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About 11% of pregnant women suffer from a major depression requiring treatment. If left untreated, there are specific risks such as preterm delivery or low birth weight. The initial difficulty lies in diagnosing the depression itself, since many depressive symptoms are falsely ascribed to the pregnancy. A further challenge is choosing the appropriate therapy. Treatment options are psychotherapy, antidepressants, electroconvulsive therapy (ECT), or the new option of light therapy. The choice of the most suitable treatment needs to be done together with the pregnant woman after careful clarification of the potential risks of each treatment option.