Skip to main content Accessibility help
×
×
Home
  • Print publication year: 2010
  • Online publication date: August 2010

Chapter 22 - Managing depression in pregnancy

Summary

A seizure may be an acute symptomatic or unprovoked event. Acute symptomatic seizures have a cause such as brain trauma, infection, or drug withdrawal. The disorders in people with epilepsy (PWE) are: psychiatric disorders, depressive disorders, bipolar disorders, anxiety disorders, and cognitive disorders. Psychiatric disorders in PWE are best managed by avoiding the ictus altogether. Although antiepileptic drug (AED) decision-making should be guided by a neurologist, it is important to understand basic treatment strategies along with the potential for rash and fetal malformations. Experts agree that monotherapy is the treatment of first choice for partial and generalized epilepsies. If the first AED fails, neurologists prescribe monotherapy with a second AED. Valproic acid use increases the risk of major malformations and should be avoided during the first trimester. The indications for psychotropic use in someone with epilepsy are the same as in the general population.
Recommend this book

Email your librarian or administrator to recommend adding this book to your organisation's collection.

Psychosomatic Medicine
  • Online ISBN: 9780511776878
  • Book DOI: https://doi.org/10.1017/CBO9780511776878
Please enter your name
Please enter a valid email address
Who would you like to send this to *
×

References

1. SmithMV, RosenheckRA, CavaleriMA, et al. Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetric clinics. Psychiatr Serv. 2004;55(4):407–14.
2. KellyR, ZatzickD, AndersT. The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in obstetrics. Am J Psychiatry. 2001;158(2):213–9.
3. O’HaraMW. Social support, life events, and depression during pregnancy and the puerperium. Arch Gen Psychiatry. 1986;43:569–73.
4. HobfollSE, RitterC, LavinJ, et al. Depression prevalence and incidence among inner-city pregnant and postpartum women. J Consult Clin Psychol. 1995;63(3):445–53.
5. O’HaraMW, SwainAM. Rates and risk of postpartum depression – a meta-analysis. Int Rev Psychiatry. 1996;8(1):37–54.
6. GjerdingenDK, FrobergDG, FontaineP. The effects of social support on women's health during pregnancy, labor and delivery, and the postpartum period. Fam Med. 1991;23:370–5.
7. WisnerKL, PerelJM, PeindlKS, et al. Prevention of recurrent postpartum depression: a randomized clinical trial. J Clin Psychiatry. 2001;62:82–6.
8. O’HaraMW, ZekoskiEM, PhilippsLH, WrightEJ. Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women. J Abnorm Psychol. 1990;99(1):3–15.
9. FlynnHA. Epidemiology and phenomenology of postpartum mood disorders. Psychiatr Ann. 2005;35:544–651.
10. KendellRE, ChalmersJC, PlatzC. Epidemiology of puerperal psychoses. Br J Psychiatry. 1987;150:662–73.
11. AttiaE, DowneyJ, ObermanM. Postpartum psychoses. In: MillerL, editor. Postpartum mood disorders. Washington (DC): American Psychiatric Publishing, Inc; 1999. p. 99–117.
12. KurkiT, HiilesmaaV, RaitasaloR, et al. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol. 2002;95:487–90.
13. WisnerKL, SitDKY, HanusaBH, et al. Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. Am J Psychiatry. 2009;166(5):557–66.
14. HofmanS, HatchMC. Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women. Health Psychol. 2000;19:535–43.
15. KellyRH, DanielsenBH, GoldingJM, et al. Adequacy of prenatal care among women with psychiatric diagnoses giving birth in California in 1994 and 1995. Psychiatr Serv. 1999;5(12):1584–90.
16. ZuckermanB, AmaroH, BauchnerH, CabralH. Depressive symptoms during pregnancy: relationship to poor health behaviors. Am J Obstet Gynecol. 1989;160:1107–11.
17. SolidayE, McCluskey-FawcettK, O’BrienM. Postpartum affect and depressive symptoms in mothers and fathers. Am J Orthopsychiatry. 1999;6(1):30–8.
18. MurrayL, Fiori-CowleyA, HooperR, CooperP. The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome. Child Dev. 1996;67(5):2512–26.
19. PhillippsLH, O’HaraMW. Prospective study of postpartum depression: 4½ year follow-up of women and children. J Abnorm Psychol. 1991;100:151–5.
20. PaulsonJF, DauberS, LeifermanJA. Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics. 2006;118(2):659–68.
21. GaynesBN, GavinN, Meltzer-BrodyS, LohrKN, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Rockville (MD): AHRQ; 2005.
22. CoxJL, HoldenJM, SagovskyR. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6.
23. MurrayL, CoxJ. Identifying depression during pregnancy with the Edinburgh Postnatal Depression Scale (EPDS). J Reprod Infant Psychol. 1990;8:99–107.
24. O’HaraMW, SchlechteJA, LewisDA, VarnerMW. Controlled prospective study of postpartum mood disorders: psychological, environmental, and hormonal variables. J Abnorm Psychol. 1991;100(1):63–73.
25. Berggren-CliveK. Out of the darkness and into the light: women's experiences with depression after childbirth. Can J Commun Ment Health. 1998;17(1):103–20.
26. ApplebyL. Suicide during pregnancy and in the first postnatal year. Br Med J. 1991;302:137–40.
27. OatesM. Deaths from suicide and other psychiatric causes: why mothers die. Report on confidential enquiries into maternal deaths in the United Kingdom. Confidential Enquiry into Maternal and Child Health (CEMACH). 2004 [cited 2005 April 26, 2005]. Available from: www.cemach.org.uk/publications/WMD2000_2002/content.htm.
28. LazarusJH, KokandiA. Thyroid disease in relation to pregnancy: a decade of change. Clin Endocrinol. 2000;53(3):265–78.
29. SitD, RothschildAJ, WisnerKL. A review of postpartum psychosis. J, Womens Health (Larchmt). 2006;15(4):352–68.
30. KumarR, MarksM, PlatzC, YoshidaK. Clinical survey of a psychiatric mother and baby unit: characteristics of 100 consecutive admissions. J Affect Disord. 1995;3(1):11–22.
31. WisnerKL, PeindlK, HanusaBH. Symptomatology of affective and psychotic illnesses related to childbearing. J Affect Disord. 1994;30:77–87.
32. HenshawC, ForemanD, CoxJ. Postnatal blues: a risk factor for postnatal depression. J Psychosom Obstet Gynaecol. 2004;25(3–4):267–72.
33. WisnerKL, PerelJM, PeindlKS, et al. Prevention of postpartum depression: a pilot randomized clinical trial. Am J Psychiatry. 2004;161(7):1290–2.
34. ZlotnickC, MillerIW, PearlsteinT, et al. A preventive intervention for pregnant women on public assistance at risk for postpartum depression. Am J Psychiatry. 2006;163(8):1443–5.
35. StuartS, O’HaraMW. Psychosocial treatments for mood disorders in women. In: SteinerM, YonkersKA, ErikssonE, editors. Mood disorders in women. London: Martin Dunitz, Ltd; 2000. p. 521–42.
36. KopelmanR, StuartS. Psychological treatments for postpartum depression. Psychiatr Ann. 2005;35:556–65.
37. DoeringP, StewartRB. The extent and character of drug consumption during pregnancy. JAMA. 1978;239:843–6.
38. HostetterA, RitchieJC, StoweZN. Amniotic fluid and umbilical cord blood concentrations of antidepressants in three women. Biol Psychiatry. 2000;4(10):1032–4.
39. SitD, PerelJM, HelselJC, WisnerKL. Changes in antidepressant metabolism and dosing across pregnancy and early postpartum. J Clin Psychiatry. 2008;69(4):652–8.
40. AlwanS, ReefhuisJ, RasmussenSA, et al. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. N Engl J Med. 2007;356(26):2684–92.
41. LouikC, LinAE, WerlerMM, et al. First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects. N Engl J Med. 2007;356(26):2675–83.
42. GlaxoSmithKline. Use of Paxil or Paxil CR during pregnancy. [cited 2009 June 9]. Available from: http://us.gsk.com/docs-pdf/media-news/mi_letter_paroxetine_pregnancy.pdf
43. EinarsonA, PistelliA, DeSantisM, et al. Evaluation of the risk of congenital cardiovascular defects associated with use of paroxetine during pregnancy. Am J Psychiatry. 2008;165(6):749–52.
44. ACOG Committee on Practice Bulletins – Obstetrics. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists, number 92, 2008. Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008;111(4):1001–20.
45. ChambersCD, JohnsonKA, DickLM, et al. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med. 1996;335:1010–5.
46. Moses-KolkoEL, BogenD, PerelJ, et al. Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: literature review and implications for clinical applications. JAMA. 2005;293(19):2372–83.
47. ChambersCD, Hernandez-DiazS, Van MarterLJ, et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med. 2006;354(6):579–87.
48. DjulusJ, KorenG, EinarsonTR, et al. Exposure to mirtazapine during pregnancy: a prospective, comparative study of birth outcomes. J Clin Psychiatry. 2006;67(8):1280–4.
49. Chun-Fai-ChanB, KorenG, FayezI, et al. Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study. Am J Obstet Gynecol. 2005;192(3):932–6.
50. EinarsonAFatoyeB, SarkarM, et al. Pregnancy outcome following gestational exposure to venlafaxine: a multicenter prospective controlled study. Am J Psychiatry. 2001;158(10):1728–30.
51. EinarsonA, BonariL, Voyer-LavigneS, et al. A multicentre prospective study to determine the safety of trazodone and nefazodone use during pregnancy. Can J Psychiatry. 2003;48(2):106.
52. SimonGE, CunninghmaML, DavisRL. Outcomes of prenatal antidepressant exposure. Arch Gen Psychiatry. 2002;159:2055–61.
53. GraciousBL. Phenelzine use throughout pregnancy and the puerperium: case report, review of the literature, and management recommendations. Depress Anxiety. 1997;6(3):124–8.
54. PearlsteinT. Perinatal depression: treatment options and dilemmas. J Psychiatry Neurosci. 2008;33(4):302–18.
55. GjerdingenD. The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. J Am Board Fam Pract. 2003;16(5):372–82.
56. WeissmanAM, LevyBT, HartzAJ, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004;161(6):1066–78.
57. GentileS. SSRIs in pregnancy and lactation: emphasis on neurodevelopmental outcome. CNS Drugs. 2005;19(7):623–33.
58. FreemanMP, DavisM, SinhaP, et al. Omega-3 fatty acids and supportive psychotherapy for perinatal depression: a randomized placebo-controlled study. J Affect Disord. 2008;110(1–2):142–8.
59. SuK-P, HuangS-Y, ChiuC-C, ShenWW. Omega-3 fatty acids in major depressive disorder: a preliminary double-blind, placebo-controlled trial. Eur Neuropsycho-pharmacol. 2003;13(4):267–71.
60. EppersonC, TermanM, TermanJ, et al. Randomized clinical trial of bright light therapy for antepartum depression: preliminary findings. J Clin Psychiatry. 2004;65(3):421–5.
61. PinnetteM, SantarpioC, WaxJ, BlackstoneJ. Electroconvulsive therapy in pregnancy. Obstet Gynecol. 2007;110:465–6.
62. YonkersKA, WisnerKL, StoweZ, et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry. 2004;161(4):608–20.
63. CunningtonM, TennisP, the International Lamotrigine Pregnancy Registry Scientific Advisory C. Lamotrigine and the risk of malformations in pregnancy. Neurology. 2005;64(6):955–60.
64. NewportDJ, VigueraAC, BeachAJ, et al. Lithium placental passage and obstetrical outcome: implications for clinical management during late pregnancy. Am J Psychiatry. 2005;162(11):2162–70.
65. FlynnHA, BlowFC, MarcusSM. Rates and predictors of depression treatment among pregnant women in hospital-affiliated obstetrics practices. Gen Hosp Psychiatry. 2006;28(4):289–95.
66. SmithMV, RosenheckRA, CavaleriMA, et al. Screening for and detection of depression, panic disorder and PTSD in public sector obstetric clinics. Psychiatr Serv. 2004;55:407–14.
67. KopelmanRC, MoelJ, MertensC, et al. Barriers to care for antenatal depression. Psychiatr Serv. 2008;59(4):429–32.
68. MarcusSM, FlynnHA, BlowF, BarryK. A screening study of antidepressant treatment rates and mood symptoms in pregnancy. Arch Womens Ment Health. 2005;8(1):25–7.
69. CohenLS, AltshulerLL, HarlowBL, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295(5):499–507.
70. WisnerK, ZarinD, HolmboeE, et al. Risk-benefit decision making for treatment of depression during pregnancy. Am J Psychiatry. 2000;157:1933–40.
71. SitDKY, WisnerKL. Decision making for postpartum depression treatment. Psychiatr Ann. 2005;35(7):577–85.