RESUMO
Postpartum depression is one of the most common complications of childbirth. Untreated postpartum depression can have substantial adverse effects on the well-being of the mother and child, negatively impacting child cognitive, behavioral, and emotional development with lasting consequences. There are a number of therapeutic interventions for postpartum depression including pharmacotherapy, psychotherapy, neuromodulation, and hormonal therapy among others, most of which have been adapted from the treatment of major depressive disorder outside of the peripartum period. Current evidence of antidepressant treatment for postpartum depression is limited by the small number of randomized clinical trials, underpowered samples, and the lack of long-term follow-up. The peripartum period is characterized by rapid and significant physiological change in plasma levels of endocrine hormones, peptides, and neuroactive steroids. Evidence supporting the role of neuroactive steroids and γ-aminobutyric acid (GABA) in the pathophysiology of postpartum depression led to the investigation of synthetic neuroactive steroids and their analogs as potential treatment for postpartum depression. Brexanolone, a soluble proprietary intravenous preparation of synthetic allopregnanolone, has been developed. A recent series of open-label and placebo-controlled randomized clinical trials of brexanolone in postpartum depression demonstrated a rapid reduction in depressive symptoms, and has led to the submission for regulatory approval to the US Food and Drug Administration (decision due in March 2019). SAGE-217, an allopregnanolone analog, with oral bioavailability, was recently tested in a randomized, double-blind, placebo-controlled phase III study in severe postpartum depression, with reportedly positive results. Finally, a 3ß-methylated synthetic analog of allopregnanolone, ganaxolone, is being tested in both intravenous and oral forms, in randomized, double-blind, placebo-controlled phase II studies in severe postpartum depression.
Assuntos
Depressão Pós-Parto/tratamento farmacológico , Desenvolvimento de Medicamentos , Moduladores GABAérgicos/uso terapêutico , Neuroesteroides/uso terapêutico , Pregnanos/uso terapêutico , Pregnanolona/uso terapêutico , Pirazóis/uso terapêutico , beta-Ciclodextrinas/uso terapêutico , Animais , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/metabolismo , Combinação de Medicamentos , Feminino , Moduladores GABAérgicos/administração & dosagem , Moduladores GABAérgicos/efeitos adversos , Humanos , Neuroesteroides/administração & dosagem , Neuroesteroides/efeitos adversos , Pregnanos/administração & dosagem , Pregnanos/efeitos adversos , Pregnanolona/administração & dosagem , Pregnanolona/efeitos adversos , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estados Unidos , United States Food and Drug Administration , beta-Ciclodextrinas/administração & dosagem , beta-Ciclodextrinas/efeitos adversosRESUMO
Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary work group to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.
Assuntos
Transtornos de Ansiedade/terapia , Ansiedade/terapia , Depressão/terapia , Complicações na Gravidez/psicologia , Transtorno Depressivo/terapia , Feminino , Humanos , GravidezRESUMO
Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary workgroup to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.
Assuntos
Ansiedade/diagnóstico , Ansiedade/terapia , Depressão/diagnóstico , Depressão/terapia , Obstetrícia , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Ansiedade/psicologia , Protocolos Clínicos , Consenso , Continuidade da Assistência ao Paciente , Depressão/psicologia , Medicina Baseada em Evidências , Feminino , Humanos , Programas de Rastreamento , Anamnese , Obstetrícia/métodos , Obstetrícia/organização & administração , Educação de Pacientes como Assunto , Assistência Perinatal/normas , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/psicologia , Escalas de Graduação Psiquiátrica , Encaminhamento e ConsultaRESUMO
Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary workgroup to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.
Assuntos
Ansiedade , Depressão , Saúde Materna/normas , Saúde Mental/normas , Complicações na Gravidez , Ansiedade/diagnóstico , Ansiedade/prevenção & controle , Consenso , Depressão/diagnóstico , Depressão/prevenção & controle , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/organização & administração , Feminino , Humanos , Programas de Rastreamento/organização & administração , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/psicologia , Melhoria de QualidadeAssuntos
Síndrome de Creutzfeldt-Jakob/diagnóstico , Diagnóstico Tardio , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Afasia Acinética/etiologia , Alcoolismo/complicações , Ataxia/etiologia , Síndrome de Creutzfeldt-Jakob/complicações , Síndrome de Creutzfeldt-Jakob/psicologia , Diagnóstico Diferencial , Progressão da Doença , Eletroencefalografia , Alucinações/etiologia , Hemianopsia/etiologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Mioclonia/etiologia , Esquizofrenia/complicações , Esquizofrenia/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/etiologiaRESUMO
For a substantial proportion of women, pregnancy can be complicated by the occurrence or reoccurrence of a psychiatric condition. Psychiatric disorders during pregnancy are associated with poor obstetric outcomes, higher risk of postpartum psychiatric illness, increased rates of substance abuse, lower participation in prenatal care, and adverse infant and family outcomes. As part of preconception care, providers should be vigilant and screen for psychiatric disorders among women of reproductive age, as the detection and appropriate management of these conditions can reduce the occurrence of adverse pregnancy and family outcomes. This manuscript reviews the treatment options and the risks and benefits of discontinuing, changing, or continuing psychotropic medications for women of reproductive age with common psychiatric disorders (depression and anxiety disorders, bipolar disorder, and schizophrenia) and offers recommendations for preconception care.