Week 13: Pregnancy and Lactation Research

5

Pregnancy and Lactation Research

Name:

Course Name:

Course Number:

Instructor’ Name:

Institution:

Date of Submission:

Pregnancy and Lactation Research

The treatment of depression mainly involves the use of antidepressants, especially serotonin-reuptake inhibitors as the first-line medications (Arnold & Flint, 2017). However, the use of some antidepressants in pregnant women with depression may be inappropriate since they may increase the health risk of their unborn child. Similarly, some of the antidepressants may be inappropriate among lactating mothers since they can increase the health risk of their nursing babies. Therefore, it would be necessary to adjust the treatment plan for the pregnant female in module 5 while considering the health risks associated with antidepressants. 

How would your treatment plan (medications, therapy, etc) change for the pregnant female in Module 5 with Depression and Module 7 with Bipolar Mania?

For the pregnant female with depression, sertraline (Zoloft) 50mg orally once daily will be integrated as the first-line treatment. Zoloft is an SSRI that is approved by the FDA for treatment of depression across the lifespan with optimal outcomes in adults, especially where there is adherence. Zoloft helps in improving mood and affect while also resolving sleeping patterns. In managing depression patients, the target is to control the psychotic and negative symptoms to ensure continued functional status (Arnold & Flint, 2017). The benefit of the use of Zoloft in pregnant mothers is that the dosage can be elevated gradually to a maximum of 200mg without risk for birth defects in the unborn baby. Thus, for the depression patient, the 50mg dosage will be sustained for 4 weeks during which a review of the symptoms will be determined for purposes of dosage changes if required (Armstrong, 2008). 

In the bipolar mania case, lamotrigine (Lamictal) 100mg is the most effective treatment. The medication is an effective mood stabilizer while also having a safe reproductive profile. Thus, for pregnant mothers, the medication does not portend any particular birth defects for the unborn child while also assuring the mother of mood stability (Armstrong, 2008). 

How would this change if the female were lactating? 

A Zoloft dosage of 50-150mg once daily is considered a safe treatment option for lactating mothers. A dosage above 200mg may have toxicity issues rather than issues related to birth defects. Thus, in the case of the mother with depression, the focus is to maintain a dosage of 50mg alongside comprehensive psychotherapy to help manage the psychotic and negative symptoms. In bipolar mania, the idea is to maintain lamotrigine (Lamictal) 100mg alongside comprehensive psychotherapy. Actually, lamotrigine (Lamictal) monotherapy for the mother is associated with higher IQ as well as better or enhanced verbal capabilities in the child (Armstrong, 2008). 

What patient teaching would you include?

In managing depression or bipolar mania in pregnant and lactating mothers, the best practice recommendation is to use a single medication as opposed to multiple medications. Multiple medications impose the risk for higher side effects for both the mother and the child. The FDA recommends a higher dosage for the current single medication as opposed to introducing multiple medications. However, to attain the optimal outcomes of the single medication, the patients will be informed of the necessity for medication adherence (Dubovicky et al., 2017). Importantly, the patients will be informed of the significance of sufficient rest and sleep. Insufficient sleep and rest tend to increase the depressive and negative symptoms which may affect the ability of the mother to bond effectively with their child or compromise their self-care for their pregnancy. The patients will be educated on the significance of psychotherapies with specific reference to cognitive-behavioral therapy (CBT) and interpersonal therapy. These therapy techniques are essential in enabling the patient to develop a sense of belonging and identity amidst the crisis of managing their mental health and their pregnancy. The patient will also be educated on the significance of exercise and appropriate nutrition during the course of treatment and pregnancy (Johns Hopkins Medicine, 2020). 

References

Arnold, K. C., & Flint, C. J. (2017). Use of Psychiatric Medications During Pregnancy and Lactation. In Obstetrics Essentials (pp. 75-81). Springer, Cham.

Armstrong, C. (2008). ACOG guidelines on psychiatric medication use during pregnancy and lactation. American Family Physician, 78(6), 772.

Dubovicky, M., Belovicova, K., Csatlosova, K., & Bogi, E. (2017). Risks of using SSRI/SNRI antidepressants during pregnancy and lactation. Interdisciplinary toxicology, 10(1), 30.

Johns Hopkins Medicine. (2020). Antidepressants and pregnancy: Tips from an expert. Johns Hopkins Medicine, based in Baltimore, Maryland. https://www.hopkinsmedicine.org/health/wellness-and-prevention/antidepressants-and-pregnancy-tips-from-an-expert