[Treatment strategy for women with puerperal psychiatric disorders--psychopharmaco-therapy and its impact on fetus and breast-fed infants]
- PMID: 14639936
[Treatment strategy for women with puerperal psychiatric disorders--psychopharmaco-therapy and its impact on fetus and breast-fed infants]
Abstract
Women have the most possibility of suffering from mental disorders during pregnancy and postpartum periods in their whole life time. Especially, postnatal depression is not uncommon with an incidence of 10-20%, fortunately a screening system has been developed, and in Japan the Edinburgh Postnatal Depression Scale (EPDS) is now practically used in both hospitals and community health service centers. Additionally most mental disorders during this period are not severely disturbed, so they do not have to be necessarily treated by psychiatrists. Severely disturbed cases, however, which include postnatal depression with self or infant harm thought or puerperal psychosis are to be treated by psychiatrists and tend to have psychopharmaco-therapy. In using psychotropic drugs attention must be paid for both women and their babies. Impact on breast-fed babies while mothers take psychotropic drugs have been reported, mostly as case reports. We have reported the controlled studies, (1) The 25 mothers with postnatal depression were treated by tricyclic antidepressants, of which 10 breast-fed and 15 did not. The drugs were amitriptyline, imipramine, clomipramine, dothiepine, (2) The 30 mothers with puerperal psychosis were treated by antipsychotic drugs, of which 12 breast-fed and 18 did not. The drugs were chlorpromazine, trifluoperazine, perphenazine and haloperidol. Both antidepressants and neuroleptics were transferred through breast-milk and a few % of maternal dose per kilogram were injected to their babies by calculating drug concentration ratios of in breast-milk/in serum. None of the breast-fed infants had adverse effects, and no developmental difference was found compared to bottle-fed infants using the Bayley Development Scale during infancy. Furthermore, the breast-fed infants were followed up as long as possible up to 30 months and no significant developmental delay was found. In addition, we reported a case study on four breast-fed babies whose mothers took fluoxetine. The infants had no adverse effects. Pregnant women and their fetuses need to be more carefully monitored. Three preliminary cases were reported here; the pregnant women took clomipramine, sulpiride, haloperidol and chlorpromazine. Drug concentrations in maternal plasma in late pregnancy and postnatally and in umbilical cords were almost the same, which meant they were freely transferred from mothers to babies. Regarding the neonate's outcome, all were full turn born with normal birth weight with good Apgar scores. Weight gain in one month was normal which meant all babies had normal sucking without hypotonic muscle. Psychiatrists must accumulate these date and contribute as one of specialists in perinatal mental health in multi-disciplinary team.
Similar articles
-
Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age.Pediatrics. 2006 Jul;118(1):e115-23. doi: 10.1542/peds.2005-2382. Pediatrics. 2006. PMID: 16818526
-
[Screening and intervention for depressive mothers of new-born infants].Seishin Shinkeigaku Zasshi. 2003;105(9):1129-35. Seishin Shinkeigaku Zasshi. 2003. PMID: 14639935 Japanese.
-
Drugs in pregnancy. Prescribing for psychiatric disorders in pregnancy and lactation.Best Pract Res Clin Obstet Gynaecol. 2001 Dec;15(6):1013-30. doi: 10.1053/beog.2001.0244. Best Pract Res Clin Obstet Gynaecol. 2001. PMID: 11800539 Review.
-
[Psychopharmaceuticals and breast feeding].Psychiatr Prax. 2000 Mar;27(2):55-63. Psychiatr Prax. 2000. PMID: 10738733 Review. German.
-
Neuroleptic drugs in breast-milk: a study of pharmacokinetics and of possible adverse effects in breast-fed infants.Psychol Med. 1998 Jan;28(1):81-91. doi: 10.1017/s0033291797005965. Psychol Med. 1998. PMID: 9483685
Cited by
-
Assessment of foetal risk associated with 93 non-US-FDA approved medications during pregnancy.Saudi Pharm J. 2012 Oct;20(4):287-99. doi: 10.1016/j.jsps.2012.05.006. Epub 2012 May 19. Saudi Pharm J. 2012. PMID: 23960803 Free PMC article.