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Adverse effects of antidepressants during pregnancy
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  1. Toshi A Furukawa
  1. Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan Correspondence to Toshi A Furukawa, furukawa@kuhp.kyoto-u.ac.jp

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Introduction

This is the fourth of a series of evidence-based case conferences. The main aim of this new series of papers is to help clinicians learn and apply the evidence-based approach in their own clinical practices. The clinical question that we seek to solve in each of this series emanates from a real clinical case. I have completely anonymised the scenario but I still hope it remains as real as it was. The presentation in this series may appear too brief and rushed but this is how EBM can be practiced by busy clinicians once you are familiar with the process. This issue's clinical question is about tolerability of drug treatments in a special population (pregnant women). The case conference below illustrates how to critically appraise and apply an article about adverse events. We anticipate that the next case conference (fifth of the series) will focus on how to use a systematic review for a treatment decision.

Clinical case

Patient

A 32-year-old woman.

Present illness

The patient suffered from her first major depressive episode after giving birth to her first baby at the age of 25. The episode lasted for 2 months and subsided without any treatment. However, when she had her second baby at the age of 28, depression recurred and this time she visited her family doctor for treatment. She was prescribed sertraline 50 mg/day, to which she responded well. However, taking care of two small boys at home was not easy and she had never fully recovered from her second depressive episode. Her mother was diagnosed with malignancy and a third major depressive episode set in. …

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