits with risks to the developing fetus. Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), at a starting daily dose of 20 mg was the first-line medication, and imipramine, a tricyclic antidepressant, at a starting daily dose of 50 mg (increasing to 75 mg after the first week) was the second-line option. At monthly follow-up visits, measures of treatment response and assessment of side effects guided changes to dosage or medication. Participants receiving ADT were instructed to monitor their infant for signs of poor neonatal adaptation after birth. When the participant’s PHQ-9 was < 5 for six months, and she was at least six months post-pregnancy completion, medication discontinuation was considered.If a patient’s PHQ-9 scores indicated she was not responding to treatment or was experiencing a relapse of symptoms after initial response, depression management was to be “stepped-up” in intensity. This stepped-care approach could include adding the other modality (e.g., ADT if receiving PST or vice versa), switching from PST to ADT, or increasing ADT dosage.