Depression in Pregnant women

Depression in women who become pregnant is challenging for the patient and the provider. According to Hardy and Reichenbacher (2019), using the drug that abates depressive symptoms effectively is the one that should be decided upon by the provider and patient. In this discussion we will be looking at a FDA approved antidepressant, an off-label antidepressant and a nonpharmacologic modality to help alleviate the symptoms of depression for the pregnant women.

Sertraline

            When looking for a FDA approved antidepressant, Sertraline was chosen because of the information showing that it has a “sufficient reproductive safety profile (Paulzen et al., 2017 as cited in Gadzhanova and Roughead, 2015; Reefhuis et al., 2015, Roca et al.,2011) with daily dosages below 150 mg suggested as a safe treatment option during pregnancy”. This information in conjunction with the information from the Drugs and Lactation Database by the National Library of Medicine, so that sertraline serum levels were so low in breastmilk, that the amount of sertraline in the breastmilk ingested by the infant was immeasurable (2006-2020).

Off-Label Antidepressant: Abilify

            Science is finding new ways to look at drugs and find new purposes for them. The term is called “repurposing drugs”. Abilify is an antipsychotic drug that is an Investigational/FDA approved medication for treating Major Depressive Disorder (MDD) which could be a benefit for women who have been taking Abilify before getting pregnant and who want to continue the medication (Mohammad et al., 2021). For the breast feeding mother, Abilify does not affect the mother’s ability to breastfeed according to the Library of Medicine’s Drugs and Lactation Database (2006-2020).

Nonpharmacologic Modality for treating Depression

            A nutritious diet whether pregnant or not is beneficial to anyone but especially a person who has depression. The science of nutritional psychiatry has come about with the emphasis on nutrition, and its effects on mental health (Galbally et., 2021). While no one study shows eating one healthy diet over another will decrease or alleviate depressive symptoms. What it shown in this article (2021) is that incorporating more vegetables, fish oil and taking on a more nutritional intake rather than junk food and “take out” foods is beneficial to decrease depressive symptoms and give a in general over all sense of well-being. Which in turn for the pregnant woman who is clinically depressed will increase her over-all wellbeing that if she is taking better care of herself and her baby this might help with her depressive symptoms.

Overall Risk Assessment

            Currently, there are no set guidelines management of a pregnant patient with depression. The collaboration between provider and patient and open ongoing dialogue of what symptoms are being targeted, what modality is being used and how are the depression symptoms are being managed. Ongoing assessment of risk and modifications as needed are the best guidelines for this disease process.

References

Galbally, M., Watson, S. J., Boyce, P., Anglin, R., McKinnon, E., & Lewis, A. J. (2021).

Maternal diet, depression and antidepressant treatment in pregnancy and across the first 12 months postpartum in the MPEWS pregnancy cohort study: Perinatal diet, depression and antidepressant use. Journal of Affective Disorders, 288, 74–82. https://doi.org/10.1016/j.jad.2021.03.047

Hardy, L. T., & Reichenbacker, O. L. (2019). A practical guide to the use of psychotropic

medications during pregnancy and lactation. Archives of Psychiatric Nursing, 33(3), 254–266. https://www.psychiatricnursing.org/article/S0883-9417(18)30389-3/fulltext.

Mohammad Sadeghi, H., Adeli, I., Mousavi, T., Daniali, M., Nikfar, S., & Abdollahi, M. (2021).

Drug Repurposing for the Management of Depression: Where Do We Stand Currently? Life (Basel, Switzerland), 11(8). https://doi.org/10.3390/life11080774

National Library of Medicine. (2006–2020). Drugs and lactation database (LactMed).

https://www.ncbi.nlm.nih.gov/books/NBK501922/.

Paulzen, M., Goecke, T. W., Stickeler, E., Gründer, G., & Schoretsanitis, G. (2017). Sertraline in

pregnancy – Therapeutic drug monitoring in maternal blood, amniotic fluid and cord blood. Journal of Affective Disorders, 1–6. https://doi.org/10.1016/j.jad.2017.01.019
REPLYQUOTEEMAIL AUTHOR 2 days agoAlison Silva RE: Week 9 Initial PostCOLLAPSE

Marlyse,

     Thanks for your post. I agree it can be challenging to work with pregnant women regarding the safety and efficacy of psychotropic medications. Non-pharmacological interventions are essential to implement, and a women’s lifestyle during pregnancy can impact her mental health and her child’s well-being. I would recommend exercise as a non-pharmacological intervention for treating depression in pregnancy. Physical activity can relieve depressive symptoms, stress, and anxiety during pregnancy and may effectively prevent depression with as little as engaging in physical activity once a week (Kolomanska et al., 2019). I would recommend Lexapro as a pharmacological treatment for depression during pregnancy. Lexapro has been shown to produce low levels in milk and not cause adverse effects in infants with doses up to 20mg (National Library of Medicine, 2021). SSRIs seem to be the safest drug choice during pregnancy and lactation.

References

Kołomańska, D., Zarawski, M., & Mazur-Bialy, A. (2019). Physical Activity and Depressive Disorders in Pregnant Women-A Systematic Review. Medicina , 55(5), 212. https://doi.org/10.3390/medicina55050212

National Library of Medicine. (2021). Escitalopram.  Drugs and lactation database (LactMed). https://www.ncbi.nlm.nih.gov/books/NBK501922/