Presentation on theme: "Treating Depression During Pregnancy with Selective Serotonin Reuptake Inhibitors Master’s Project 646 Jenny Collins."— Presentation transcript:
Treating Depression During Pregnancy with Selective Serotonin Reuptake Inhibitors Master’s Project 646 Jenny Collins
Introduction ■Peak prevalence of depression in women occurs between ages 25 and 45, which includes the childbearing years ■One in four women will experience depression during pregnancy ■Most agree that all types of medication should be avoided during pregnancy
Symptoms of Depression ■Sleep disturbances ■Lack of interest ■Feelings of guilt ■Loss of energy ■Difficulty concentrating ■Changes in appetite ■Suicidal thoughts or ideations
Untreated Depression During Pregnancy ■Miscarriage ■Babies born at an early gestational age ■Low birth weight ■Increased risk of preeclampsia ■Low neonatal Apgar scores ■Increased admissions to neonatal ICUs ■Postpartum depression--most serious
Drug Discontinuation During Pregnancy ■Discontinuation may lead to serious relapses ■Sample of 201 women showed that 43 percent experienced a relapse of major depression during pregnancy ■Exposure of a fetus to maternal depression may be as toxic as exposure to antidepressants
Treatment Options ■Behavioral therapy--First Line ■Support groups ■Counseling ■Psychotherapy ■Individual ■Group ■Family ■Pharmacotherapy ■TCA’s ■SSRI’s--used most often, due to less side affects and most studied ■Note: No psychiatric medication has been endorsed by the FDA for use during pregnancy ■The decision to place a pregnant patient on an SSRI is based on clinical judgment and the latest research
SSRI Exposure During Pregnancy ■Most common ■Fluoxetine (1st developed) ■Sertraline ■Fluvoxamine ■Most SSRIs fit under the Category C on the pregnancy-risk factors ■However, Paroxetine was relabeled in 2005 to a Category D (positive evidence of fetal risk) ■Maternal use of SSRIs in late pregnancy may be a risk factor for Persistent Pulmonary Hypertension (PPHN) of the newborn ■Neonatal Withdrawal
Neonatal Withdrawal ■Symptoms ○Difficulty breathing ○Jitteriness ○Increased muscle tone ○Irritability ○Altered sleep patterns ○Tremors ○Difficulty feeding ■Baby should stay in a special care nursery for several days until the withdrawal symptoms go away
What is Persistent Pulmonary Hypertension? ■10-20% of all affected infants will not survive ■Present shortly after birth with severe respiratory failure requiring intubation and mechanical ventilation
SSRIs Linked to PPHN? ■Remember: PPHN results from increased pulmonary vascular resistance ■Serotonin: ■Vasoconstrictive properties ■Inhibits nitric oxide (vasodilator) ■Bottom Line: Women taking SSRIs in the second half of pregnancy will see their baseline risk of having a child with PPHN increase from 0.1% to 0.6%. ■The study was too small to compare the risk in one drug compared to another
Guidelines for SSRI Use During Pregnancy ■Only in cases of moderate to severe depression ■Use the minimum effective dosage needed to maintain psychiatric stability and normal functioning ■History of recurrent episodes of depression predisposes women to relapse during pregnancy ■Paroxetine use among pregnant women and women planning pregnancy should be avoided ■Taper SSRIs during late pregnancy as gradually as possible and over several weeks (needs more research)
Future Research ■Undertake larger studies ■Control for trimester and length of exposure ■Control for dosage and type of SSRI used ■Children after they are born? ■Determine the benefits/risks of tapering SSRIs during late pregnancy
Conclusion ■Remember this is a unique population ■Recognize that depression is common in women of childbearing age ■There is a serious risk of relapse of depression when SSRIs are discontinued ■Decisions regarding treatment should always be individualized and based on nature and severity of current and past symptoms of mood instability ■Paroxetine (Paxil) use in pregnancy or in women planning to become pregnant should be avoided ■Be on the look out for those neonatal withdrawal symptoms
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