Pharmacotherapy of Depression in Pregnancy

Patkar, Ashwin A.; Bilal, Louai; Masand, Prakash S.

doi:10.1080/10401230490453662

Cited by 23 publications

(20 citation statements)

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“…Although until now no definitive data were available, it has been assumed that the use of antidepressants during pregnancy reflects usage patterns in the general population 25. Indeed, in the general population, SSRIs have been the most widely used antidepressant because of their established efficacy, their milder adverse effect profile, and their safety in overdose 25. In certain circumstances, agents such as venlafaxine, bupropion, and mirtazapine, as well as tricyclic antidepressants, have been preferred by healthcare providers.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of antidepressant use in a cohort of pregnant women

Ramos¹,

Oraichi²,

Rey

et al. 2007

BJOG

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Objective (1) To determine the prevalence of antidepressant utilisation before, during, and after pregnancy, (2) to determine switches, dosages, and classes of antidepressant used during pregnancy, and (3) to identify factors associated with their use at the beginning and at the end of pregnancy.Design Retrospective longitudinal cohort.Setting The 'Medication and Pregnancy' cohort was used for this study. This cohort was built by the linkage of three administrative databases (Régie de l'Assurance Maladie du Québec [RAMQ], Med-É cho, and l'Institut de la Statistique du Québec).Population All pregnancies occuring in Quebec between January 1 1998 and December 31 2002.Methods Date of entry in the cohort was the first day of gestation. To be eligible for this study, women had to be (1) 15-45 years old at cohort entry and (2) covered by the RAMQ drug plan for at least 12 months before, during, and at least 12 months after pregnancy. Antidepressant users were defined as those receiving at least one antidepressant before, during, or after pregnancy, depending on the time period analysed. Logistic regression models were used to identify factors associated with receiving an antidepressant either at the beginning or at the end of pregnancy.Main outcome measures To determine the prevalence and predictors associated with the use of antidepressants.Results A total of 97 680 women met inclusion criteria. The prevalence rates significantly declined during the first trimester compared with before pregnancy (3.7 versus 6.6%, P < 0.01). During pregnancy, antidepressants were used under the recommended daily dosage 7.7% of the time, and 4.7% of women switched to another class of antidepressant. Factors significantly associated with antidepressant utilisation on the first day of gestation (P < 0.05) were older maternal age, being on welfare, and calendar year; receiving at least six different types of medications other than antidepressants, having at least two different prescribers, having at least three visits to the physician, and having at least one diagnosis of depression in the year before pregnancy also increased the odds of having an antidepressant. Similar predictors were found at the end of pregnancy.Conclusions Our findings indicate that antidepressant utilisation declines once pregnancy is diagnosed.

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Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of antidepressant use in a cohort of pregnant women

Ramos¹,

Oraichi²,

Rey

et al. 2007

BJOG

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“…19 The recommended daily dose of bupropion for treatment of major depressive disorders ranges between 75 and 450 mg. 6,7 The use of antidepressants, and bupropion in particular, in treatment of pregnant patients is consistent with several practice guidelines. 2,20 The use of bupropion (Zyban) as an aid for smoking cessation is available for males and non-pregnant females and typically lasts 7 or 12 weeks and the recommended dose is 150 mg twice a day. 5 …”

Section: Commentsmentioning

confidence: 99%

“…1 Consequently, it is often necessary to start or continue treatment of depression during pregnancy. 2,3 Bupropion hydrochloride is one of the most frequently prescribed antidepressant in the US, and is used to treat depression in pregnant women. 4,5 …”

Section: Introductionmentioning

confidence: 99%

Bupropion therapy during pregnancy: the drug and its major metabolites in umbilical cord plasma and amniotic fluid

Fokina

West

Oncken

et al. 2016

American Journal of Obstetrics and Gynecology

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Background Bupropion is used for treatment of depression during pregnancy. However, its use as a smoking cessation aid for pregnant women is currently under evaluation. Objectives The aim of this opportunistic study was to investigate the transfer of bupropion and its major pharmacologically active metabolites, hydroxybupropion and threohydrobupropion, across the placenta in vivo. In addition, the concentrations of the drug and its metabolites were determined in the amniotic fluid. Methods The following samples were collected at deliveries from twenty-two women taking bupropion: maternal blood (n=22), umbilical cord venous blood (n=22), and amniotic fluid (n=9). The concentrations of the drug and its metabolites in blood plasma and amniotic fluid were determined by means of liquid chromatography-mass spectrometry. Placental passage was calculated as a ratio of umbilical cord venous plasma to maternal plasma concentrations. Results The levels of hydroxybupropion and threohydrobupropion in umbilical cord venous plasma were invariably lower than their corresponding concentrations in maternal plasma. The concentrations of bupropion in umbilical cord plasma were lower than in maternal plasma in the majority of the maternal-cord blood pairs. The median values of the umbilical cord venous plasma to maternal plasma ratios were: bupropion, 0.53 (interquartile range 0.35, n=18), hydroxybupropion, 0.21 (interquartile range 0.12, n=18), and threohydrobupropion, 0.61 (interquartile range 0.11, n=21). In umbilical cord venous plasma, the median concentration of bupropion was 5.3 ng/ml; hydroxybupropion, 103.6 ng/ml and threohydrobupropion, 59.6 ng/ml. Bupropion and its metabolites were detectable in the amniotic fluid but the concentrations of threohydrobupropion were higher than those in the corresponding umbilical cord venous plasma. Conclusion Bupropion and its active metabolites cross the placenta to the fetal circulation. The concentrations of hydroxybupropion and threohydrobupropion in umbilical cord venous plasma were higher than bupropion concentrations suggesting a higher fetal exposure to the metabolites than the parent drug. The higher levels of threohydrobupropion in the amniotic fluid than those in umbilical cord venous plasma suggest that enzymes involved in the metabolism of bupropion to threohydrobupropion are most likely active in the fetus. The biological consequences of fetal exposure to maternally administered bupropion and/or its active metabolites via placental transfer and recirculation of the amniotic fluid are yet to be determined.

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“…In fact, depressive symptoms may occur more frequently during pregnancy than in the postpartum period (Suri et al, 2007). During pregnancy, ~20% of women report symptoms of depression (Patkar et al, 2004), and 4–7% of pregnant women suffer from major depressive disorder (Andersson et al, 2003; Gorman et al, 2004; Melville et al, 2010). Among women who experience postpartum depression, nearly 40% develop their symptoms during pregnancy (Johnson, 1997).…”

Section: Maternal Depressionmentioning

confidence: 99%

The effects of maternal depression and maternal selective serotonin reuptake inhibitor exposure on offspring

Olivier¹,

Åkerud²,

Kaihola³

et al. 2013

Front. Cell. Neurosci.

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It has been estimated that 20% of pregnant women suffer from depression and it is well-documented that maternal depression can have long-lasting effects on the child. Currently, common treatment for maternal depression has been the selective serotonin reuptake inhibitor medications (SSRIs) which are used by 2–3% of pregnant women in the Nordic countries and by up to 10% of pregnant women in the United States. Antidepressants cross the placenta and are transferred to the fetus, thus, the question arises as to whether children of women taking antidepressants are at risk for altered neurodevelopmental outcomes and, if so, whether the risks are due to SSRI medication exposure or to the underlying maternal depression. This review considers the effects of maternal depression and SSRI exposure on offspring development in both clinical and preclinical populations. As it is impossible in humans to study the effects of SSRIs without taking into account the possible underlying effects of maternal depression (healthy pregnant women do not take SSRIs), animal models are of great value. For example, rodents can be used to determine the effects of maternal depression and/or perinatal SSRI exposure on offspring outcomes. Unraveling the joint (or separate) effects of maternal depression and SSRI exposure will provide more insights into the risks or benefits of SSRI exposure during gestation and will help women make informed decisions about using SSRIs during pregnancy.

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Pharmacotherapy of Depression in Pregnancy

Cited by 23 publications

References 100 publications

Prevalence and predictors of antidepressant use in a cohort of pregnant women

Prevalence and predictors of antidepressant use in a cohort of pregnant women

Bupropion therapy during pregnancy: the drug and its major metabolites in umbilical cord plasma and amniotic fluid

The effects of maternal depression and maternal selective serotonin reuptake inhibitor exposure on offspring

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