Dear Colleagues,

Depression and anxiety disorders are the most common psychiatric morbidities in pregnancy and, in particular, after delivery. However, there are still errors and shortcomings among healthcare professionals in the recognition, diagnosis and treatment of depression during pregnancy and in the postpartum stage, with resulting consequences and repercussions for the gestation itself or the fetus or neonate. These women have a poor quality of life, and they are more likely to smoke or use alcohol or other substances, which may worsen the pregnancy outcome or the need to breastfeed. Indeed, the use of antidepressant and anxiolytic drugs during pregnancy and postpartum may constitute a potential risk to the fetus or neonate but are also a clear benefit for patients with depression already manifested during pregnancy or for those with a new onset of postpartum depression. Moreover, the abrupt discontinuation of antidepressants may be associated with relapses/recurrences. The art of medicine is exemplified by balancing the risks of untreated psychiatric disorders such as depressive symptoms during pregnancy or breastfeeding and the risks of adverse fetal or neonatal outcomes associated with exposure to antidepressants or anxiolytic medicines. Papers addressing these topics are invited to be submitted to this Special Issue, especially those combining a high level of academic experience in women’s mental health, in neonatal complications and in the use of drugs in pregnancy and lactation coupled with a practical focus on providing excellent management of the disease.

Dr. Georgios Eleftheriou
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• depression
• anxiety disorder
• pregnancy
• breastfeeding
• antidepressants
• anxiolytics

Title: Consensus Panel Recommendations for the Pharmacological Management of Breastfeeding Women with Postpartum depression
Authors: Georgios Eleftheriou; Riccardo Zandonella Callegher; Raffaella Butera; Marco De Santis; Anna Franca Cavaliere; Sarah Vecchio; Cecilia Lanzi; Riccardo Davanzo; Emi Bondi; Lorenzo Somaini; Mariapina Gallo; Matteo Balestrieri; Guido Mannaioni; Gugliemo Salvatori; Umberto Albert
Affiliation: 1 Italian Society of Toxicology (SITOX), via Giovanni Pascoli 3, 20129 Milan, Italy 2 Poison Control Center, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy 3 Italian Society of Psychiatry (SIP), piazza Santa Maria della Pietà 5, 00135 Rome, Italy 4 Psychiatry Unit, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy 5 Italian Society of Obstetrics and Gynecology (SIGO), via di Porta Pinciana 6, 00187 Rome, Italy 6 Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy 7 Department of Gynecology and Obstetrics, Fatebenefratelli Gemelli, Isola Tiberina, 00186 Rome, Italy 8 Ser.D Biella—Drug Addiction Service, 13875 Biella, Italy 9 Division of Clinic Toxicology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy 10 Italian Society of Neonatology (SIN), Corso Venezia 8, 20121 Milan, Italy 11 Maternal and Child Health Institute IRCCS "Burlo Garofolo”, Trieste, Italy 12 Department of Psychiatry, ASST Papa Giovanni XXIII, 24100 Bergamo, Italy 13 Italian Society of Addiction Diseases (S.I.Pa.D), via Tagliamento 31, 00198 Rome, Italy 14 Italian Society for Drug Addiction (SITD), via Roma 22, 12100 Cuneo, Italy 15 Italian Society of Neuropsychopharmacology (SINPF), via Cernaia 35, 00158 Rome, Italy 16 Department of Medicine, Surgery and Health Sciences, University of Trieste, 34128 Trieste, Italy 17 Division of Clinic Psychiatry, Azienda Sanitaria Universitaria Giuliano-Isontina, 34148 Trieste, Italy 18 Italian Society of Pharmacology, Via Giovanni Pascoli, 3, 20129 Milan, Italy 19 Chair, Task Force on Breastfeeding, Minister of Health, Rome 20 Italian Society of Pediatrics, Via Gioberti 60, 00185 Rome 21 Department of Medical and Surgical Neonatology Ospedale Pediatrico Bambino Gesù, Rome
Abstract: Introduction: The initiative of a consensus on the topic of antidepressant and anxiolytic drug use during breastfeeding is developing in an area of clinical uncertainty. Although many studies have been published in recent years, there is still a paucity of authoritative evidence-based indications useful for guiding the prescription of these drugs during breastfeeding, and the data from the literature are complex and require expert judgment to draw clear conclusions. Methods: For the elaboration of the consensus, we have involved the scientific societies of the sector, namely, the Italian Society of Toxicology, the Italian Society of Pharmacology, the Italian Society of Neuropsychopharmacology, the Italian Society of Psychiatry, the Italian Society of Obstetrics and Gynaecology, the Italian Society of Paediatrics, the Italian Society of Drug Addiction and the Italian Society of Addiction Pathology. An interdisciplinary team of experts from different medical specialties (toxicologists, pharmacologists, psychiatrists, gynaecologists, paediatricians, neonatologists) was first established to identify the needs underlying the consensus. The team, in its definitive structure, includes all the representatives of the aforementioned scientific societies; the task of the team was the evaluation of the most accredited international literature as well as using the methodology of the “Nominal Group Technique” with the help of a thorough review of the literature and with various discussion meetings, to arrive at the drafting and final approval of the document. Results: The following four areas of investigation were identified: (1) The importance of management of anxiety and depressive disorders during breastfeeding, identifying the risks associated with untreated maternal depression during breastfeeding. (2) The assessment of the overall risk of adverse infant outcomes associated with the exposure to antidepressants or anxiolytic medicines. (3) The long-term outcome of infants’ cognitive development or behaviour associated with the exposure to antidepressants or anxiolytic medicines during breastfeeding. (4) The evaluation of pharmacological treatment of opioid-abusing breastfeeding women with depressive disorders. Conclusions: Considering the state of the art, it is therefore necessary in the first instance to frame the issue of pharmacological choices in breastfeeding women who need treatment with antidepressant and anxiolytic drugs on the basis of data currently available in the literature. Particular attention must be paid to the evaluation of the risk/benefit ratio, understood both in terms of therapeutic benefit with respect to the potential risks of the treatment during breastfeeding and on the breastfed infant outcome, and of the comparative risk between the treatment and the absence of treatment; in the choice prescription, the specialist needs to be aware of both the potential risks of pharmacological treatment and the equally important risks of an untreated or undertreated disorder.