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Treatment Issues During Pregnancy and Lactation

Published online by Cambridge University Press:  07 November 2014

Claudia L. Baugh  and
Zachary N. Stowe
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Abstract

The lifetime incidence of mood disorders is twice as great in women compared with men, with the highest risk occurring during the childbearing years. The management of mental illness during pregnancy and lactation is a particularly complex clinical situation. The cornerstone of such a clinical decision is a completion of an assessment of the risks of the illness vs the risks of treatment. The following article reviews the factors influencing infant outcome and outlines the essential elements of the process of determining risk for the use of psychotropics in women during pregnancy and lactation. As the available data rapidly change, the facets of the risk benefit assessment are consistent and often the issue of specific medication is decided by prior history and exposure.

Type
Feature Articles
Information
CNS Spectrums , Volume 4 , Issue 10: Women and the Mood Disorders Spectrum , October 1999 , pp. 34 - 39
Copyright
Copyright © Cambridge University Press 1999

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References

REFERENCES

1.Weissman, MM, Bland, R, Joyce, PR, Newman, S, Wells, JE, Wittchen, HU. Sex differences in rates of depression: cross-national perspectives. J Affect Dis. 1993;29:77–84.CrossRefGoogle ScholarPubMed
2.Blazer, DG, Kessler, RC, McGonagle, KA. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry. 1994;151:979–986.Google Scholar
3.Montkowski, A, Barden, N, Wotjak, C, et al.Long-term antidepressant treatment reduces behavioral deficits in transgenic mice with impaired glucocorticoid receptor function. J Neuroendocrinol. 1995;7:841–845.CrossRefGoogle ScholarPubMed
4. Clinical Practice Guideline Number 5: Depression in Primary Care, 1: Detection and Diagnosis. Rockville, Md: US Dept of Health and Human Services, Agency for Health Care Policy and Research; 1993. AHCPR publication 93-0550.Google Scholar
5.Centers for Disease Control and Prevention. Impact of multiple births on low birthweight—Massachusetts, 1989-1996. JAMA. 1999;281:1980–1981..Google Scholar
6.Kiely, M. Reproductive and Perinatal Epidemiology. Boca Raton, FL: CRC Press; 1991:69.Google Scholar
7.McBride, WG. Limb deformities associated with iminodibenzyl hydrochloride. Med J Aust. 1972;492:175–178.Google Scholar
8.Riccardi, VM. The Genetic Approach to Human Disease. New York, NY: Oxford University Press; 1977:34.Google Scholar
9.Heinonen, OP, Stone, D, Shapiro, S. Birth Defects and Drugs in Pregnancy. Littleton, Mass: Publishing Sciences Group; 1977.Google Scholar
10.Cohen, LS, Heller, VL, Rosenbaum, JF. Treatment guidelines for psychotropic drug use in pregnancy. Psychosomatics. 1989;30:1.CrossRefGoogle ScholarPubMed
11.Doering, JC, Stewart, RB. The extent and character of drug consumption during pregnancy. JAMA. 1978;239:843–846.CrossRefGoogle ScholarPubMed
12.Koren, G, Pastuszak, A, Ito, S. Drugs in pregnancy. N Engl J Med. 1998;338:1128–1137.CrossRefGoogle ScholarPubMed
13.Klein, DF, Skrobala, AM, Garfinkel, RS. Preliminary look at the effects of pregnancy on the course of panic disorder. Anxiety. 1995;1:227–232.CrossRefGoogle Scholar
14.Neziroglu, F, Anemone, R, Yaryura, TJA. Onset of obsessive-compulsive disorder in pregnancy. Am J Psychiatry. 1992;149:947–950.Google ScholarPubMed
15.Buesching, DP, Glasser, ML, Frate, DA. Progression of depression in the prenatal and postpartum periods. Women Health. 1986 2:61–78.Google Scholar
16.Cutrona, CE. Causal attributions and perinatal depression. J Abnorm Psychol. 1983;92:161–172.CrossRefGoogle ScholarPubMed
17.Manly, PC, McMahon, RJ, Bradley, CF, Davidson, PO. Depressive attributional style and depression following childbirth. J Abnorm Psychol. 1982;91:245–254.CrossRefGoogle ScholarPubMed
18.O'Hara, MW, Rehm, LP, Campbell, SB. Predicting depressive symptomology: cognitive-behavioral models of postpartum depression. J Abnorm Psychol. 1982;91:457–461.CrossRefGoogle Scholar
19.Raskin, VD, Richman, JA, Gaines, C. Patterns of depressive symptoms in expectant and new parents. Am J Psychiatry. 1990;147:658–660.Google ScholarPubMed
20.Watson, JP, Elliot, SA, Rugg, AJ, Brough, DI. Psychiatric disorders in pregnancy and the first postnatal year. Br J Psychiatry. 1984;144:453–462.CrossRefGoogle ScholarPubMed
21.Kumar, R, Robson, KM. A prospective study of emotional disorders in childbearing women. Br J Psychiatry. 1984;144:35–47.CrossRefGoogle ScholarPubMed
22.O'Hara, MW, Neunaber, DJ, Zekoski, EM. Prospective study of postpartum depression: prevalence, course, and predictive factors. J Abnor Psychol. 1984;93:3:158–171.CrossRefGoogle ScholarPubMed
23.Kendell, RE, Chalmers, JC, Platz, C. Epidemiology of puerperal psychoses. Br J Psychiatry. 1987:150:662–673.CrossRefGoogle ScholarPubMed
24.Cooper, PJ, Murray, L. Course and recurrence of postnatal depression: evidence for the specificity of the diagnostic concept. Br J Psychiatry. 1995;166:191–195.CrossRefGoogle ScholarPubMed
25.Richards, JP. Postnatal depression: a review of recent literature. Br J Gen Pract. 1990;40:472–476.Google ScholarPubMed
26.Stowe, ZN, Nemeroff, CB. Women at risk for postpartum-onset major depression. Am J Obstet Gynecol. 1995;173:639–645.CrossRefGoogle ScholarPubMed
27.Troutman, B, Cutrona, C. Nonpsychotic postpartum depression among adolescent mothers. J Abnorm Psychol. 1990;99:69.CrossRefGoogle ScholarPubMed
28.Metz, A, Sichel, DA, Goff, DC. Postpartum panic disorder. J Clin Psychiatry. 1988;49:278–279.Google ScholarPubMed
29.Sichel, DA, Cohen, LS, Rosenbaum, JF, Driscoll, J. Postpartum onset of obsessive-compulsive disorder. Psychosomatics. 1993;34:277–279.CrossRefGoogle ScholarPubMed
30.Perkin, MR, Bland, JM, Peacock, JL, Anderson, R. The effect of anxiety and depression during pregnancy on obstetrical complications. Br J Obstet Gynaecol. 1993;100:629–34.CrossRefGoogle Scholar
31.Steer, RA, Scholl, TO, Hediger, ML, Fischer, RL. Self-reported depression and negative pregnancy outcomes. Epidemiology. 1992;45:1093–1099.Google ScholarPubMed
32.Avant, K. Anxiety as a potential factor affecting maternal attachment. J Obstet Gynecol Neonatal Nurs. 1981;10:416–419.Google ScholarPubMed
33.Brazelton, TB. Mother infant reciprocity. In: Klaus, MH, Leger, T, Trause, MA, eds. Maternal Attachment and Mothering Disorders: A Roundtable. North Brunswick, NJ: Johnson & Johnson; 1975:49–54.Google Scholar
34.Campbell, SB, Cohn, JF, Meyers, T. Depression in first time mothers: mother-infant interaction and depression chronicity. Dev Psychol. 1995;31:349–357.CrossRefGoogle Scholar
35.Cradon, AJ. Maternal anxiety and neonatal well being. J Psychosom Res. 1979;23:113–115.CrossRefGoogle Scholar
36.Cutrona, CE, Troutman, BR. Social support, infant temperament and parenting self-efficacy: a multidimensional model of postpartum depression. Child Development. 1986;57:1507–1518.CrossRefGoogle Scholar
37.Murray, L, Fiori-Cowley, A, Hooper, R, Cooper, P. The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome. Child Dev. 1996;67:2512–2526.CrossRefGoogle ScholarPubMed
38.Teti, DM, Messinger, DS, Gelfand, DM, Isabella, R. Maternal depression and the quality of early attachment: an examination of infants, preschoolers, and their mothers. Dev Psychol. 1995;31:364–376.CrossRefGoogle Scholar
39.Zahn-Waxler, C, Cummings, EM, Ianoff, RJ, et al.Young off-spring of depressed patients: a population of risk for affective problems and childhood depression. In: Cichetti, D, Schneider-Rosen, , eds. Childhood Depression. San Francisco, Calif: Jossey-Bass; 1984:81–105.Google Scholar
40.Bowlby, J. Maternal Care and Mental Health. World Health Organization, Geneva, Switzerland; 1951. WHO Monograph Series, No. 2.Google Scholar
41.Harlow, HF, Harlow, MK. Social deprivation of monkeys. Sci Am. 1966;207:136–146.Google Scholar
42.Plotsky, PM, Meaney, MJ. Early, postnatal experience alters hypothalamic corticotropin-releasing factor (CRF) mRNA, median eminence CRF content and stress-induced release in adult rats. Brain Res Mol Brain Res. 1993;18:195–200.CrossRefGoogle ScholarPubMed
43.Altshuler, LL, Cohen, L, Szuba, MP, et al.Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines. Am J Psychiatry. 153:592–606; 1996.Google ScholarPubMed
44.Cohen, LS. Psychotropic drug use in pregnancy. Hosp Community Psychiatry. 1989;40:566–567.Google ScholarPubMed
45.Kerns, LL. Treatment of mental disorders in pregnancy: a review of psychotropic drug risks and benefits. J Nerv Ment Dis. 1986;174:652–659.CrossRefGoogle ScholarPubMed
46.Miller, LJ. Clinical strategies for the use of psychotropic drugs during pregnancy. Psychiatr Med. 1991;9:275–298.Google ScholarPubMed
47.Miller, LJ. Psychiatric medication during pregnancy: understanding and minimizing the risks. Psychiatr Ann. 1994;24:69–75.CrossRefGoogle Scholar
48.Robinson, HE, Stewart, DE, Flak, E. The rational use of psychotropic drugs in pregnancy and postpartum. Can J Psychiatry. 1986;31:183–190.CrossRefGoogle ScholarPubMed
49.Stowe, ZN, Stader, JR, Nemeroff, CB. Psychopharmacology during pregnancy and lactation. In: Schatzberg, AF, Nemeroff, CB, eds. APA Textbook of Psychopharmacology. Washington, DC: APA Press; 1998:979–996.Google Scholar
50.Wisner, KL, Perel, JM. Psychopharmacologic agents and electroconvulsive therapy during pregnancy and the puerperium. In: Cohen, RL, ed. Psychiatric Consultation in Childbirth Settings: Parent- and Child-Oriented Approaches. New York, NY: Plenum Medical Book Company; 1988:165–206.CrossRefGoogle Scholar
51.Buist, A, Norman, TR, Dennerstein, L. Breastfeeding and the use of psychotropic medication: a review. J Affect Disord. 1990;19:197–206.CrossRefGoogle ScholarPubMed
52.Wisner, KL, Perel, JM, Findling, RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996;153:1132–1137.Google ScholarPubMed
53.Llewellyn, AM, Stowe, ZN. Psychotropic medications in lactation. J Clin Psychiatry. 1998;59:41–52.Google ScholarPubMed