Gebelik ve Laktasyon Döneminde Ruhsal Bozukluklar ve Tedavisi

Öz

Ruhsal hastalıklar kadınlarda sıklıkla 18-45 yaşları arasındaki reprodüktif dönemde ortaya çıkmaktadır. Dolayısıyla gebelik ve postpartum dönem pek çok kadın için anksiyete bozukluğu, depresyon, yeme bozukluğu ve psikoz gibi ruhsal hastalıklara yatkınlığın arttığı bir dönem olabilmektedir. Bu yazıda gebelik ve laktasyon döneminde ruhsal bozukluklar ve tedavi seçenekleri güncel tedavi kılavuzları ışığında gözden geçirilmiştir. Gebelikte psikofarmakolojik tedavinin yararları ve riskleri dikkate alınmalı, teratojenite ve laktasyon riski göz önünde bulundurulmalıdır.  Gebelik ve laktasyon döneminde en düşük etkin dozda ve mümkünse tek ilaç kullanılmalıdır ve fetüs/bebek yakından izlenmelidir.

Anahtar kelimeler: Gebelik ve laktasyon, ruhsal bozukluklar, tedavi, ilaç kullanımı, teratojenite

 

Anahtar Kelimeler

• Gebelik ve laktasyon, ruhsal bozukluklar, tedavi, ilaç kullanımı, teratojenite

Kaynakça

1. Carter D, Kostaras X. Psychiatric disorders in pregnancy. British Columbia Medical Journal. 2005;47(2):96.
2. Bülbül F, Çöpoğlu ÜS, Demir B, Bulut M, Alpak G, Ünal A, et al. Psikiyatrik hastalığı nedeniyle yatarak tedavi gören gebe hastaların klinik ve sosyodemografik özellikleri ve izlem sonuçları.
3. Özdamar Ö, YILMAZ O, Beyca HH, Muhcu M. Gebelik ve Postpartum Dönemde Sık Görülen Ruhsal Bozukluklar (Common Psychiatric Disorders in Pregnancy and Postpartum Period). Zeynep Kamil Tıp Bülteni. 2014;45(2):71-7.
4. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstetrics & Gynecology. 2004;103(4):698-709.
5. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms
6. during pregnancy: a systematic review. American journal of obstetrics and gynecology. 2010;202(1):5-14.
7. Klein MH, Essex MJ. Pregnant or depressed? The effect of overlap between symptoms of depression and somatic complaints of pregnancy on rates of major depression in the second trimester. Depression. 1994;2(6):308-14.
8. Melville JL, Gavin A, Guo Y, Fan M-Y, Katon WJ. Depressive disorders during pregnancy: prevalence and risk factors in a large urban sample. Obstetrics and gynecology. 2010;116(5):1064.

9. Kocabaşoğlu N, Başer SZ. GEBELİK ve DOĞUMLA TETİKLENEN PSİKİYATRİK HASTALIKLAR. 2008.
10. Toohey J. Depression during pregnancy and postpartum. Clinical obstetrics and gynecology. 2012;55(3):788-97.
11. O'hara MW, Swain AM. Rates and risk of postpartum depression-a meta-analysis. International review of psychiatry. 1996;8(1):37-54.
12. Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J, et al. Antenatal risk factors for postnatal depression: a large prospective study. Journal of affective disorders. 2008;108(1):147-57.
13. Akman C, Uguz F, Kaya N. Postpartum-onset major depression is associated with personality disorders. Comprehensive psychiatry. 2007;48(4):343-7.
14. Stuart S, Couser G, Schilder K, O'HARA MW, Gorman L. Postpartum anxiety and depression: onset and comorbidity in a community sample. The Journal of nervous and mental disease. 1998;186(7):420-4.
15. Uguz F, Gezginc K, Kayhan F, Sarı S, Büyüköz D. Is pregnancy associated with mood and anxiety disorders? A cross-sectional study. General hospital psychiatry. 2010;32(2):213-5.
16. Guler O, Koken GN, Emul M, Ozbulut O, Gecici O, Uguz F, et al. Course of panic disorder during the early postpartum period: a prospective analysis. Comprehensive psychiatry. 2008;49(1):30-4.
17. Hertzberg T, Wahlbeck K. The impact of pregnancy and puerperium on panic disorder: a review. Journal of Psychosomatic Obstetrics & Gynecology. 1999;20(2):59-64.
18. Rambelli C, Montagnani M, Oppo A, Banti S, Borri C, Cortopassi C, et al. Panic disorder as a risk factor for post-partum depression: Results from the Perinatal Depression-Research & Screening Unit (PND-ReScU) study. Journal of affective disorders. 2010;122(1):139-43.
19. Rasmussen SA, Tsuang MT. Clinical characteristics and family history in DSM-III obsessive-compulsive disorder. The American journal of psychiatry. 1986.
20. Altshuler LL, Hendrick V, Cohen LS. Course of mood and anxiety disorders during pregnancy and the postpartum period. Journal of Clinical Psychiatry. 1998.
21. Maina G, Albert U, Bogetto F, Vaschetto P, Ravizza L. Recent life events and obsessive–compulsive disorder (OCD): the role of pregnancy/delivery. Psychiatry Research. 1999;89(1):49-58.
22. Bergink V, Bouvy PF, Vervoort JS, Koorengevel KM, Steegers EA, Kushner SA. Prevention of postpartum psychosis and mania in women at high risk. American Journal of Psychiatry. 2014.
23. Yonkers KA, Wisner KL, Stowe Z, Leibenluft E, Cohen L, Miller L, et al. Management of bipolar disorder during pregnancy and the postpartum period. American Journal of Psychiatry. 2004.
24. Grof P, Robbins W, Alda M, Berghoefer A, Vojtechovsky M, Nilsson A, et al. Protective effect of pregnancy in women with lithium-responsive bipolar disorder. Journal of affective disorders. 2000;61(1):31-9.
25. Viguera AC, Nonacs R, Cohen LS, Tondo L, Murray A, Baldessarini RJ. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. American Journal of Psychiatry. 2014.
26. Freeman MP, Smith KW, Freeman SA, McElroy SL, Kmetz G, Wright R, et al. The impact of reproductive events on the course of bipolar disorder in women. The Journal of clinical psychiatry. 2002;63(4):284-7.
27. Sharma V, Pope CJ. Pregnancy and bipolar disorder: a systematic review. The Journal of clinical psychiatry. 2012;73(11):1447-55.
28. Dunner DL, Patrick V, Fieve RR. Life events at the onset of bipolar affective illness. The American journal of psychiatry. 1979.
29. Kendrick K. Treatment of perinatal mood and anxiety disorders: a review. Canadian Journal of Psychiatry. 2007;52(8):489.
30. Pearlstein T. Perinatal depression: treatment options and dilemmas. Journal of psychiatry & neuroscience: JPN. 2008;33(4):302.
31. Freeman MP. Bipolar disorder and pregnancy: risks revealed. The American journal of psychiatry. 2007;164(12):1771-3.
32. Ross LE, McLean LM, Psych C. Anxiety disorders during pregnancy and the postpartum period: a systematic review. Depression. 2006;6(9).
33. Güz H DN. Gebelikte psikotrop ilaç kullan› m›. Klinik Psikofarmakoloji Bülteni. 1998;8:1-7.
34. Rubin PC, Ramsay M. Prescribing in pregnancy: Blackwell/BMJ; 2008.
35. Ornoy A. Valproic acid in pregnancy: how much are we endangering the embryo and fetus? Reproductive Toxicology. 2009;28(1):1-10.
36. Association AP. Practice guideline for the treatment of patients with major depressive disorder: American Psychiatric Association; 2010.
37. Çetin M. Gebelikte Psikotrop İlaç Kullanımı: Bir Güncelleme. Bulletin of Clinical Psychopharmacology. 2011;21(2):161-73.
38. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar disorders. 2013;15(1):1-44.
39. Food, Drug Administration H. Content and format of labeling for human prescription drug and biological products; requirements for pregnancy and lactation labeling. Final rule. Federal register. 2014;79(233):72063.
40. Hewett K, Gee MD, Krishen A, Wunderlich H-P, Le Clus A, Evoniuk G, et al. Double-blind, placebo-controlled comparison of the antidepressant efficacy and tolerability of bupropion XR and venlafaxine XR. Journal of Psychopharmacology. 2009.
41. Association AP. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging (A task force report of the American Psychiatric Association): American Psychiatric Pub; 2008.
42. Bulletın AP. Clinical management guidelines for obstetriciangynecologists number 92. April 2008 (replaces practice bulletın number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008;111(4):1001-20.
43. Galbally M, Roberts M, Buist A. Mood stabilizers in pregnancy: a systematic review. Australian and New Zealand Journal of Psychiatry. 2010;44(11):967-77.
44. Vigod SN, Gomes T, Wilton AS, Taylor VH, Ray JG. Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study. bmj. 2015;350:h2298.
45. Trixler M, Tényi T. Antipsychotic use in pregnancy. Drug safety. 1997;16(6):403-10.
46. Bulbul F, Copoglu US, Alpak G, Unal A, Demir B, Tastan MF, et al. Electroconvulsive therapy in pregnant patients. General hospital psychiatry. 2013;35(6):636-9.
47. Bulut M, Bez Y, Kaya MC, Copoglu US, Bulbul F, Savas HA. Electroconvulsive therapy for mood disorders in pregnancy. The journal of ECT. 2013;29(2):e19-e20.
48. Einarson A, Boskovic R. Use and safety of antipsychotic drugs during pregnancy. Journal of Psychiatric Practice®. 2009;15(3):183-92.
49. Gentile S. Antipsychotic therapy during early and late pregnancy. A systematic review. Schizophrenia bulletin. 2010;36(3):518-44.
50. Esscher A, Essén B, Innala E, Papadopoulos FC, Skalkidou A, Sundström-Poromaa I, et al. Suicides during pregnancy and 1 year postpartum in Sweden, 1980–2007. The British Journal of Psychiatry. 2015:bjp. bp. 114.161711.
51. Wesseloo R, Kamperman A, Munk-Olsen T, Pop V, Kushner S, Bergink V. Postpartum relapse risk in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. European Neuropsychopharmacology. 2015;25:S414.
52. Cohen LS, Viguera AC, McInerney KA, Freeman MP, Sosinsky AZ, Moustafa D, et al. Reproductive Safety of Second-Generation Antipsychotics: Current Data From the Massachusetts General Hospital National Pregnancy Registry for Atypical Antipsychotics. American Journal of Psychiatry. 2015:appi. ajp. 2015.15040506.
53. Petzoldt J, Wittchen HU, Einsle F, Martini J. Maternal anxiety versus depressive disorders: specific relations to infants' crying, feeding and sleeping problems. Child: care, health and development. 2015.