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ANGELS Update Antidepressants in Pregnancy

ANGELS Update Antidepressants in Pregnancy. Linda L.M. Worley, MD, Associate Professor UAMS, Departments of Psychiatry & OB/GYN. REVIEW: Untreated Depression in PG linked to increased risks for:. Miscarriage Growth restriction (Teixeira et al 1999; British Medical Journal)

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ANGELS Update Antidepressants in Pregnancy

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  1. ANGELS UpdateAntidepressants in Pregnancy Linda L.M. Worley, MD, Associate Professor UAMS, Departments of Psychiatry & OB/GYN

  2. REVIEW: Untreated Depression in PG linked to increased risks for: • Miscarriage • Growth restriction (Teixeira et al 1999; British Medical Journal) • Poor prenatal care compliance & nutritional intake • Use of other drugs/smoking • Prematurity • Pre-eclampsia (Kurki et al 2000; Obstetrics and Gynecology) • Low APGAR scores

  3. REVIEW: Untreated Depression in PG linked to increased risks for: • Suicidal ideation & attempts (Einarson et al 2001; J Psychiatry Neurosci) • Postpartum depression (Post 1992; Am J Psychiatry) • Decreased success @ breastfeeding • Increased CRH & decreased fetal responses to a novel stimulus(Sandman et al 1999; Ann NY Acad Sciences) • Irritable & difficult to console infants

  4. Risks of exposure to antidepressants • Neonatal discontinuation syndrome (see next slide)

  5. “Serotonin overstimulation” (Laine et al 2003) “Poor Perinatal adaptation” (Chambers et al 1996) Myoclonus Restlessness Tremor Shivering Hyperreflexia Nausea Involuntary movements Rigidity Tachypnea/ respiratory distress/ desaturation on feeding Hypoglycemia Poor tone Weak/absent cry Jitteriness Hypo-thermia

  6. Cautious approach • Informed consent: Risks & benefits of treatment versus not • Monitor neonate for withdrawal &/or toxicity from antidepressants for at least 48 hours after birth (Koren 2004; Arch Pediatr Adolesc Medicine)

  7. Potential Strategies to Manage Neonate To Decrease Risk for Toxicity: Taper/stop maternal drug prior to due date if risk of maternal illness doesn’t outweigh risk of complications To Decrease Risk for Withdrawal: Lactation may provide minimal additional dose to reduce rapid drug concentration drop

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