Date: July 31, 2024 • Issue no: #101
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🫄 Maternal Mental Health ✅ Review the common diagnostic guidelines
📚 Key pearls for important patient questions 🧵 And more! |
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TOGETHER WITH PROSPEROUS LIFE MD |
Learn your charting personality with this quiz to cut over an hour off your evening charting. Take quiz |
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A pregnant 28-year-old female at 33 weeks at 2 days presents to the clinic with symptoms of persistent sadness, anxiety, and fatigue that have been ongoing for several weeks. She reports apathy towards her pregnancy and feelings of worthlessness. Based on these findings, which of the following treatments is the most appropriate initial therapy in addition to cognitive behavioral therapy? [A] Fluoxetine [B] Sertraline [C] Bupropion [D] Paroxetine Scroll down to find the answer at the end! 👇
Need to refresh your memory before answering this question? Head over to Pathway to review the latest guidelines on Peripartum Depression, as well as some landmark trials.
Our editorial team prepared the following summarized guidelines for the evaluation and management of Peripartum Depression based on guidelines from the American Academy of Family Physicians (AAFP 2023), the American College of Obstetricians and Gynecologists (ACOG 2023), the Canadian Task Force on Preventive Health Care (CTFPHC 2022), among others. |
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A Message from Dr. Junaid Niazi, Prosperous Life MD |
How Physicians Can Cut Over an Hour Off Their Evening Charting |
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Answer - B. Sertraline
Explanation - This patient’s presentation is consistent with peripartum depression, a common mood disorder that can occur during pregnancy or in the postpartum period for up to one year. Symptoms include persistent sadness, anxiety, fatigue, and difficulty bonding with the baby.
Zoloft (Sertraline) is a recommended treatment for peripartum depression according to current ACOG guidelines. Sertraline is a selective serotonin reuptake inhibitor (SSRI) that has been shown to be effective in treating depression and anxiety with a favorable safety profile for use during pregnancy.
Although fluoxetine is an SSRI that can be effective for depression, it has a longer half-life and a higher likelihood of causing side effects compared to sertraline, particularly during pregnancy. According to the most recent AAFP guidelines, five specific birth defects that have been related to paroxetine therapy include anencephaly, atrial septal defects, right ventricular outflow tract obstruction defects, gastroschisis, and omphalocele. Fluoxetine has been associated with right ventricular outflow tract obstruction defects and craniosynostosis. Bupropion is primarily used for major depressive disorder and smoking cessation, but it is not typically the first-line treatment for peripartum depression due to limited data on its safety during pregnancy.
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EPDS scale and important cutoffs What are the guideline recommendations for the diagnosis of peripartum depression? -
Obtain screening for depression during the peripartum period in all pregnant individuals. (B)
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Use the EPDS or the PHQ-9 as a screening tool for peripartum depression. (B)
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Assess for the presence of suicidal ideas, homicidal ideas, and psychotic symptoms in patients with peripartum depression. (A)
- Refer pregnant and postpartum individuals at increased risk of perinatal depression for counseling interventions. (B)
What are the guideline recommendations for the medical management of peripartum depression? -
Offer psychopharmacotherapy for perinatal depression and refer patients to appropriate behavioral health resources when indicated. Counsel patients on the benefits and risks of psychopharmacotherapy for perinatal mental health conditions when clinically indicated. (B)
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Do not withhold or discontinue medications for mental health conditions due to pregnancy or lactation status alone. (D)
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Offer SSRIs as first-line pharmacotherapy for perinatal depression. Consider offering SNRIs as reasonable alternatives. Individualize pharmacotherapy based on prior response to treatment, and if there is no pharmacotherapy history, offer sertraline or escitalopram as reasonable first-line medications. (B)
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Offer SSRIs if pharmacologic therapy is chosen, but avoid using paroxetine and fluoxetine during pregnancy if possible. (B)
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Consider offering brexanolone in the postpartum period for moderate-to-severe perinatal depression with onset in the third trimester or within 4 weeks postpartum, weighing the benefits (rapid onset of action) against the risks and challenges (limited access, high cost, lack of data supporting safety with breastfeeding, requirement for inpatient monitoring during the infusion, lack of efficacy data beyond 30 days). (B)
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Peripartum depression medications, dosages, and pregnancy category
Acknowledgements: Editorial Team: Jeremy Swisher, MD, Cole Phillips, MD, Khudhur Moh, MD, Hovhannes K, MD |
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