Understanding posttraumatic stress disorder (PTSD) during pregnancy is important given that PTSD is relatively common and persistent in nature. PTSD will occur in approximately 10% of women in their lifetime, with one-third of episodes lasting more than five years. Given the relatively high prevalence of PTSD in young women and the chronic nature of the illness, many women may experience PTSD symptoms during pregnancy.
Ms. P is a 32-year-old married woman who presented for consultation regarding the use of medication during pregnancy. She had been taking fluoxetine (Prozac) 20 mg for many years for the treatment of recurrent major depression and generalized anxiety. In addition, she was prescribed gabapentin (Neurontin) for sleep.
Both citalopram and escitalopram are antidepressants belonging to the SSRI class. While escitalopram (marketed in the U.S. as Lexapro) contains only the S-stereoisomer (or enantiomer) of the drug citalopram, Celexa or generic citalopram is a racemic mixture of the S-citalopram and its mirror image, R-citalopram, which is less effective as an antidepressant.
Postpartum psychosis is the most severe form of postpartum psychiatric illness, occurring in approximately 1 to 2 per 1000 women after childbirth. Although bipolar disorder is a risk factor for postpartum psychosis, a substantial number of women who develop postpartum psychosis have no history of psychiatric illness and experience psychiatric illness only in the context of childbearing. What may cause or trigger postpartum psychosis in this population is not well understood.
Depression during pregnancy is common and has major health implications for the mother, the fetus and the family. On this website, we have reviewed numerous treatments for affective disorders in pregnancy, including psychotropic medications and several forms of psychotherapy. We have not had much data to support the use of light therapy for antepartum depression, yet I often discuss light therapy as a potential adjunctive treatment for patients with a seasonal component to their depression. A recent study, published by Wirz-Justice and colleagues in the Journal of Clinical Psychiatry, provides evidence that light therapy may be a useful non-pharmacologic treatment for women who suffer from depression during pregnancy(1).
Part 4: The Postpartum Period
Part 3: Planning for the Postpartum Period
Part 1: Pre-Pregnancy Planning
It is estimated that up to 95% of women experience some type of sleep disturbance during pregnancy. While for many women the insomnia is relatively benign and may respond to simple interventions, other women experience more severe insomnia which has a significant impact on their quality of life and ability to function. Various non-benzodiazepine hypnotic agents, specifically zalepion (Sonata), eszopiclone (Lunesta), and zolpidem (Ambien), are commonly used for the short-term treatment of insomnia; however, information regarding the reproductive safety of these sleep aids has been sparse.
