Transcript Treating Depression During Pregnancy with Selective Serotonin

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
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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Questions?