Transcript ANGELS: Antidepressants in Pregnancy Update

ANGELS Update
Antidepressants in
Pregnancy
Linda L.M. Worley, MD, Associate Professor
UAMS, Departments of Psychiatry & OB/GYN
REVIEW: Untreated Depression in PG
linked to increased risks for:
• Miscarriage
• Growth restriction (Teixeira et al 1999; British Medical Journal)
• Poor prenatal care compliance & nutritional
intake
• Use of other drugs/smoking
• Prematurity
• Pre-eclampsia (Kurki et al 2000; Obstetrics and Gynecology)
• Low APGAR scores
REVIEW: Untreated Depression in PG
linked to increased risks for:
• Suicidal ideation & attempts (Einarson et al 2001; J
Psychiatry Neurosci)
• Postpartum depression (Post 1992; Am J Psychiatry)
• Decreased success @ breastfeeding
• Increased CRH & decreased fetal
responses to a novel stimulus (Sandman et al 1999;
Ann NY Acad Sciences)
• Irritable & difficult to console infants
Risks of exposure to antidepressants
• Neonatal discontinuation syndrome
(see next slide)
“Poor Perinatal
adaptation”
“Serotonin
overstimulation”
(Laine et al 2003)
(Chambers et al 1996)
Myoclonus
Tachypnea/
Restlessness
respiratory
Tremor
distress/
Jitteriness
desaturation on
Shivering
Hypofeeding
Hyperreflexia
thermia
Hypoglycemia
Nausea
Poor tone
Involuntary
Weak/absent cry
movements
Rigidity
Cautious approach
• Informed consent: Risks & benefits of
treatment versus not
• Monitor neonate for withdrawal &/or
toxicity from antidepressants for at least
48 hours after birth (Koren 2004; Arch Pediatr Adolesc Medicine)
Potential Strategies to Manage Neonate
To Decrease Risk for Toxicity:
Taper/stop maternal drug prior to due date if risk
of maternal illness doesn’t outweigh risk of
complications
To Decrease Risk for Withdrawal:
Lactation may provide minimal additional dose
to reduce rapid drug concentration drop