Perinatal Depression

2018 ◽  
Author(s):  
Tiffany A. Moore Simas ◽  
Bailey McGuiness ◽  
Valerie Valant ◽  
Nancy Byatt
Keyword(s):  
Bipolar Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Perinatal Depression ◽  
Absolute Risk ◽  
Psychiatric Evaluation ◽  
Baby Blues ◽  
One Year ◽  
Effective Diagnosis ◽  
Maternal Suicide ◽  
In Pregnancy

Perinatal depression includes major and minor depression occurring in pregnancy and one year postpartum. Affecting one in seven women, it is one of the most common pregnancy complications; however, it is often under recognized and undertreated. A personal history of perinatal or non-perinatal depression significantly increases risk. Screening using a validated instrument is recommended in the context of systems to ensure effective diagnosis, treatment, and follow-up. Evidence-based treatment includes psychotherapy and pharmacotherapy. Selective serotonin reuptake inhibitors are well-studied in pregnancy, are associated with low overall absolute risk, and are differentially secreted into breast milk. If left untreated, perinatal depression is associated with significant short- and long-term negative maternal-child consequences including, among many others things, poor bonding. Of note, maternal suicide exceeds hemorrhage and hypertensive disorders as a cause of maternal mortality. It is critical to recognize that one in five women who screen positive for perinatal depression will have bipolar disorder and are at highest risk for postpartum psychosis, suicide, and infanticide, especially if prescribed unopposed anti-depressant monotherapy. Women who screen positive for having bipolar disorder should be referred for psychiatric evaluation. This review contains 6 figures, 13 tables and 54 references Keywords: Pregnancy, Postpartum, Perinatal, depression, Mood disorder, Baby blues, Bipolar disorder, Psychosis, Psychotherapy, Psychopharmacology

Perinatal Depression

2018 ◽  
Author(s):  
Tiffany A. Moore Simas ◽  
Bailey McGuiness ◽  
Valerie Valant ◽  
Nancy Byatt
Keyword(s):  
Bipolar Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Perinatal Depression ◽  
Absolute Risk ◽  
Psychiatric Evaluation ◽  
Baby Blues ◽  
One Year ◽  
Effective Diagnosis ◽  
Maternal Suicide ◽  
In Pregnancy

Perinatal depression includes major and minor depression occurring in pregnancy and one year postpartum. Affecting one in seven women, it is one of the most common pregnancy complications; however, it is often under recognized and undertreated. A personal history of perinatal or non-perinatal depression significantly increases risk. Screening using a validated instrument is recommended in the context of systems to ensure effective diagnosis, treatment, and follow-up. Evidence-based treatment includes psychotherapy and pharmacotherapy. Selective serotonin reuptake inhibitors are well-studied in pregnancy, are associated with low overall absolute risk, and are differentially secreted into breast milk. If left untreated, perinatal depression is associated with significant short- and long-term negative maternal-child consequences including, among many others things, poor bonding. Of note, maternal suicide exceeds hemorrhage and hypertensive disorders as a cause of maternal mortality. It is critical to recognize that one in five women who screen positive for perinatal depression will have bipolar disorder and are at highest risk for postpartum psychosis, suicide, and infanticide, especially if prescribed unopposed anti-depressant monotherapy. Women who screen positive for having bipolar disorder should be referred for psychiatric evaluation. This review contains 6 figures, 13 tables and 54 references Keywords: Pregnancy, Postpartum, Perinatal, depression, Mood disorder, Baby blues, Bipolar disorder, Psychosis, Psychotherapy, Psychopharmacology

To treat or not to treat: maternal depression, SSRI use in pregnancy and adverse neonatal effects

2006 ◽  
Vol 36 (12) ◽  
pp. 1663-1670 ◽  
Author(s):  
MARIE-PAULE AUSTIN
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Absolute Risk ◽  
Late Pregnancy ◽  
Postnatal Period ◽  
Regulatory Body ◽  
Retrospective Case ◽  
Increased Risk ◽  
Adverse Neonatal Outcomes ◽  
A Prospective Study ◽  
In Pregnancy

Recent pharmaceutical company and regulatory body circulars warning against the use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy have left clinicians in somewhat of a quandary as to how to manage their more severely depressed patients in pregnancy. Conversely, up to 75% of depressed women ceasing their antidepressants periconceptually will relapse. Studies reporting on adverse neonatal outcomes following exposure to SSRIs in the latter half of pregnancy suggest that the fetus is exposed to significant concentrations of these medications during this time. Adverse neonatal effects affecting the respiratory, gastrointestinal and neurological systems are, however, predominantly mild and self-limiting. One small retrospective case study suggests that SSRI exposure in the latter half of pregnancy may be associated with an increased risk of persistent pulmonary hypertension of the neonate (PPHN), however, the absolute risk of developing PPHN remains very small and these findings will require replication with a prospective study. While the studies to date suggest the need to closely monitor SSRI-exposed neonates in the immediate postnatal period, preferably with a neonatal withdrawal scale and access to neonatology services, there is currently no clear argument for women to be weaned off their SSRI in late pregnancy. The decision to use SSRIs at this time will have to be made on a case-by-case basis in close consultation with the mother and her partner.

Navigating Tx of Bipolar Disorder in Pregnancy

Ob Gyn News ◽  
2005 ◽  
Vol 40 (3) ◽  
pp. 11
Author(s):  
DIANA MAHONEY
Keyword(s):  
Bipolar Disorder ◽  
In Pregnancy

scholarly journals Guideline concordance and outcome in long-term naturalistic treatment of bipolar disorder - a one-year longitudinal study using latent change models

2020 ◽  
Author(s):  
Joannes W. Renes ◽  
Dominique F. Maciejewski ◽  
Eline J. Regeer ◽  
Adriaan W. Hoogendoorn ◽  
Willem A. Nolen ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Longitudinal Study ◽  
Change Models ◽  
One Year

scholarly journals Correction: Selective serotonin reuptake inhibitors and venlafaxine in pregnancy: Changes in drug disposition

PLoS ONE ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. e0191508
Author(s):  
Andreas Austgulen Westin ◽  
Malin Brekke ◽  
Espen Molden ◽  
Eirik Skogvoll ◽  
Olav Spigset
Keyword(s):  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Drug Disposition ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
In Pregnancy

scholarly journals Psychiatric Illnesses among the Patients Admitted for Self-poisoning in a Tertiary Care Hospital of Nepal

2013 ◽  
Vol 2 (1) ◽  
pp. 10-13 ◽  
Author(s):  
Ajay Risal ◽  
Pushpa Prasad Sharma ◽  
Rajkumar Karki
Keyword(s):  
Tertiary Care Hospital ◽  
Organophosphorus Compounds ◽  
Care Center ◽  
Tertiary Care ◽  
Psychiatric Evaluation ◽  
Care Hospital ◽  
Age Group ◽  
Psychiatric Illnesses ◽  
History Of ◽  
One Year

Background and Aims- Self-poisoning is the commonest mode of suicide in our part of the world. Patients attempting suicide by self-poisoning usually land up in the Emergency. They are admitted for management of medical complications and subsequently referred to Psychiatry for evaluation of possible Psychiatric illnesses. The aim of this study was to explore the patterns of psychiatric illnesses in the patients admitted for self-poisoning in a tertiary care center in Nepal. Methods- The study population included those patients who were admitted and being managed for self-poisoning and brought for psychiatric evaluation during the period of one year (1st June 2011- 30th June 2012) at Dhulikhel Hospital, Nepal. Each patient underwent a detailed psychiatric evaluation by a consultant psychiatrist once they were medically stable. Details including sociodemographic data, psychiatric diagnosis, and treatment offered and outcome was tabulated and analyzed using SPSS-16. Results- Among the total patients (N=100), 43 were in the age group 21-40 years, median age being 27.5. There was almost equal gender distribution. Majority was of Mongolian ethnicity, homemaker by occupation and married. More than 90% were single-attempters, suicidal attempt using organophosphorus compounds. Almost 50% had depression; family dispute (19%) and marital disharmony (17%) were the most common psychosocial precipitant. Conclusion- Patients with history of self-poisoning are commonly brought to the Emergency Department of any tertiary care hospital. It is widely prevalent on younger age group. It is usually by the use of Organophosphorus compound in our setting and most commonly associated with depression. Hence, psychiatric care is essential for these patients. Journal of Advances in Internal Medicine 2013;02(01):10-13 DOI: http://dx.doi.org/10.3126/jaim.v2i1.7630

Interactions between SSRI's and statins: Clinical relevance versus statistical significance

2017 ◽  
Vol 41 (S1) ◽  
pp. S757-S758 ◽  
Author(s):  
S. Petrykiv ◽  
L. De Jonge ◽  
M. Arts
Keyword(s):  
Drug Interactions ◽  
Clinical Relevance ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Absolute Risk ◽  
Statistical Significance ◽  
Developed Countries ◽  
Lipid Lowering ◽  
Supporting Evidence ◽  
Cytochrome P450 Enzyme

IntroductionDepression and hypercholesterolemia are two of the most commonly treated conditions in the developed countries, while the lipid–lowering agents and antidepressants are among the most widely prescribed drugs in the world. There is a common concern that selective serotonin reuptake inhibitors (SSRIs) can trigger statin adverse effects, especially myopathy. However, the supporting evidence originates from studies in-vitro and big epidemiological studies. Recent pharmacokinetic insights indicate that the magnitude of pharmacokinetic interaction between SSRIs and statins is likely to be below the threshold for clinical significance.Objectives and aimsExplorative study on pharmacokinetic effects of SSRIs on statin drugs.MethodsWe performed a detailed literature review through PubMed, EMBASE and Cochran's Library to assess the clinical relevance of combined SSRIs and statin use. To address pharmacokinetic interactions between two drug groups, we focused on:– cytochrome P450 enzyme metabolism of statins;– CYP enzyme inhibition by SSRIs;– SSRIs–statin drug interactions;– non-CYP pharmacokinetic pathways.ResultsWith regard to pharmacokinetic drug interactions and the risk of statin related myopathy, escitalopram, citalopram, and paroxetine are to be safe in co-therapy with all statins. Rosuvastatin and pravastatin are almost certain to be safe in co-therapy with all SSRIs. Fluoxetine and sertraline are also likely to be safe, even when combined with atorvastatin, simvastatin, and lovastatin.ConclusionThough the absolute risk of concomitant use of SSRIs with statins seems to be negligible, even this risk can be minimized by using lower statin doses and monitoring the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Coprophagia in an Elderly Man: A Case Report and Review of the Literature

2005 ◽  
Vol 35 (4) ◽  
pp. 417-427 ◽  
Author(s):  
David A. Beck ◽  
Nora R. Frohberg
Keyword(s):  
Mental Retardation ◽  
Behavioral Interventions ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Cerebral Atrophy ◽  
Laboratory Evaluation ◽  
Psychiatric Evaluation ◽  
Obsessive Compulsive ◽  
Supportive Psychotherapy ◽  
Compulsive Disorder ◽  
Medical Disorders

Objective: Coprophagia or the ingestion of feces has long been associated with psychiatric illness. It is considered to be a variant of pica. This behavior requires an extensive medical and psychiatric differential diagnosis. Medical disorders associated with coprophagia include seizure disorders, cerebral atrophy, and tumors. Psychiatric disorders associated with coprophagia include mental retardation, alcoholism, depression, obsessive compulsive disorder, schizophrenia, fetishes, delirium, and dementia. In animals, coprophagia is associated with boredom, thiamine deficiency, and lesions of the amygdala. Methods: A case of coprophagia in an elderly man is reported here. A 77-year-old man with mild mental retardation was referred for urgent psychiatric evaluation due to coprophagia. The case is discussed and the literature reviewed. Results: Psychiatric evaluation revealed cognitive dysfunction and depression. Physical examination and laboratory evaluation were noncontributory. He was started on sertraline 25 mg daily with resolution of his coprophagia. Coprophagia has been treated using behavioral interventions, supportive psychotherapy, elemental diets, tricyclic antidepressants, carbamazepine, haloperidol, and electroconvulsive therapy. Conclusions: Use of Selective Serotonin Reuptake Inhibitors (SSRIs) may also be an effective treatment for coprophagia, particularly in the setting of depression or anxiety.

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