84 Methadone and Breast Feeding

Mothers who are treated with methadone and are abstinent from substance use should not be discouraged from breast-feeding. Negligible amounts of methadone appear to be transmitted in breast milk (80), and recent guidelines have maintained that, regardless of the mother's dose, nursing is unlikely to adversely affect the infant. The amount of metha-done transmitted to an infant from breast milk is not enough to prevent NAS. Breast-feeding fosters maternal attachment and is valuable for both the...

44 Pregnancy Induced Hypertension

Pregnancy-induced hypertension (PIH) is considered a serious complication during pregnancy (9), and pre-eclampsia, a form of PIH, has been associated with depression during pregnancy (58). Some of the symptoms associated with severe pre-eclampsia are hypertension, pro-teinuria, with associated edema in the last half of pregnancy, headaches, visual disturbances, and upper abdominal pain (9,59,60). Although the etiology of this condition is as yet uncharacterized, investigators have hypothesized...

53 Reported Adverse Outcomes 531 Poor Neonatal Adaptability

The use of SSRI agents in late gestation has been associated with poor neonatal adaptability, a transient period ofjitteriness, difficulty breathing, and some difficulty feeling (106,133,134). As such, infants born to mothers exposed to SSRIs near term should be carefully monitored. These adverse effects are, however, transient, self-limiting generally require no treatment, and appear to have no long-lasting effects on the infants. 5.3.2. Increase in Spontaneous Abortions Of note, some of the...

73 School Aged Children

Elana was diagnosed with schizophrenia when she was 26 and thereafter relied on disability payments. She had a son, Rico, with a man who was later diagnosed with bipolar disorder and who drank alcohol and used drugs. The parents lived in neighboring rural towns but raised their son together with the help of the father's extended family, who doted on Rico. Elana was a gentle and concerned parent. Throughout his schooling, Rico required extra help. He was diagnosed with a learning disability and...

3 Impact Of Psychotropic Medications On Offspring

All psychotropic medications diffuse readily across the placenta during pregnancy. Thus, the fetus is exposed to medication and its potential complications. Risks of medication exposure can include organ malformation (teratogenicity), obstetrical complications, perinatal syndromes (neonatal toxicity), and long-term postnatal behavioral sequelae (behavioral teratogenicity) (3). Teratogenicity is defined as an organ malformation congenital deformity that occurs with a significantly greater risk...

3 Treatment Of Postpartum Mood Disorders

Incorporating the Biopsychosocial Model of Treatment It is important to take into consideration the psychosocial as well as the biological contributions to mental disorders in any patient presenting with depression or psychosis. This is particularly true when women present in the puerperium. At no other time in a woman's life is she required to navigate a developmental transition that is potentially wrought with challenging psychodynamic issues, and changes in interpersonal relationships,...

7 Relationship Between Postpartum Psychosis And Bipolar Affective Disorder

Many researchers believe that postpartum psychosis is either a variant or a manifestation of a manic mixed episode and in many women demarcates the onset of bipolar disorder 110,120,121 . Postpartum psychosis is a rare condition affecting 0.1-0.2 of all women experiencing childbirth 110,122 . Women with bipolar disorder have a significantly higher risk than women without a psychiatric disorder of developing postpartum psychosis 5,12,17,18,104-108,123 . Recent studies have found that for women...

45 Inadequate Prenatal Care

The lack of motivation and self-esteem associated with depression during pregnancy may lead to inadequate prenatal care because depressed women are known not to seek out prenatal care until well into their pregnancies 62 . Previous studies have found that women with psychiatric disorders attend fewer than 50 of prenatal care appointments 62 . A cohort study of almost 10.6 million births found a relative risk RR of 2.8 for preterm birth in Caucasian women with inadequate prenatal care compared...

4 Risks Of Untreated Depression During Pregnancy

Many pregnant, depressed women experience an amplification of physical symptoms during pregnancy, including increased heart rate, loss of appetite, stomach pain, headaches, and sexual dysfunction 48 , during both the period leading up to and during MDEs. However, the risks of untreated depression go well beyond the somatic symptoms cited previously. Past studies suggest that the most notable adverse pregnancy outcomes associated with antenatal depression include increases in spontaneous preterm...

Sanjog Kalra and Adrienne Einarson

Depression has been identified by the World Health Organization as a major cause of morbidity in the 21st century. As women between 25 and 44 yr represent the population at highest risk for depression, a substantial number are likely to become pregnant while suffering from this illness. In this chapter, we summarize the prevalence and clinical course of depression during pregnancy. We also document evidence-based information regarding the safety and efficacy of both pharmacological and...

Neill Epperson and Jennifer Ballew

Postpartum depression PPD or, simply, postpartum are the most commonly used lay terms for describing major depressive disorder occurring in the postnatal period. Whether the disorder occurs de novo, is a relapse of a previous depressive episode, or has its origin in the antepartum period, depression after childbirth is associated with significant maternal and infant morbidity and, in worst cases, mortality. With most epidemiological studies demonstrating a prevalence of 10-13 , PPD is one of...

22 Tools Used to Detect the Presence of Depressive Symptoms in Pregnancy

Much of the recent epidemiological data on depression has been obtained via the use of lay-administered self-report questionnaires, some of which have been validated for use in pregnant women. The items contained in the questionnaires are based on those contained in previously validated instruments and the diagnostic criteria for MDD set forth by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders DSM-IV 13 . These lay-administered tools facilitate data collection...

3 Effect Of Pregnancy On Drug Metabolism

Physiological changes in pregnancy can affect serum concentrations of psychiatric medications Table 4 . Some of these changes may increase or decrease the dose necessary for some medications. The blood level of nortriptyline, a tricyclic antidepressant, has been found to drop below the therapeutic range as women reach the fifth month of pregnancy 12 . Certain hepatic enzymes in the cytochrome P450 system are induced by high levels of estradiol and progesterone during pregnancy 13-16 . These...

2 Unintended Pregnancy

More than 50 of pregnancies in the United States are unplanned 10 , and many women become pregnant while taking medications. Clinicians working with chronically mentally ill women should keep in mind their relatively high incidence of unprotected sex and inadequate use of contraception 11 . For women who do not wish to conceive, it is wise to provide education about methods of contraception and to inquire about recent missed menstrual periods. Adequate contraception has become particularly...