Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

Uğuz, Faruk

doi:10.1590/1516-4446-2015-1673

Cited by 16 publications

(12 citation statements)

References 124 publications

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“…Factors to be considered in treatment strategy decisions are family psychiatric history, previous adverse reactions to drug treatment, risks related to untreated maternal OCD, safety and effectiveness of drugs during pregnancy, the availability of non-pharmacological treatments [333], OCD severity, and related reduced global functioning [334]. Pharmacological treatment should be indicated in cases of severe depression and anxiety, elevated risk of suicide, OCD-related sleep and eating disorders, and unresponsiveness to CBT [335].…”

Section: Ocd Treatment During Pregnancymentioning

confidence: 99%

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Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD)

Casale

Sorice²,

Padovano³

et al. 2019

131

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Section: Ocd Treatment During Pregnancymentioning

confidence: 99%

“…Generally, higher antidepressant doses are used in OCD than those used in the treatment of major depression [352]. For this reason, the risk of pre-term birth associated with overdose of SSRI [101,353] should be taken into account, and the minimum effective dose should be used [335].…”

Section: Ocd Treatment During Pregnancymentioning

confidence: 99%

Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD)

Casale

Sorice²,

Padovano³

et al. 2019

131

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“…2009, Gentile 2014. Sertralin ve sitalopram/essitalopramı tolere edemeyen hastalarda ikinci tercih olarak fluvoksamin, üçüncü tercih olarak da fluoksetin daha uygun görülmektedir (Uguz 2015).…”

Section: Tedaviunclassified

“…Alışılmış günlük dozların üzerine çıkmak, gebe hastalar için uygun bir seçenek olarak görülmemektedir. Bir kısım gebe ve annelerin, serotonerjik ilacın değiştirilmesinden yarar görmesi olasıdır ve ilk seçenekten daha uygun görülmektedir (Uguz 2015). Serotonerjik ilaçların kombine kullanılması veya antipsikotiklerle güçlendirilmesi, perinatal dönemde güvenirliğine dair bilginin yetersiz olduğu ve sadece zorunlu durumlarda düşük dozlarda düşünülmesi gereken seçeneklerdir.…”

Section: Tedaviunclassified

Gebelik ve Postpartum Dönemde Obsesif Kompulsif Bozukluk

Demirkol¹,

Şimşek²,

Yılmaz³

et al. 2018

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry

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ÖzGebelik ve postpartum dönem birçok psikiyatrik hastalığın gelişmesi veya alevlenmesi açısından riskli dönemlerdir. Genel kanı gebelik ve postpartum dönemde obsesif kompulsif bozukluğun genel topluma göre sıklığının daha yüksek olduğu yönündedir. Bu dönemlerde obsesyon ve kompulsiyonların varlığı gözden kaçırılmamalıdır. Sıklıkla bulaşma ve saldırganlıkla ilişkili obsesyonlar; yıkama-temizleme yönünde kompulsiyonlar görülmektedir. Tedavide ilk tercih selektif serotonin geri alım inhibitörleri ve bilişsel davranışçı terapidir. Bu yazıda gebelik ve postpartum dönemde obsesif kompulsif bozukluğun sıklığı, etiyolojisi, komorbiditesi, klinik özellikleri ve tedavisi kısaca gözden geçirilmiştir.Anahtar sözcükler: Obsesif kompulsif bozukluk, gebelik, postpartum dönem. AbstractPregnancy and postpartum period are risky periods about occurrence and recurrence of many psychiatric disorders. General opinion is that obsessive compulsive disorder is more common in pregnancy and postpartum period than the normal population. Obsessions and compulsions should be questionned in these periods. Obsessions are generally about contagion and agression, compulsions are generally about washing and cleaning. Selective serotonin reuptake inhibitors and cognitive behavioral therapy are the first rank treatment options. In this article we briefly reviewed prevalence, etiology, comorbidities, clinical features and treatment options of obsessive compulsive disorder in pregnancy and postpartum period.

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“…More concerning are the effects of SRIs on fetal development as discussed by Uguz,1 including increasing evidence of the role of fluoxetine and paroxetine in fetal defects and high risk of poor neonatal adaptation syndrome, whereas for other SRIs, the data on this possible linkage are few and inconsistent. The effects of antipsychotics on the developing fetus remain unexplored and not adequately evaluated at this time to recommend use.…”

mentioning

confidence: 99%

Cognitive-behavioral therapy as an effective, safe, and acceptable intervention for OCD during pregnancy

Iniesta‐Sepúlveda

Storch

2017

Rev. Bras. Psiquiatr.

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We read with great interest Uguz's 1 review of pharmacotherapy of obsessive-compulsive disorder (OCD) during pregnancy. Given the relative frequency with which OCD, as well as other psychiatric disorders, present during pregnancy, establishing evidence-based therapies that are safe and acceptable is of critical importance.Within the strengths of this article (e.g., clinical relevance to a vulnerable population), there was limited mention of cognitive-behavioral psychotherapeutic interventions for OCD during pregnancy. This is of particular concern for two reasons. First, cognitive-behavioral therapy (CBT) with exposure and response prevention is the single most effective intervention available for adults with OCD, demonstrating superiority as a monotherapy both to serotonin reuptake inhibitor (SRI) medications and to other forms of psychotherapy in terms of response rates and degree of improvement.2 Based on the strength of this evidence, CBT is recommended as a first-line intervention for those with OCD regardless of pregnancy. As an augmentation approach to SRIs, CBT has demonstrated greater reduction in OCD symptoms than risperidone, which did not differ from placebo.3 Preliminary efficacy data, similar in quality to that for SRIs during pregnancy, supports this approach in working with women in the postpartum period. 4 Given the similarity of content, onset, and development patterns of OCD in pregnancy and the postpartum, these results should be extrapolatable.Second, the side effect profile of many medications, especially antipsychotics (i.e., weight gain, increased appetite), makes their use a last resort in this population, and some women may find pharmacotherapy an undesirable treatment approach. More concerning are the effects of SRIs on fetal development as discussed by Uguz, 1 including increasing evidence of the role of fluoxetine and paroxetine in fetal defects and high risk of poor neonatal adaptation syndrome, whereas for other SRIs, the data on this possible linkage are few and inconsistent. The effects of antipsychotics on the developing fetus remain unexplored and not adequately evaluated at this time to recommend use. As reviewed above, cognitive-behavioral interventions have demonstrated sound efficacy across numerous studies for reducing obsessive-compulsive symptoms in adults, with a negligible side effect profile and no theoretical reason why it might impact the developing fetus. Thus, clinicians should base treatment decisions on a complete assessment of all available therapies; when data are limited for OCD during pregnancy, extrapolating from the treatment literature more broadly may be appropriate to achieve the most effective and safe treatment of the affected individual and developing fetus, since pregnancy does not appear to be related to poor response to CBT. 5In short, caution should be used in incorporating conclusions from this report into clinical practice, given the strength of the current literature supporting pharmacotherapy during pregnancy (relative to CBT) and the associa...

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Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

Cited by 16 publications

References 124 publications

Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD)

Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD)

Gebelik ve Postpartum Dönemde Obsesif Kompulsif Bozukluk

Cognitive-behavioral therapy as an effective, safe, and acceptable intervention for OCD during pregnancy

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