The last time TCPR covered the topic of psychotropics in pregnancy was less than two years ago, in February of 2009. Since then, however, some new treatment guidelines have been published, and they appear to be useful to clinicians.
These new guidelines were issued jointly by our APA and by the American College of Obstetricians and Gynecologists. In addition to providing a nice summary of the neonatal risks of antidepressant exposure, the paper offers clear, concise, and easy to follow algorithms for the management of depression in three scenarios doctors are likely to encounter.
SSRIs theoretically work by inhibiting the reuptake of serotonin, presumably by blocking the serotonin transporter pump whose job is to clean up excess serotonin in the synapses between neurons.
As we reviewed in the July/August 2009 issue of TCPR (Vol 7, Issue 7), cardiac disease leads to major depression, and, conversely, depression is a risk factor for developing cardiac disease.
Historically, research into the effectiveness of antidepressants for depressed youths has been unimpressive. The history of SSRI use in children has been fraught with its own series of disappointments and controversies.
No clinician wants to be a “pill-pusher,” and most of our patients do not want that kind of treatment. So what can we offer our depressed patients beyond medications?
Most people with bipolar disorder are maintained on antidepressants, but the evidence base is rather meager. In a recent trial, researchers recruited 70 patients with bipolar disorder, all of whom had responded to a combination of a mood stabilizer and an antidepressant.