Depression and bipolar mania in pregnant and lactating women

Depression and bipolar mania in pregnant and lactating women

Change in treatment plan during pregnancy

Depression and mood-related disorders are common conditions experienced by pregnant women. Postpartum blues and postpartum depressions are also associated with the aftermath of pregnancy. Management of depressive disorders in pregnant and non-pregnant women is different due to the risk associated with the medications of use. Managements of bipolar disorders in pregnancy is difficult compared to non-pregnant women (Alwan & Bérard, 2019). Studies have shown that there is no significant evidence that clarifies the risks to the developing fetus that are associated with exposure to mood stabilizers.

According to Pacchiarotti et al. (2016), the first step to managing bipolar disorders in pregnant women is to consider the use of medications that are favorable to the fetus. Drugs that have been proven to have clinical teratogenicity should be eliminated from the treatment regimen while the favorable ones should be prescribed. One factor that should be considered before making medication prescription is the duration of the pregnancy (trimester). The first trimester is sensitive, and at that stage, fetuses should never be exposed even to the slightest of teratogenic medications. Studies have shown that a fetus is susceptible to teratogens when the mother is in the first trimester. Also, neonatal withdrawals and adaption syndromes have been reported to be more common in the final stages of pregnancy.

Therefore, maintain great care should be the priority before medication prescription. Common antidepressants that have been reported to cause defects in the developing fetus include the class of drugs under selective serotonin reuptake inhibitors (SSRIs), especially paroxetine. Studies have indicated that paroxetine is associated with minor cases of fetal heart defects and poor pregnancy outcomes. Also, monoamine oxidase inhibitors should be avoided during pregnancy; due to their effect in limiting intrauterine fetal growth leading to low birth weight. A small dose of the antidepressants are prescribed to minimize the risks of congenital disabilities in pregnant women undergoing treatment for depression. A better option is to consider monotherapy for the available antidepressants while prescribing a lower dose. Lithium, which is considered to be the most effective for managing antenatal bipolar disorders, the drug should be avoided in pregnant women due to its teratogenicity. Also, carbamazepine and valproate should never be prescribed for pregnant women due to their association with teratogenic defects in fetuses.

Change in treatment plan during lactation

Some drugs such as chlorpromazine and haloperidol are excreted in breast milk and therefore consumed by the fetus while breastfeeding. Reports have indicated severe potential side effects of developmental regression in infants exposed to haloperidol and chlorpromazine. The dosage for the medication should be as low as possible (if they are the only available option) to reduce maternal serum concentration of the drug (Khan et al., 2016). Low serum concentration will mean that the concentration of the drug in milk will be significantly lower; hence, fewer side effects to the newborn.

Patient education

A lactating mother prescribed with antidepressants should monitor the baby closely and report if the baby experiences the following signs: irritability, jittery, frequent crying, respiratory distress, and poor feeding habits (Hendrick and Wilkins-Haug, 2016). For women who still have a desire to get pregnant in the future, she should never consider the use of sodium valproate, however effective the drug is in the management of depression and mood disorders due to the effects of birth malformations such as small fingers, cleft palate, reduced intelligence quotient, and small toe.

References

Hendrick, V., & Wilkins-Haug, L. (2016). Bipolar disorder in pregnant women: treatment of mania and hypomania. In UpToDate. UpToDate, Waltham (MA).

Khan, S. J., Fersh, M. E., Ernst, C., Klipstein, K., Albertini, E. S., & Lusskin, S. I. (2016). Bipolar disorder in pregnancy and postpartum: principles of management. Current psychiatry reports, 18(2), 13.

Pacchiarotti, I., Leon-Caballero, J., Murru, A., Verdolini, N., Furio, M. A., Pancheri, C., … & Montes, J. M. (2016). Mood stabilizers and antipsychotics during breastfeeding: focus on bipolar disorder. European Neuropsychopharmacology, 26(10), 1562-1578.

Alwan, S., & Bérard, A. (2019). Epidemiology of the Use of Psychotropic Drugs in Pregnant and Nursing Women. In Perinatal Psychopharmacology (pp. 3-16). Springer, Cham.