Pharmacological treatment of unipolar depression during pregnancy and breast-feeding-A clinical overview

被引:19
作者
Nielsen, Rene Ernst [1 ,2 ]
Damkier, Per [3 ]
机构
[1] Aarhus Univ Hosp, Aalborg Psychiat Hosp, Unit Psychiat Res, DK-9000 Aalborg, Denmark
[2] Reg Psychiat Serv W, Aalborg, Denmark
[3] Odense Univ Hosp, Dept Clin Chem & Pharmacol, DK-5000 Odense, Denmark
关键词
Abnormalities; Antidepressive agents; Breast-feeding; Depression; Pregnancy; SEROTONIN-REUPTAKE INHIBITORS; PERSISTENT PULMONARY-HYPERTENSION; POOR NEONATAL ADAPTATION; IN-UTERO EXPOSURE; MATERNAL USE; ELECTROCONVULSIVE-THERAPY; TRICYCLIC ANTIDEPRESSANTS; CONGENITAL-MALFORMATIONS; PRENATAL EXPOSURE; MAJOR MALFORMATIONS;
D O I
10.3109/08039488.2011.650198
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Background: This overview is aimed at clinicians working with patients in the fertile age who suffer from depressive disorders. The study of adverse effects of antidepressants on the foetus is hampered by difficulty in distinguishing between the behavioural changes that are related to the disorder itself and changes that accompany its treatment with antidepressants. The current lack of solid scientific knowledge and the implications, mainly emotional, of treating pregnant or breast-feeding women often raise anxiety and cause concern among patients and clinicians. Methods: Currently available data are evaluated and clinical recommendations given. Results and Conclusions: Citalopram and sertraline can be used during pregnancy, while some controversy remains over in utero exposure to paroxetine and fluoxetine, which might be associated with an increased risk of foetal cardiovascular malformation. Less data is available concerning fluvoxamine and escitalopram use but current data does not indicate a specific risk. Citalopram, paroxetine and sertraline can be used during breast-feeding, while fluoxetine probably should be avoided. Nortriptyline, amitriptyline and clomipramine can be used during pregnancy and lactation, although data are more abundant for SSRI treatment. Venlafaxine can be used during pregnancy, while caution is advised during breast-feeding. Other antidepressants should be avoided because of lack of data on their effect. A strongly indicated lithium therapy should be continued. Close monitoring of lithium levels throughout pregnancy is mandatory, as is detailed foetal echocardiography in weeks 18-22 of gestation. Lithium should not be used during breast-feeding. Electroconvulsive therapy (ECT) is a valid option if indicated, both during pregnancy and breast-feeding.
引用
收藏
页码:159 / 166
页数:8
相关论文
共 95 条
  • [71] PRESKORN SH, 1989, J CLIN PSYCHIAT, V50, P34
  • [72] The use of electroconvulsive therapy in special patient populations
    Rabheru, K
    [J]. CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE, 2001, 46 (08): : 710 - 719
  • [73] Placental Transfer of SSRI and SNRI Antidepressants and Effects on the Neonate
    Rampono, J.
    Simmer, K.
    Ilett, K. F.
    Hackett, L. P.
    Doherty, D. A.
    Elliot, R.
    Kok, C. H.
    Coenen, A.
    Forman, T.
    [J]. PHARMACOPSYCHIATRY, 2009, 42 (03) : 95 - 100
  • [74] Delivery outcome after maternal use of antidepressant drugs in pregnancy: an update using Swedish data
    Reis, M.
    Kallen, B.
    [J]. PSYCHOLOGICAL MEDICINE, 2010, 40 (10) : 1723 - 1733
  • [75] Pre-, Peri- and Postpartal Depression First Cognition from FRAMES (Franconian Maternal Health Evaluation Studies)
    Reulbach, U.
    Bleich, S.
    Knoerr, J.
    Burger, P.
    Fasching, P. A.
    Kornhuber, J.
    Beckmann, M. W.
    Goecke, T. W.
    [J]. FORTSCHRITTE DER NEUROLOGIE PSYCHIATRIE, 2009, 77 (12) : 708 - 713
  • [76] Moclobemide in pregnancy
    Rybakowski, JK
    [J]. PHARMACOPSYCHIATRY, 2001, 34 (02) : 82 - 83
  • [77] Is the exposure to antidepressant drugs in early pregnancy a risk factor for spontaneous abortion? A review of available evidences
    Santone, Giovanni
    Ricchi, Gianmatteo
    Rocchetti, David
    Tofani, Stefania
    Bellantuono, Cesario
    [J]. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE-AN INTERNATIONAL JOURNAL FOR EPIDEMIOLOGY AND PSYCHIATRIC SCIENCES, 2009, 18 (03): : 240 - 247
  • [78] WHAT HAPPENED LATER TO LITHIUM BABIES - FOLLOW-UP-STUDY OF CHILDREN BORN WITHOUT MALFORMATIONS
    SCHOU, M
    [J]. ACTA PSYCHIATRICA SCANDINAVICA, 1976, 54 (03) : 193 - 197
  • [79] ANESTHETIC AGENTS AND EXCRETION IN BREAST-MILK
    SPIGSET, O
    [J]. ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1994, 38 (02) : 94 - 103
  • [80] The breast feeding mother and xenon anaesthesia: four case reports. Breast feeding and xenon anaesthesia
    Stuttmann, Ralph
    Schaefer, Claudia
    Hilbert, Peter
    Meyer, Markus R.
    Maurer, Hans H.
    [J]. BMC ANESTHESIOLOGY, 2010, 10