In the July 2010 issue of Current Psychiatry, you will find a thorough review on the evaluation and treatment of insomnia in women across the life cycle. The bottom line is that many women experience insomnia during times of hormonal transition. The authors provide some useful guidelines for evaluating women who present with sleep problems (taken from Table 2):
About half of all pregnancies are unplanned. In this situation, many women who conceive while on psychotropic medications decide to abruptly stop their medications when they discover they are pregnant. While this may seem like the safest option, in terms of protecting the developing fetus, we have data demonstrating high rates of relapse in women who discontinue antidepressant medications or mood stabilizers proximate to conception. We now have data (from several studies in non-pregnant populations) to indicate that the rate of medication discontinuation (abrupt vs. gradual) may also affect risk of relapse.
Increased muscle tone, jitteriness, sleep disturbance, irritability, feeding problems, mild respiratory distress and myoclonus have been reported as symptoms of a potential neonatal distress syndrome related to exposure to SSRIs in late pregnancy. The average duration of symptoms reported is 48 hours. It is estimated that between 25-30% of SSRI-exposed infants are at risk for this syndrome. No treatment intervention is required. Reassuringly, follow-up studies have shown that at 2, 4, 6, and 8 months SSRI-exposed infants are indistinguishable from control infants without known exposure.
Pregnancy and the postpartum period is a time of increased risk for depression. Therefore, women who are treated with antidepressant medications must consider whether or not to stay on medication during pregnancy. Despite reassuring data regarding the reproductive safety of various antidepressants, a woman may prefer not to continue medication during pregnancy due to concerns about long term effects of medication on the baby. However, by discontinuing antidepressant medication, a woman increases her risk of depression during pregnancy. This is a highly personal decision for women as the potential risks of continuing medication must be weighed against the possibility of relapse and the potential effects of untreated depression on the pregnancy and baby.
About 15% of women suffer from depression during pregnancy, and the rate of depressive illness is greater in women with pre-existing histories of depression. While there are data to support the use of certain antidepressants during pregnancy, many women are reluctant to seek pharmacologic treatment during pregnancy and may benefit from efficacious non-pharmacologic options. In a recent review article from Medscape, Christopher Tjoa and colleagues from the University of Pennsylvania summarize the literature assessing the efficacy of non-pharmacologic options for the treatment of antenatal depression.
In treating pregnant women with mood or anxiety disorders, we tend to focus primarily on the reproductive safety of psychotropic medications; however, it must be recognized that withholding or withdrawing pharmacologic treatment for depression or anxiety during pregnancy may carry some degree of risk. Untreated psychiatric illness in the mother cannot be considered a benign event, and a number of studies have indicated that depression during pregnancy may negatively affect pregnancy outcomes (reviewed in Bonari 2004).
As part of the landmark health insurance reform bill that passed Congress on Monday, the Melanie Blocker Stokes MOTHERS Act – legislation sponsored by U.S. Senator Robert Menendez (D-NJ) – will become law. The legislation will establish a comprehensive federal commitment to combating postpartum depression through new research, education initiatives and voluntarily support service programs. The legislation is designed to:
Depression during pregnancy is relatively common, affecting about 10 to 15% of women. While there is a growing body of literature supporting the reproductive safety of certain antidepressants, many women and their physicians would prefer to avoid the use of these medications during pregnancy; thus, there is a clear need for effective non-pharmacologic treatments for women who suffer from depression during pregnancy.
Anxiety often results in the activation of the sympathetic nervous system. This activation is commonly known as the “fight or flight response”; symptoms may include increased heart rate, shortness of breath, perspiration, chest pain, and nausea or diarrhea. Activation of the fight or flight response is also associated with the activation of numerous other responses in the body, including the production of various stress hormones, including cortisol.
Choosing whether to maintain or discontinue mood stabilizer treatment during pregnancy requires weighing the risks of teratogenic outcomes associated with exposure to a particular drug against the risks of recurrence of untreated affective illness. However, [...]
