A cautionary note on the use of antidepressants in postpartum depression

Sharma, Verinder

doi:10.1111/j.1399-5618.2006.00336.x

Cited by 40 publications

(19 citation statements)

References 29 publications

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“…Use of antidepressants during pregnancy, especially after discontinuing mood stabilizers, may have exerted mood-destabilizing effects (36)(37)(38)(39). Alternatively, antidepressant use during pregnancy may reflect the presence of bipolar II disorder patients, who are often treated with antidepressants, or may simply be an indicator for more severe illness (40)(41)(42).…”

Section: Recurrence Of Bipolar Disorder In Pregnancymentioning

confidence: 93%

Risk of Recurrence in Women With Bipolar Disorder During Pregnancy: Prospective Study of Mood Stabilizer Discontinuation

Viguera¹,

Whitfield²,

Baldessarini³

et al. 2007

AJP

466

267

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Discontinuation of mood stabilizer, particularly abruptly, during pregnancy carries a high risk for new morbidity in women with bipolar disorder, especially for early depressive and dysphoric states. However, this risk is reduced markedly by continued mood stabilizer treatment. Treatment planning for pregnant women with bipolar disorder should consider not only the relative risks of fetal exposure to mood stabilizers but also the high risk of recurrence and morbidity associated with stopping maintenance mood stabilizer treatment.

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Section: Recurrence Of Bipolar Disorder In Pregnancymentioning

confidence: 93%

Risk of Recurrence in Women With Bipolar Disorder During Pregnancy: Prospective Study of Mood Stabilizer Discontinuation

Viguera¹,

Whitfield²,

Baldessarini³

et al. 2007

AJP

466

267

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“…It is important to provide education about the signs and symptoms of hypomania and mania, since antidepressant treatment may trigger the onset of such symptoms, which should be addressed promptly (20). Whenever possible, the patient's spouse or significant other should also be interviewed and educated about such "Exposure of a child to postpartum depression should be considered an exposure in the same way that taking an antidepressant while breastfeeding is an exposure.…”

Section: Postpartum Depression and Bipolar Disordermentioning

confidence: 98%

“…Thus, postpartum depression is relatively common in women with bipolar disorder. It remains unclear what proportion of women presenting with a first episode of postpartum depression will have symptoms that progress to a bipolar diagnosis, although a family history of bipolar disorder may be the strongest predictor (20).…”

Section: Postpartum Depression and Bipolar Disordermentioning

confidence: 99%

Antidepressant Use in the Postpartum Period: Practical Considerations

Payne

2007

AJP

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Treatment in Psychiatry begins with a hypothetical case illustrating a problem in current clinical practice. The authors review current data on prevalence, diagnosis, pathophysiology, and treatment. The article concludes with the authors' treatment recommendations for cases like the one presented.A 30-year-old woman, 6 weeks postpartum, is referred by her obstetrician for possible postpartum depression. The patient noted onset of symptoms 2 days after delivery of her son; describing the onset, she said she felt as if "a curtain descended upon" her. Her symptoms include low mood, tearfulness, decreased sleep and appetite, significant weight loss, and anhedonia. She feels she cannot care for her son properly and has intrusive thoughts that some unspecified harm may come to him. She adamantly denies thoughts of hurting herself or her son but worries constantly that "something bad will happen." At night, she feels restless and frequently checks that the baby is still breathing. Her concentration is poor, and she often does not shower or take care of household duties, but she does care for her son. On examination, the patient appears sad and anxious, with psychomotor retardation. She denies a previous psychiatric history. Her family history is notable for bipolar I disorder in a paternal uncle and a grandfather. She is breastfeeding.A 27-year-old woman with a history of recurrent major depression since age 18 presents for a consultation during her second trimester of pregnancy. The patient has a history of nonresponse to selective serotonin reuptake inhibitors (SSRIs) and has been hospitalized twice for severe depressive episodes. During the second hospitalization, at age 25, she required six ECT treatments. Since that time, she has been maintained with good results on 75 mg daily of nortriptyline. Her treating psychiatrist recommended that she continue taking the nortriptyline during the pregnancy, which she has done. The patient is now seeking consultation and recommendations regarding breastfeeding after delivery.These clinical vignettes demonstrate just a few of the complexities of treating women with mood disorders during the childbearing years. Much attention has been given to the treatment of women with mood disorders during pregnancy. Less, however, has been focused on the treatment of such women during the postpartum period, although many of the clinical issues are the same-including the fact that if the patient is breastfeeding, the treating psychiatrist has two patients to consider, not just one. This review covers the treatment of new-onset and existing mood disorders during the postpartum period; postpartum depression in bipolar disorder; the implications of breastfeeding while taking psychiatric medications; and nonpharmacological interventions. Postpartum Mood DisordersThree types of postpartum mood disorders are described in the literature: postpartum blues, postpartum depression, and postpartum psychosis. Postpartum blues is a relatively common phenomenon occurring in up to 80% of women, generally wit...

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“…Also, caution should be exercised in using antidepressants for treatment of postpartum depression in women with a family history of bipolar disorder or in those who experience major depression for the first time following childbirth [50]. Antidepressants can be used in combination with neuroleptics in the treatment of postpartum depression with psychotic features after a careful attempt to rule out a bipolar diathesis.…”

Section: Antidepressantsmentioning

confidence: 99%

Treatment of Postpartum Psychosis: Challenges and Opportunities

Sharma¹

2008

CDS

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Postpartum psychosis is a rare but serious psychiatric illness that follows delivery. Although controversy continues to surround its diagnostic status, it is generally considered an episode of bipolar disorder with accompanying psychotic features. The consequences of untreated postpartum psychosis can be serious due to the associated risk of suicide and infanticide; however, its close temporal association with childbirth should provide an opportunity to undertake prophylactic measures in women at risk for developing postpartum psychosis. This article reviews the literature concerning acute and prophylactic pharmacological treatment and suggests a comprehensive approach for management of postpartum psychosis.

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A cautionary note on the use of antidepressants in postpartum depression

Abstract: Caution is urged in the use of antidepressants to treat early-onset PPD in women at risk for developing BP disorder due to a family history of bipolar illness.

Cited by 40 publications

References 29 publications

Risk of Recurrence in Women With Bipolar Disorder During Pregnancy: Prospective Study of Mood Stabilizer Discontinuation

Risk of Recurrence in Women With Bipolar Disorder During Pregnancy: Prospective Study of Mood Stabilizer Discontinuation

Antidepressant Use in the Postpartum Period: Practical Considerations

Treatment of Postpartum Psychosis: Challenges and Opportunities

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