Somatic Treatments in Treatment of Depression During Pregnancy

Öz

Although some psychotropic drugs are known to be teratogenic no psychotropic drug is of proven safety for treatment of depression during pregnancy. Untreated mood disorders during pregnancy pose significant risks for mother and the newborn. This review focuses on the use of somatic tretments of depression during pregnancy.Electroconvulsive therapy, bright light therapy, transcranial magnetic stimulation and vagal nerve stimulation are relatively safe and effective treatments during pregnancy if steps are taken to decrease potential risks. A clear information related to the somatic treatment should be given to the patient and informed consent should be obtained.

 

Anahtar Kelimeler

• Depression, pregnancy, somatic treatment

Gebelikte Depresyonun Somatik Tedavisi

Öz

Psikotrop ilaçların bir kısmının gebelikte kullanımının teratojenik olduğu bilinmesine rağmen, gebelikte depresyon tedavisinde tamamen güvenli olduğu kanıtlanmış bir tedavi yöntemi bulunmamaktadır. Gebelikte yeterince tedavi edilmeyen duygudurum bozuklukları hem anne hem de yenidoğan için önemli riskler oluşturmaktadır. Bu yazıda gebelikte depresyon tedavisinde kullanılabilecek somatik tedaviler incelenmiştir. Elektrokonvülsif tedavi, parlak ışık tedavisi, transkranial manyetik stimülasyon ve vagal sinir stimülasyonu, potansiyel riskleri azaltmak için gerekli önlemler alındığında gebelik sırasında nispeten güvenli ve etkili tedavilerdir. Gebelikte depresyon tedavisinde somatik tedaviler uygulanacağında mutlaka hastanın anlayacağı biçimde detaylı bilgi verilmeli, bilgilendirilmiş onamı alınmalıdır.

Anahtar Kelimeler

• Depresyon, gebelik, somatik tedavi

Kaynakça

1. Abrams R (2002) Electroconvulsive Therapy. New York, Oxford University Press.
2. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. ACOG Committee on PracticeBulletins- Obstetrics. (2008) ObstetGynecol, 111:1001-1020.
3. American Psychiatric Association. (2001) The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. 2nd edition. Washington DC, American Psychiatric Association.
4. Anderson EL, Reti IM (2009) ECT in pregnancy: a review of the literature from 1941 to 2007. Psychosom Med, 71:235-242.
5. Avery DH, Holtzheimer PE 3rd, Fawaz W, Russo J, Neumaier J, Dunner DL et al. (2006) A controlled study of repetitive transcranial magnetic stimulation in medication-resistant major depression. Biol Psychiatry, 2006;59:187-194.
6. Bar-Oz B, Einarson T, Einarson A, Boskovic R, O'Brien L, Malm H et al. (2007) Paroxetine and congenital malformations: meta- analysis and consideration of potential confounding factors. Clin Ther, 29:918-26.
7. Ben-Menachem B, Ristanovic R, Murphy J (1998) Gestational outcomes in patients with epilepsy receiving vagus nerve stimulation. Epilepsia, 39:180.
8. Bozkurt A, Karlidere T, Isintas M, Ozmenler NK, Ozsahin A, Yanarates O (2007) Acute and maintenance electroconvulsive therapy for treatment of psychotic depression in a pregnant patient. J ECT, 23:185-187.

9. Bowley CJ, Walker HAC. (2005) Anesthesia for ECT. In: The ECT handbook-The third report of the Royal College of Psychiatrist Special Committe on ECT, 2 nd ed. (Eds. AIF Scott):124-135. London, Royal College of Psychiatrists.
10. Bulut M, Bez Y, Kaya MC, Copoglu ÜS, Bülbül F, Savaş HA (2013) Electroconvulsive therapy for mood disorders in pregnancy. J ECT, 29:19-20.
11. Burton C, Gill S, Clarke P, Galletly C (2014) Maintaining remission of depression with repetitive transcranial magnetic stimulation during pregnancy: a case report. Arch Womens Ment Health, 17:247-250.
12. Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL et al. (2006) Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med, 354:579-587.
13. Chun-Fai-Chan B, Koren G, Fayez I, Kalra S, Voyer-Lavigne S, Boshier A et al. (2005) Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study. Am J Obstet Gynecol, 192:932-936.
14. Cohen LS, Friedman JM, Jefferson JW, Johnson EM, Weiner ML (1994) A reevaluation of risk of in utero exposure to lithium. JAMA, 271:146–150.
15. Danielsson I, Lister L (2009) A pilot study of the teratogenicity of vagus nerve stimulation in a rabbit model. Brain Stimul, 2:41-49.
16. De Asis SJ, Helgeson L, Ostroff R (2013) The use of Propofol to prevent fetal deceleration during electroconvulsive therapy treatment. J ECT, 29:57-58.
17. Deave T, Heron J, Evans J, Emond A (2008) The impact of maternal depression in pregnancy on early child development. BJOG, 115:1043-1051.
18. DeBattista C, CochranM, Barry JJ, Brock-Utne JG (2003) Fetal heart rate decelerations during ECT-induced seizures: is it important? Acta Anaesthesiol Scand, 47:101–103.
19. Ding Z, White PF (2002) Anesthesia for electroconvulsive therapy. Anesth Analg, 94:1351-1364.
20. Dodd S, Berk M (2006) The safety of medications for the treatment of bipolar disorder during pregnancy and the puerperium. Curr Drug Saf, 1:25-33.
21. El Marroun H, Jaddoe VW, Hudziak JJ, Roza SJ, Steegers EA, Hofman A et al. (2012) Maternal use of selective serotonin reuptake inhibitors, fetal growth, and risk of adverse birth outcomes. Arch Gen Psychiatry, 69:706-714.
22. Epperson CN, Terman M, Terman JS, Hanuba BH, Oren DA, Peindl KS et al. (2004) Randomized clinical trial of bright light therapy for antepartum depression:preliminary findings. J Clin Psychiatry, 65:421-425.
23. Evans J, Heron J, Francomb H, Oke S, Golding J (2001) Cohort study of depressed mood during pregnancy and after childbirth. BMJ, 323:257-260.
24. Evans J, Melotti R, Heron J, Ramchandani P, Wiles N, Murray L et al. (2011) The timing of maternal depressive symptoms and child cognitive development: a longitudinal study. J Child Psychol Psychiatry, 23:632-640.
25. Fitzgerald PB, Daskalakis ZJ (2011) The effects of repetitive transcranial magnetic stimulation in the treatment of depression. Expert Rev Med Devices, 8:85-95.
26. Frassetto F, Tourneur-Martel F, Barjhoux CE, Villier C, Bot BL, Vincent F (2002) Goiter in a new born exposed to lithium in utero. Ann Pharmacother, 36:1745-1748.
27. Freeman RK, Garite TJ, Nageotte MP (2003) Fetal Heart RateMonitoring. 3rd ed. Baltimore, Lippincott Williams&Wilkins.
28. Fukuchi T, Okada Y, Katayama H, Nishijima K, Kato S, Netsu S (2003) A case of pregnant woman with severe obsessivecompulsive disorder successfully treated by modified electroconvulsive therapy. Seishin Shinkeigaku Zassh, 105:927-932.
29. Gahr M, Blacha C, Connemann BJ, Freudenmann RW, Schonfeldt- Lecuona C (2012) Successful treatment of major depression with electroconvulsive therapy in a pregnant patient with previous nonresponse to prefrontal rTMS. Pharmacopsychiatry, 45:79– 80.
30. Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G et al. (2005). Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess, 119:1-8.
31. Graff LA, Dyck DG, Schallow JR (1991) Predicting postpartum depressive symptoms and structural modelling analysis. Percep Mot Skills, 73:1137–1138.
32. Handforth A, DeGiorgio CM, Schachter SC, Uthman BM, Naritoku DK, Tecoma ES et al. (1998) Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology, 51:48-55.
33. Herman NL, Li AT, Van Decar TK, Johnson RF, Bjoraker RW, Downing JW, Jones D (2000) Transfer of methohexital across the perfused human placenta. J Clin Anesthes, 12:25–30.
34. Hızlı Sayar G, Ozten E, Tufan E, Cerit C, Kağan G, Dilbaz N et al. (2014) Transcranial magnetic stimulation during pregnancy. Arch Womens Ment Health, 17:311-315.
35. Hollins K (2007) Consequences of antenatal mental health problems for child health and development. Curr Opin Obstet Gynecol, 19:568-572.
36. Husain MM, Stegman D, Trevino K (2005) Pregnancy and delivery while receiving vagus nerve stimulation for the treatment of major depression: a case report. Ann Gen Psychiatry, 4:16.
37. Ishikawa T, Kawahara S, Saito T, Otsuka H, Kemmotsu O, Hirayama E et al. (2001) Anesthesia for electroconvulsive therapy during pregnancy - a case report. Masui, 50:991–997.
38. Iwasaki K, Sakamoto A, Hoshino T, Ogawa R (2002) Electroconvulsive therapy with thiamylal or propofol during pregnany Can J Anesth, 49:324-325.
39. Jauniaux E, Gulbis B, Shannon C (1998) Placental propofol transfer and fetal sedation during maternal general anaesthesia in early pregnancy. Lancet, 352:290–291.
40. Källén B, Olausson PO ( 2008) Maternal use of selective serotonin re-uptake inhibitors and persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf, 17:801-6.
41. Kieler H, Artama M, Engeland A, Ericsson O, Furu K, Gissler M et al. (2012) Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from the five Nordic countries. BMJ,12;344.
42. Kim DR, Epperson N, Paré E, Gonzalez JM, Parry S, Thase ME et al. (2011) An open label pilot study of transcranial magnetic stimulation for pregnant women with major depressive disorder. J Women's Health, 20:255-261.
43. Kim DR, Sockol L, Barber JP, Moseley M, Lamprou L, Rickels K et al. (2011) A survey of patient acceptability of repetitive transcranial magnetic stimulation (TMS) during pregnancy. J Affect Disord, 129:385–390.
44. Klirova M, Novak T, Kopecek M, Mohr P, Strunzova V (2008) Repetitive transcranial magnetic stimulation (rTMS) in major depressive episode during pregnancy. Neuro. Endocrinol. Lett, 29:69–70.
45. Kozma C (2005). Neonatal toxicity and transient neurodevelopmental deficits following prenatal exposure to lithium: Another clinical report and a review of the literature. Am J Med Genet A, 132:441-444.
46. Kripke DF, Mullaney DJ, Klauber MR, Risch SC, Gillin JC (1992) Controlled trial of bright light for nonseasonal major depressive disorders. Biol Psychiatry, 31:119-134.
47. Kulin NA, Pastuszak A, Sage SR, Schick-Boschetto B, Spivey G, Feldkamp M et al. (1998) Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA, 279:609-610.
48. Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O (2000) Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol, 95:487-490.
49. Leiknes KA, Cooke MJ, Jarosch-von Schweder L, Harboe I, Hİie B (2015) Electroconvulsive therapy during pregnancy: a systematic review of case studies. Arch Womens Ment Health, 18:1-39.
50. Le SY, Dubertret C, Le FB (2011) Prevalence and correlates of majör depressive episode in pregnant and postpartum women in the United States. J Affect Disord, 135:128–138.
51. Lovas A, Almos PZ, Peto Z, Must A, Horváth S (2011) Anesthesia for electroconvulsive therapy in early pregnancy. J ECT, 27:328- 330.
52. Lund N, Pedersen LH, Henriksen TB ( 2009) Selective serotonin reuptake inhibitor exposure in utero and pregnancy outcomes. Arch Pediatr Adolesc Med, 163:949-54.
53. Malhotra N, Vani, Malhotra P, Bhardwaj R (2008) Modified electroconvulsive therapy during pregnancy. J Anaesthesiol Clin Pharmacol, 24:351–352.
54. Marangell LB, Rush AJ, George MS, Sackeim HA, Johnson CR, Husain MM et al. (2002) Vagus nerve stimulation (VNS) for major depressive episodes: one year outcomes. Biol Psychiatry, 51:280-287.
55. Matalon S, Schechtman S, Goldzweig G, Ornoy A (2002) The teratogenic effect of carbamazepine: a meta-analysis of 1255 exposures. Reprod Toxicol, 16:9–17.
56. Mc Mahon CL, Braddock SR (1998) Septo-opticdysplasia in a child exposed to valproicacid in utero. Teratology, 57: 284.
57. Minik G, Atlas M (2007) What’s the best strategy for bipolar disorder during pregnancy. J Fam Practice, 56:665-668.
58. Molina M, Vega O, Valero J, Rubio J, Povo A, Diago V, Perales A (2010) Electroconvulsive therapy during pregnancy. J Matern Fetal Neonatal Med, 23(S1):539.
59. Moore SJ, Turnpenny P, Quinn A, Glover S, Lloyd DJ, Montgomery T, Dean JC (2000) A clinical study of 57 children with fetal anticonvulsant syndromes. J Med Genet, 37:489–497.
60. Morrow J, Russell A, Guthrie E, Parsons L, Robertson I, Waddell R et al. (2006) Malformation risks of antiepilepticdrugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register. J Neurol Neurosurg Psychiatry,77:193-198.
61. Nahas Z, Bohning DE, Molloy MA, Oustz JA, Risch SC, George MS (1999) Safety and feasibility of repetitive transcranial magnetic stimulation in the treatment of anxious depression in pregnancy: a case report. J Clin Psychiatry, 60:50–52.
62. O’Hara MW, Zekoski EM, Philipps LH, Wright EJ (1999) Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women. J Abnorm Psychol, 99:3–15.
63. O’Reardon JP, Solvason HB, Janicak PG, et al. (2007) Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry, 62:1208-1216.
64. Oren DA, Wisner KL, Spinelli M, Epperson CN, Peindl KS, Terman JS et al. (2002) An open trial of morning light therapy for antepartum depresion. Am J Psychiatry, 159:666-669.
65. Ornoy A (2009) Valproic acid in pregnancy: how much are we endangering the embryo and fetus? Reprod Toxicol, 28:1-10.
66. Ozten E, Sayar GH, Gül IG, Tufan AE, Cerit C, Dilbaz N (2014) The efficacy of electroconvulsive therapy in major depressive disorder relapsed or unresponsive to transcranial magnetic stimulation in pregnancy: three case studies . American Journal of Clinical Medicine Research, 2:18-21.
67. Ozten E, Sayar GH, Karamustafalıoğlu KO (2013) Acute and maintenance transcranial magnetic stimulation in a pregnant woman with major depression: a case report . OA Case Reports, 2:22.
68. Pacifici GM, Nottoli R ( 1995) Placental transfer of drugs administered to the mother. Clin Pharmacokinet, 28:235–269.
69. Pastuszak A, Schick-Boschetto B, Zuber C, Feldkamp M, Pinelli M, Sihn S et al. (1993) Pregnancy outcome following first-trimester exposure to fluoxetine. JAMA, 5:2246-2248.
70. Patel V, Prince M (2006) Maternal psychological morbidity and lowbirth weight in India. Br J Psychiatry, 188:284-285.
71. Prieto Martin RM, Palomero Rodriguez MA, de Miguel FP, Yusta MG, Alonso BB, Muriel VC (2006) Electroconvulsive therapy in the third trimester of pregnancy: a case report. Rev Esp Anestesiol Reanim, 53:653–656.
72. Rush AJ, George MS, Sackeim HA, Marangell LB, Husain MM, Giller C et al. (2000) Vagus nerve stimulation for treatment-resistant depressions: a multicenter study. Biol Psychiatry,47:276-286.
73. Rush AJ, Marangell LB, Sackeim HA, George MS, Brannan SK, Davis SM et al. (2005) Vagus nerve stimulation for treatment- resistant depression: a randomized, controlled acute phase trial. Biol Psychiatry, 58:347-354.
74. Saatçioğlu O, Tomruk NB (2011) The use of electroconvulsive therapy in pregnancy: a review. Isr J Psychiatry Relat Sci, 48:6-11.
75. Sackeim HA, Rush AJ, George MS, Marangell LB, Husain MM, Nahas Z et al. (2001) Vagus nerve stimulation for treatment-resistant depression: efficacy, side effects, and predictors of outcome. Neuropsychopharmacology, 25:713-728.
76. Sandman CA, Wadhwa PD, Chicz-DeMet A, Dunkel-Schetter C, Porto M (1997) Maternal stress, HPA activity, and fetal/infant outcome Ann N Y Acad Sci, 814:266-275.
77. Serim B, Ulas H, Ozerdem A, Alkin T (2010) Electroconvulsive therapy in an adolescent pregnant patient. Prog Neuropsychopharmacol Biol Psychiatry, 34:546–547.
78. Sodhi P, Poddar B, Parmar V (2001) Fatal cardiac malformation in fetal valproate syndrome. Indian J Pediatr, 68:989-990.
79. Talge NM, Neal C, Glover V, Early Stress, Translational Research and Prevention Science Network: Fetal and Neonatal Experience on Child and Adolescent Mental Health (2007) Antenatal maternal stres and long-term effects on child neurodevelopment: how and why? J Child Psychol Psychiatry, 48:245-261.
80. Terman JS, Terman M, Lo ES, Cooper TB ( 2001). Circadian time of morning light administration and therapeutic response in winter depression. Arch Gen Psychiatry, 58:69-75.
81. Wadhwa PD, Sandman CA, Porto M, Dunkel-Schetter C (1993) The association between prenatal stres and infant birth weight and gestational age at birth: a prospective investigation Garite TJ. Am J Obstet Gynecol, 169:8588-65.
82. Walker R, Swartz CM (1994) Electroconvulsive therapy during high-risk pregnancy. Gen Hosp Psychiatry, 16:348-353.
83. Wirz-Justice A, Bader A, Frish U, Stieglitz RD, Alder J, Bitzer J et al. (2011) A randomized, double-blind, placebo controlled study of light therapy for antepartum depression. J Clin Psychiatry, 72:986-993.
84. Wyszynski DF, Nambisan M, Surve T, Alsdorf RM, Smith CR, Holmes LB (2005) Increased rate of major malformations in offspring exposed to valproate during pregnancy. Neurology, 64:961-965.
85. Yacobi S, Ornoy A (2008) Is lithium a real teratogen? What can we conclude form the prospective versus retrospective studies? a review. Isr J Psychiatry Relat Sci, 45: 95-106.
86. Yamada N, Martin-Iverson MT, Daimon K, Tsujimoto T, Takahashi S (1995) Clinical and chronobiological effects of light therapy on nonseasonal affective disorders. Biol Psychiatry, 37:866-873.
87. Yang HS, Seo HJ, Lee YK (2011) Anesthetic care for electroconvulsive therapy during pregnancy. Korean J Anesthesiol, 60:217– 220.
88. Yonkers KA, Wisner KL, Stowe Z, Leibenluft E, Cohen L, Miller L et al. (2004) Management of bipolar disorder during pregnancy and postpartum period. Am J Psychiatry, 161:608-620.
89. Zhang D, Hu Z (2009) RTMS may be a good choice for pregnant women with depression. Arch Womens Ment Health, 12:189–190.