Respond to Dawn: Colleagues, For this week’s discussion I have chosen psychotrop

Respond to Dawn:
Colleagues,
For this week’s discussion I have chosen psychotropic medications in pregnant women for the treating major depressive disorder (MDD). Appropriate pharmacological therapy is necessary for pregnant women as maternal depression has been associated with various detrimental health concerns for both mother and baby. Babies born to women with untreated depression are at risk of prematurity, low birth weight, and intrauterine growth restrictions (Center for Drug Evaluation and Research, 2018). Currently there are no Food and Drug Administration (FDA) approved antidepressants specifically for MDD in pregnant women. Obviously, each pregnant patient needs to be evaluated on their own merit and treatment plan adjusted accordingly. When treating these patients, it is important to establish a risk-benefit ratio (Chan et al., 2014).
According to the Centers for Disease Control and Prevention (CDC) approximately 1.1 million pregnant women were prescribed an antidepressant, and the most commonly prescribed were Selective Serotonin Reuptake Inhibitors (SSRIs): sertraline, citalopram, escitalopram, and fluoxetine (Dawson et al., 2016). According to Dawson, fluoxetine has the best evidence-based established support associated with the lowest risk of fetal abnormalities (2016). Mood stabilizers do treat or enhance the treatment of depression, so it is not necessarily an “off label” use. Lamotrigine is known for its low metabolic interference and is another good option to treat depression in pregnancy. I had a few patients in this current clinical rotation who we counseled on staying on or changing to Lamotrigine for pregnancy. Although one study suggested an increased risk of cleft lip/cleft palate, extensive additional data have not replicated this finding (Betcher & Wisner, 2020).
Cognitive Behavioral Therapy (CBT) is one of the most evidence-based psychological interventions for the treatment of several psychiatric disorders such as depression (Gautam et al., 2020). The goal of CBT therapy is to change the negative patterns of thinking that or associated with depression. In addition, it teaches patients better coping strategies to better manage stress and depression symptoms.
To recap, there are no FDA approved antidepressants to specifically treat depression during pregnancy. However, there is evidence that SSRIs and mood stabilizers are safe and effective in treating depression in pregnant mothers. There is also compelling evidence showing it is more important to treat depression than leaving it untreated as this can also cause health risks for both mother and baby. As mentioned earlier, each patient needs to be assessed and treated on their own accord. Medications should be managed at lowest effective dosing and using non-pharmacological treatments such as CBT.
Thank you,