Therapies used in pregnant women who present Major Depressive Disorder and its postpartum implications

Authors

DOI:

https://doi.org/10.33448/rsd-v10i10.18071

Keywords:

Major Depressive Disorder; Postpartum Depression; Maternal Responsiveness; Selective Serotonin Reuptake Inhibitors; Nursing.

Abstract

Objective: Debate on the therapies most used in pregnant women with MDD and analyze the postpartum implications, in addition to the risks and benefits of the drugs of choice. Methodology: Integrative literature review, using articles from the academic platforms SciELO, PuBMED, MEDLINE and Science Direct, considering an interval between 2016-2021, that addressed the subject of pharmacological therapy with Selective Serotonin Reuptake Inhibitors (SSRIs) and/or Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) in the gestational period or non-adherence to treatment, with a finding of 12 articles that met the inclusion and exclusion criteria. Results: Most studies support the effectiveness of treatment with SSRIs and/or SNRIs in pregnant women, but there is difficulty in developing a plan with the lowest possible risk, because the drugs with the best results also present a certain degree of risk. These same studies, as well as others, highlight the teratogenic effects and some other findings during treatments with SSRIs and/or SNRIs and, in case of non-treatment, the effects of depression throughout pregnancy. Some of the findings indicate adherence to co-treatment using non-pharmacological therapies, such as psychotherapy (recommended by guidelines as the ideal initial treatment in mild to moderate cases), associated with pharmacological therapy. Conclusions: It can be concluded that there are studies on the benefits and harms of the use of antidepressants during pregnancy, in such a way that it is difficult to define the best strategy, it being up to professionals to define cost-benefit according to each patient and situation.

References

World Health Organization (WHO) (2020) Depression. https://www.who.int/en/news-room/fact-sheets/detail/depression

Albert, P. R. (2015). Why Is Depression More Prevalent in Women?. Journal of Psychiatry & Neuroscience, 40 (4), 219–221.

Gordon, J. L., & Girdler, S. S. (2014). Hormone replacement therapy in the treatment of perimenopausal depression. Curr Psychiatry Rep., 16 (12), 517.

American Psychiatric Association (2014). Manual diagnóstico e estatístico de transtornos mentais V (DSM-V). Porto Alegre: Artmed

Carvalho, L. A. G. et al. (2020). Tratamento farmacológico da depressão em gestantes: uma revisão da literatura. Brazilian Journal of Health Review, Curitiba, 3(4), 10891-10900.

Klieman, A., Boing, E., & Crepaldi, M. A. (2017). Fatores de risco para ansiedade e depressão na gestação: revisão sistemática de artigos empíricos. Mudanças- Psicologia da Saúde, 25(2), 69-76

Silva, B. A. B. et al. (2020). Depressão em gestantes atendidas na atenção primária à saúde. Cogitare enferm. [Internet]; 25. https://dx.doi.org/10.5380/ce.v25i0.69308.

Krob, A. D. et al. (2017). Depressão na gestação e no pós-parto e a responsividade materna nesse contexto. Rev. Psicol. Saúde, Campo Grande, 9(3), 3-16. https://dx.doi.org/10.20435/pssa.v9i3.565

Fonseca, A. D., & Canavarro, M. C. (2017). Depressão Pós-Parto. In: PROPSICO: Programa de atualização em Psicologia Clínica e da Saúde Ciclo 1. 111-164. Porto Alegre: Artmed Panamericana Editora.

Zhao, X., Liu, Q., Cao, S., Pang, J., Zhang, H., Feng, T. et al. (2017). A meta-analysis of Selective Serotonin Reuptake Inhibitors (SSRIs) use during prenatal depression and risk of low birth weight and small for gestational age. J. Affective Disorders, 230, 1-124. https://dx.doi.org/10.1016/j.jad.2018.08.061

Hutchison, S. M., Masse, L. C., Pawluski, J. L., & Oberlaner, T. F. (2018). Perinatal Selective Serotonin Reuptake Inhibitor (SSRI) Effects on Body Weight at Birth and Beyond: a review of animal and human studies. J. Reproductive Toxicology. https://dx.doi.org/10.1016/j.reprotox.2018.02.004

Guan, H-B., Wei, Y., Wang, L-L., Qiao, C., & Liu, C-X. (2018). Prenatal Selective Serotonin Reuptake Inhibitor Use and Associated Risk for Gestacional Hypertension and Preeclampsia: a meta-analysis of cohort studies. J. Women’s Health. https://dx.doi.org/<10.1089/jwh.2017.6642

Gao, S-Y., Wu, Q-J., Sun, C., Zhang, T-N., Shen, Z-Q., Liu, C-X. et al. (2018). Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 milion births. BMC Medicine, 16(205). https://dx.doi.org/10.1186/s12916-018-1193-5

Singal, D., Chateau, D., Struck, S., Lee, J. B., Dahl, M., Derksen, S. et al. (2020). In Utero Antidepressants and Neurodevelopmental Outcomes in Kindergarteners. PEDIATRICS, 145(5).

Masarwa, R., Bar-Oz, B., Gorelik, E., Reif, S., Perlman, A., & Matok, I. (2019). Prenatal exposure to selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors and risk for persistent pulmonary hypertension of the newborn: a systematic review, meta-analysis, and network meta-analysis. American J. Obst. Gyneco. https://dx.doi.org/10.1016/ajog.2018.08.030.

Vallee, J., Wong, Y., Mannino, E., Nordeng, H., & Lupattelli, A. (2021). Association between Antidepressant Treatment during Pregnancy and Postpartum Self-Harm Ideation in Women with Psychiatric Disorders: a cross-sectional, multinational study. Int J. Environ. Res. Public. Health, 18(46), 2-15. https://dx.doi.org/10.3390/ijerph18010046.

Berard, A., Sheehy, O., Zhao, J-P., Chambers, C., Roth, M., Bozzo, P. et al. (2019). Impact of antidepressant use, discontinuation, and dosage modification on maternal depression during pregnancy. J. Euro. Neuro., 29, 803-812. https://dx.doi.org/10.1016/j.euroneuro.2019.06.007.

Brown, H. K. (2018). Prenatal Selective Serotonin Reuptake Inhibitor Exposure and Child Neurodevelopment: the importance of maternal mental illness. J. American Acad. Child&Adol. Psyc., 57(3), 150-153. http://dx.doi.org/10.1016/j.jaac.2018.01.002.

Pawluski, J. L., & Gemmel, M. (2018). Perinatal SSRI medications and offspring hippocampal plasticity: interactions with maternal stress and sex. HORMONES, 17, 15-24. DOI: <10.1007>

Molenaar, N. M., Kamperman, A. M., Boyce, P., & Bergink, V. (2018). Guidelines on treatment of perinatal depression with antidepressants: na internacional review. Aust.&New Zeland J. Psych., 52(4), 320-327. http://dx.doi.org/10.1177/0004867418762057.

Field, T., Diego, M., & Hernandes-Reif, M.(2006). Prenatal depression effects on the fetus and newborn: a review. Infant Behavior & Development, 29, 445-455.

Chisolm, M. S., & Payne, J. L. (2016). Management of psychotropic drugs during pregnancy. Thebmj. https://doi.org/10.1136/bmj.h5918.

Field, T., Diego, M., & Hernandez-Reif, M. (2010). Prenatal Depression Effects and Interventions: a review. Infant Behavior & Development, 33(4), 409-418. http://dx.doi.org/ 10.1016/j.infbeh.2010.04.005.

Balkowiec-Iskra, E., Mirowska-Guzel, D. M., & Wielgos, M. (2017). Effect of antidepressants use in pregnancy on foetus development and adverse effects in newborns. Ginekologia Polska, 88(1), 36-42. http://dx.doi.org/10.5603/GP.a2017.0007.

Pearlstein, T. (2013). Use of Psychotropic Medication during Pregnancy and the Postpartum Period. Women’S Health, 9(6), 605-615.

Goracci, A. et al. (2015). Antidepressant use in pregnancy: a critical review of the risk and benefits. Rev. Psichiatr., 50(3), 118-126.

Camacho, R. S. et al. (2006). Transtornos psiquiátricos na gestação e no puerpério: classificação, diagnóstico e tratamento. Rev. Psiquiatr. Clín., São Paulo, 33(2), 92-102.

Nomura, M. L., & Pinto e Silva, J. L. C. (2007). Riscos e benefícios dos inibidores seletivos da recaptação de serotonina para a depressão durante a gravidez e lactação. Rev. Bras. Ginecol. Obstet., Rio de Janeiro, 29(7). https://doi.org/10.1590/S0100-72032007000700001 .

Mendes, K. D. S., Silveira, R. C. C. P., & Galvão, M. C. (2008). Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm., 17(4), 758-764.

Published

04/08/2021

How to Cite

SILVA, R. d’Oliveira B.; PITOMBEIRA, M. G. V.; OLIVEIRA, I. C. M. .; PEREIRA, A. de S.; MAIA, F. T. S. R. . Therapies used in pregnant women who present Major Depressive Disorder and its postpartum implications. Research, Society and Development, [S. l.], v. 10, n. 10, p. e34101018071, 2021. DOI: 10.33448/rsd-v10i10.18071. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/18071. Acesso em: 2 dec. 2021.

Issue

Section

Health Sciences