TREATMENT OF DEPRESSIVE AND ANXIETY DISORDERS DURING PREGNANCY AND LACTATION: A CASE STUDY

Teodora Inić; Mina Cvjetković Bošnjak; Dušan Kuljančić

doi:10.5937/sanamed19-54756

Teodora Inić University clinical center Vojvodina, Psychiatry Clinic, Novi Sad, Serbia
Mina Cvjetković Bošnjak 1. University clinical center Vojvodina, Psychiatry Clinic, Novi Sad, Serbia:;2. University in Novi Sad, Faculty of medicine, Novi Sad, Serbia
Dušan Kuljančić 1. University clinical center Vojvodina, Psychiatry Clinic, Novi Sad, Serbia; 2. University in Novi Sad, Faculty of medicine, Novi Sad, Serbia

DOI: https://doi.org/10.5937/sanamed19-54756

Keywords: Depression, anxiety, pregnancy, lactation, pharmacotherapy

Abstract

Introduction:Depressive and anxiety disorders are among the most common psychiatric conditions, as stated by the WHO in 2015. These disorders often manifest during adolescence or young adulthood, making it unsurprising for women in pregnancy or lactation periods to experience either a first manifestation or a recurrence of symptoms. When these disorders occur during pregnancy or lactation, antidepressant treatment may be required per established protocols. However, concerns often arise among patients, such as: “Is this medication safe for me and my baby? Could it negatively affect my baby’s development?” These hesitations can sometimes extend to healthcare providers if they lack adequate education on the topic. Therapeutic guidelines worldwide recommend psychotherapy for mild symptoms, whereas pharmacotherapy, often combined with psychotherapy, is carefully considered for moderate symptoms.

Case Report: This paper presents three case studies of pregnant women with depressive and anxiety disorders. The first case involves a patient with prenatal depression who achieved complete remission after starting antidepressant therapy. The second case highlights the recurrence of symptoms following the discontinuation of psychopharmaceuticals. The third case emphasizes the importance of individualized treatment plans and illustrates the recurrence of symptoms in a patient previously in remission.

Conclusion: Pregnant women with mental health challenges often have significant concerns about using psychopharmaceuticals during pregnancy. This paper aims to underscore that the appropriate selection and dosage of antidepressant medications can lead to remission of disorders without adverse effects on either the mother or child.

References

Cohen LS, Rosenbaum JF. Psychotropic drug use during pregnancy: weighing the risks. J Clin Psychiatry. 1998;58(suppl 2):18-28.

Besag FMC, Vasey MJ. Should antidepressants be avoided in pregnancy? Drug Saf. 2023;46(1):1-17. doi: 10.1007/s40264-022-01257-1.

Răchită AIC, Strete GE, Sălcudean A, Ghiga DV, Rădulescu F, Călinescu M et al. Prevalence and risk factors of depression and anxiety among women in the last trimester of pregnancy: across-sectional study. Medicina (Kaunas). 2023;59(6):1009. doi: 10.3390/medicina59061009.

Bennet HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol. 2004; 103(4):698-709. doi: 10.1097/01.AOG.0000116689.75396.5f.

Costa B, Vale N. Advances in psychotropic treatment for pregnant women: efficacy, adverse outcomes, and therapeutic monitoring. J Clin Med. 2024;13(15):4398. doi: 10.3390/jcm13154398.

Einarson A, Choi J, Einarson TR, Koren G. Adverse effects of antidepressant use in pregnancy: an evaluation of fetal growth and preterm birth. Depress Anxiety. 2010; 27(1):35-8. doi: 10.1002/da.20598.

Al-Fadel N, Alrwisan A. Antidepressant use during pregnancy and the potential risk of motor outcomes and intellectual disabilities in offspring: a systematic review. Drugs Real World Outcomes. 2021;8(2):105-23. doi:10.1007/s40801-021-00232-z.

Jahan N, Went TR, Sultan W, Sapkota A, Khurshid H, Qureshi IA et al. Untreated depression during pregnancy and its effect on pregnancy outcomes: a systematic review. Cureus. 2021;13(8):e17251. doi: 10.7759/cureus.17251.

Gallitelli V, Franco R, Guidi S, Puri L, Parasiliti M, Vidiri A et al. Depression treatment in pregnancy: is it safe, or is it not? Int J Environ Res Public Health. 2024;21(4):404. doi: 10.3390/ijerph21040404.

Meltzer-Brody S, Howard LM, Bergink V, Vigod S, Jones I, Munk-Olsen T, et al. Postpartum psychiatric disorders. Nat Rev Dis Primers. 2018 Apr 26;4:18022. doi: 10.1038/nrdp.2018.22.

van der Veere CN, de Vries NKS, van Braeckel KNJA,Bos AF. Intra-uterine exposure to selective serotonin reuptake inhibitors (SSRIs), maternal psychopathology, and neurodevelopment at age 2.5years - Results from the prospective cohort SMOK study. Early Hum Dev. 2020;147:105075. doi: 10.1016/j.earlhumdev.2020.105075.

Jimenez-Solem E, Andersen JT, Petersen M, Broedbaek K, Jensen JK, Afzal S, et al. Exposure to selective serotonin reuptake inhibitors and the risk of congenital malformations: A nationwide cohort study. BMJ Open. 2012;2(3) :e001148. doi:10.1136/bmjopen-2012-001148.

Huang W, Page RL, Morris T, Ayres S, Ferdinand AO, Sinha S. Maternal exposure to SSRIs or SNRIs and the risk of congenital abnormalities in offspring: A systematic review and meta-analysis. PLoS One. 2023;18(11):e0294996. doi: 10.1371/journal.pone.0294996

Reis M, Källén B. Combined use of selective serotonin reuptake inhibitors and sedatives/hypnotics during pregnancy: Risk of relatively severe congenital malformations or cardiac defects. A register study. BMJ Open. 2013;3(2) :e002166. doi:10.1136/bmjopen-2012-002166.

Bérard A, Iessa N, Chaabane S, Muanda FT, Boukhris T, Zhao JP. The risk of major cardiac malformations associated with paroxetine use during the first trimester of pregnancy: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;81(4):589-604. doi: 10.1111/bcp.12849.

Einarson A. Paroxetine use in pregnancy and increased risk of heart defects: Evaluating the evidence. Can Fam Physician. 2010;56(8):767-8. Erratum in: Can Fam Physician. 2010;56(11):1112.

Munger Clary HM. Caution: Benzodiazepines in pregnancy and risk of adverse perinatal outcomes. Epilepsy Curr. 2024;24(2):105-7. doi:10.1177/15357597241227656.

McElhatton PR. The effects of benzodiazepine use during pregnancy and lactation. Reprod Toxicol. 1994;8(6):461-75. doi: 10.1016/0890-6238(94)90029-9.

Noh Y, Lee H, Choi A, Kwon JS, Choe SA, Chae J, et al. First-trimester exposure to benzodiazepines and risk of congenital malformations in offspring: A population-based cohort study in South Korea. PLoS Med. 2022;19(3) :e1003945. doi: 10.1371/journal.pmed.1003945.