Part 3: Planning for the Postpartum Period

This is a continuation of the case presented in a previous post.

Ms. D continued to be somewhat symptomatic but much more stable during the rest of her pregnancy while on the combination of fluoxetine and clonazepam.  There was a discussion regarding the option of increasing her dose of fluoxetine to provide further benefit, but the patient decided that even though she was not feeling her best she wanted to remain on 20mg.

At her last appointment prior to delivery, she discussed her desire to change to venlafaxine ER after delivery, as fluoxetine had sexual side effects that she did not have on venlafaxine ER and because venlafaxine was more effective for her. The patient stated that she would like to formula feed after delivery.
Here are some key points to consider:

It is important to get as well as possible prior to delivery to give the patient the best chance of doing well during the postpartum period.  This often would include optimizing the dose of medications.

She has a history of responding very well and very quickly to venlafaxine ER, but the immediate postpartum period is an especially vulnerable time.  Typically it is recommended that patients stay on the medications taken during pregnancy across the postpartum period rather than switching to another medication and potentially increasing the risk of relapse during the postpartum period.

 

Betty Wang, MD