On Tuesday, June 23, 2020, it is sunny and rainy, breeze!
In fact, I always wanted to talk about this theme of patients with depression. Just last Monday, a colleague will consult such a patient:
Female depression patients, take Wenrafin hydrochloric acid, take 25 mg every morning. On May 27th of the last menstruation, I found that I was pregnant today. I asked what to do?
In the exchange, I learned that the patient had not discussed with his psychiatrist who had a recent pregnancy plan. It was an unexpected pregnancy, but he was taking antidepressants and was worried that the drug would affect the child.
1. The response to the patient on the spot
In the early pregnancy, we followed the principle of "full" or "no" in medical theory, which means that even if it is affected by the drug and radiation factors, but if there is no miscarriage, we will still suggest that you relax your mood and continue the mood and continuePregnancy, but we need to do a good job of delivery on a regular basis, and we need to pay attention to the problem of drugs. We want to care about your depression and condition:
First of all, the dose of medication before stopping the medicine is 25 mg. The condition control should be good. Now suddenly stop the medicine. We need a professional psychiatrist to make another evaluation of your situation;
Secondly, we want to say that pregnancy and production may have an impact on the condition (but even women who do not have a history of depression still have about 10%of pregnant women with depression). If the condition recur during pregnancy, then we need to take medicine again.Because you are pregnant by accident and have not made a plan with the doctor, then whether the medicine is still used to use Wenrafarin during pregnancy, this also requires us to communicate with your psychiatrist.We want to leave your contact information here, and we will follow up regularly.
2. Pharmaceutical professional views on this issue
1. What should we do in the front, so what should we talk to the doctor/pharmacist before planning to be pregnant?
Because pregnancy leads to changes in hormone levels in the body, it will increase the risk of illness and recurrence of mental illness. Therefore, some of our work needs to be done in front. Many psychiatric diseases have a long period of medication.Patients come to consult whether the drugs they take will affect the fetus. We are actually very anxious. Writing popular science and wanting more people to have this consciousness.This is not only responsible to the mother, but also for the baby.The following content is inductive from a professional perspective. When we talk to the doctor/pharmacist about planning to be pregnant, we should talk about what we should talk about:
A. Note that it should not be that the mother talks with the doctor about this topic. Our other family members should also participate;
B. Pregnancy is not a 100 % risk. Even normal women may face some spontaneous abortion or spontaneous risk;
C. Clarify whether the medicine you take is a taboo drug during pregnancy, such as sodium propyate and Kamasi. Even if you do not intend to get pregnant, you need to understand the risk that these drugs may teratogen.
D. The maternal and their families have the ability to deal with the disease.
E. During pregnancy and postpartum recurrence, if the drug is required, the risk of damage that the drug may bring
f. Plan for drug adjustment, time and psychological preparation, and drug selection scheme.
2. If patients with depression suddenly stopped the drug, is it high risk of recurrence of depression during pregnancy?
In fact, this problem is very important. Often, it is often necessary to consider that taking medicine from the perspective of the patient may be harmful to the baby.From this level, the medication continues to confirm the above, plan, we really need to do it in advance.
On June 9, 2020, HAMIDEH BAYRAMPOR, the University of Columbia, Canada, was published in a systematic review and META analysis of META analysis in J Clin Psychiatry.Eight studies that meet the enrollment standards were screened from the record of 2,172 questions, and 6 of them have reached the preset quality standards, including 4 forward -looking queue research and 2 retrospective queue studies, which are in the United States (4), respectively (4), and the United States (4), respectively.Spain (1) and Japan (1).
In the system summary, the patient’s suspension ratio was 22%-78%, and the recurrence ratio was 15%-68%. The recurrence ratio reported by the four research institutes was about 60%or even higher.All admission studies show that the recurrence risk of recurrence in early pregnancy (January-March) is the highest.Compared with continuing medication, antidepressants before and after pregnancy do not seem to significantly increase the risk of recurrence of depression during pregnancy.The Asian group analysis further showed that the suspension of drugs in mild and moderate depression seemed to be relatively safe, and there was no significant difference between the risk of depression and recurrence during pregnancy.However, the recurrence risk of severe depression patients after stopping the drug is more than twice the continued medication.
It is worth noting that the main predictive factors of depression recurrence during pregnancy after stopping the drug include the high degree of chronic chronic diseases, the number of previous recurrences, and the history of previous suicide attempts. It is prompted that the past disease may be more seriously related to the risk of recurrence.
3. The safety level of depression drugs during pregnancy
During pregnancy, the blood capacity is increased (about 30%), so if you need medication during pregnancy, the dose of medication in advanced pregnancy needs to be added.However, the liver enzyme activity during pregnancy is obvious. The CYP2D6 activity in the late pregnancy increases almost 50%, and the CYP1A2 activity decreases by 70%:
Welcome everyone to leave a message at the end of the article and ask your questions. Professional psychiatry clinical pharmacists sincerely answer you!
Psychiatric Clinical Pharmacist Mango Control: Ten years of employment, provide psychiatric specialty drug consulting services,
 David Taylor.The maudsley prelbing guidelits in psychiatry [m].Beijing: People’s Health Publishing House, 2016.
 Bayrampour H, Kapoor A, Bunka M, et al. The Risk of Relapse of DEPRESSION Pregnancy after Discontinuit: A SystemAntic Review AN D meta -nalysis. J clin psychiatry. 2020; 81 (4): 19r13134.