Discussion: Prescribing for Older Adults and Pregnant Women

Peripartum Depression occurs during pregnancy or after childbirth. This new term acknowledges depression that surrounds having a baby can have an onset during pregnancy.

Treatment includes:

APA guidelines for treating women with major depressive disorder who are pregnant, or breastfeeding recommend psychotherapy without medication as a first-line treatment for mild depression with a pregnant or breastfeeding mother. For moderate or severe depression antidepressants such as SSRIs, SNRIs, etc. can serve as primary treatment (American Psychiatric Association, 2020).

FDA Approved Drug

Brexanolone is an IV aqueous β-cyclodextrin-based formulation that produces stable serum levels Brexanolone is thought to be connected to GABA-A receptor activity. To compensate for the decline in allopregnanolone that follows childbirth, Brexanolone increased doses of allopregnanolone ( a horomone that rises in

Discussion Prescribing for Older Adults and Pregnant Women

Discussion Prescribing for Older Adults and Pregnant Women

childbirth but then quickly depletes after childbirth. It is thought to be a precipitating factor for PPD). like what the mothers’ levels are in the 3rd trimester (Fadden and Citrome ,2020).

Off-Label Drug

In a double-blind randomized trial of sertraline for peripartum depression, Sertraline produced a remarkably larger response rate (59 %) than placebo (26 %) and a more than twofold increased remission rate (53 % vs. 21 %) (Psychopharmacology, 2014).


Nonpharmacological Interventions

Interventions include physical therapy, kinesitherapy, music therapy and acupuncture. Cognitive behavioral therapy

Discussion Prescribing for Older Adults and Pregnant Women

Discussion Prescribing for Older Adults and Pregnant Women

and interpersonal psychotherapy are 2 of the most common interventions with strong clinical efficacy for treating peripartum depression. Physical therapies such as repetitive transcranial magnetic stimulation and light therapy are also effective. rTMS has been shown to last 6 months or more. Light therapy targets sleep and circadian rhythms which can heavily influence PPD (Medicine, 2020).


Faden, J., & Citrome, L. (2020). Intravenous Brexanolone for postpartum depression: what it is, how well does it work, and will it be used?. Therapeutic advances in psychopharmacology, 10, 2045125320968658. https://doi.org/10.1177/2045125320968658

Hantsoo, L., Ward-O’Brien, D., Czarkowski, K. A., Gueorguieva, R., Price, L. H., & Epperson, C. N. (2014). A randomized, placebo-controlled, double-blind trial of sertraline for postpartum depression. Psychopharmacology231(5), 939–948. https://doi.org/10.1007/s00213-013-3316-1

Torres, Felix. (2020). What is Peripartum Depression (formerly Postpartum)? American Psychiatric Association.  https://www.psychiatry.org/patients-families/postpartum-depression/what-is-postpartum-depression

Wang, Y., Li, H., Peng, W., Chen, Y., Qiu, M., Wang, J., Hao, Q., Tu, Y., Liu, Y., & Zhu, T. (2020). Non-pharmacological interventions for postpartum depression: A protocol for systematic review and network meta-analysis. Medicine99(31), e21496. https://doi.org/10.1097/MD.0000000000021496

Older adults and depression

As people grow older, they are likely to encounter physical and mental changes. They may experience diseases that are commonly seen in the older population such as diabetes, high blood pressure, and degenerative diseases. In addition to all these changes, they may also experience other changes such as children moving out of the house, causing them to be empty nesters, or loved ones getting ill and passing. These changes may precipitate mental health disorders such as depression. According to Csajbók, Kagstrom, and Cermakova, (2022) third of older adults experience a mental health disorder like depression. Mental health clinicians need to properly understand the variations in older adults, their comorbidities, lifestyle changes, order of medications being administered, and their pharmacodynamics in relation to any medications they prescribe for depression.

According to Chen et al., (2021) music, physical exercise, and massage have been shown to improve depressive symptoms in older adults. Depending on the severity of depressive symptoms, it will be beneficial to initiate nonpharmacological options. Patients should be educated on the goals of each treatment option. Patients who already have multiple medications should also attempt nonpharmacological options first to avoid potential side effects and interactions with other medications.

According to Glass, Hermida, Hershenberg, and Schwartz, (2020) many medications have been approved for the treatment of depression in the elderly. However, SSRI and SNRI are more preferred compared to tricyclics due to more favorable side effects.  Citalopram is most frequently used due to its limited interaction in the liver

Before starting any antidepressant for an older adult, It is important to take into consideration the drug-drug interaction, family history, and other comorbidities since antidepressants may also treat other depressive-related disorders, start with the lowest possible dose and titrate while monitoring for any drug interaction or adverse effect (Glass, Hermida, Hershenberg, and Schwartz, 2020).




Csajbók, Z., Kagstrom, A., & Cermakova, P. (2022). Season of birth has no effect on symptoms of depression and anxiety in older adults. Scientific Reports, 12(1), 1–9. https://doi.org/10.1038/s41598-022-10892-8


Chen, Y.-J., Li, X.-X., Pan, B., Wang, B., Jing, G.-Z., Liu, Q.-Q., Li, Y.-F., Bing, Z.-T., Yang, K.-H., Han, X.-M., & Ge, L. (2021). Non-pharmacological interventions for older adults with depressive symptoms: A network meta-analysis of 35 randomized controlled trials. Aging & Mental Health, 25(5), 773–786. https://doi.org/10.1080/13607863.2019.1704219


Glass, O. M., Hermida, A. P., Hershenberg, R., & Schwartz, A. C. (2020). Considerations and Current Trends in the Management of the Geriatric Patient on a Consultation-Liaison Service. Current Psychiatry Reports, 22(5), 1–12. https://doi.org/10.1007/s11920-020-01147-2


Vijay, A., Becker, J. E., & Ross, J. S. (2018). Patterns and predictors of off-label prescription of psychiatric drugs. PloS One, 13(7), e0198363. https://doi.org/10.1371/journal.pone.0198363