Discussion: Prescribing for Older Adults and Pregnant Women
NRNP 6675 WEEK 9 DISCUSSION POST : Prescribing for Older Adults and Pregnant Women
Patients affected by or at risk of mental health disorders have unique health needs that should be addressed in the care process. Psychiatric mental health nurses are responsible for adopting evidence-based interventions that optimize treatment outcomes such as safety, quality, and efficiency in the care process. They weigh the benefits and risks of the different treatment approaches based on patient characteristics. Therefore, the purpose of this paper is to explore pharmacotherapy for major depression during pregnancy.
Depression in pregnancy or perinatal depression is one of the major risks that affect the pregnant mother, unborn child, and the family as a whole. Perinatal depression affects up to 12.9% of pregnant women and may progress to the postpartum period. It has high comorbidity with disorders such as generalized anxiety disorder and obsessive-compulsive disorder (Miller et al., 2018). Pharmacotherapy is largely considered in treating perinatal depression. Currently, there is no FDA-approved drug for use in treating patients that develop depression during pregnancy. However, it is recommended that patients with a history of depression before pregnancy continue with the FDA-approved drugs during pregnancy. The drugs include escitalopram (Lexapro) and fluoxetine (Prozac). Fluoxetine and Lexapro produce their effect by i
Discussion Prescribing for Older Adults and Pregnant Women
nhibiting serotonin reuptake into the presynaptic neurons, hence, increasing its concentration and mood (Mitchell & Goodman, 2018). The non-FDA drugs for major depression that patients can continue using during pregnancy include other antidepressants such as Sertraline and paroxetine.
Risk assessments should be performed before initiating a pregnant patient on antidepressants. Accordingly, healthcare providers should determine whether the prescribed drug is associated with an increased risk of teratogenicity. The drug should not predispose the fetus to birth defects over baseline (LUSSKIN et al., 2018). The other risk assessment needed in the prescription of antidepressants is the determination of whether the drug predisposes the pregnant mother to pregnancy complications. Psychiatric mental health nurse practitioners should ensure that the selected medications do not cause complications such as premature birth, miscarriage, stillbirth, or intrauterine growth restriction. The risks of neurodevelopment and neonatal complications such as neurobehavioral teratogenicity should also be assessed before the administration of the medication (Komorowski, 2022). Therefore, the healthcare provider should strive to achieve a balance between the potential risks that each drug has and the known risks of major depression to help pregnant mothers and their families to make informed decisions.
FDA-approved medications used in treating depression have considerable benefits. First, they have minimal harm and optimal
Discussion Prescribing for Older Adults and Pregnant Women
benefits to the patients. The drugs have been evaluated for clinical efficacy in improving depressive symptoms. The drugs also have a high level of tolerability, which enhances outcomes such as treatment adherence by the patients. The risks of FDA-approved drugs include the fact that they may not be effective for all patients. Patients have different characteristics that affect the pharmacokinetics and pharmacotherapeutics of FDA-approved drugs. Therefore, non-FDA-approved drugs prove beneficial in such cases, as they act as alternatives for improving patient outcomes in the treatment process. However, non-FDA-approved drugs have minimal evidence-based data supporting their use, hence, the increased risk of patient harm due to side and adverse effects associated with them. Clinical practice guidelines do not exist for the treatment of perinatal depression (Molenaar et al., 2018). Therefore, some of the factors to consider in treatment include safety and risks of the available treatment and patient factors that may affect the treatment outcomes.
Overall, perinatal depression is a serious mental health problem that should be managed effectively during pregnancy. Risk assessment should be performed to determine the suitability of antidepressants. A focus should be on ensuring minimal harm and optimal benefits to the mother and fetus. Since clinical practice guidelines for depression management in pregnancy do not exist, providers should consider other alternatives such as psychotherapy if symptoms are less severe.
References
Komorowski, J. (2022). Chapter 17—Antidepressants in pregnancy. In D. Mattison & L.-A. Halbert (Eds.), Clinical Pharmacology During Pregnancy (Second Edition) (pp. 311–321). Academic Press. https://doi.org/10.1016/B978-0-12-818902-3.00014-2
LUSSKIN, S. I., KHAN, S. J., ERNST, C., HABIB, S., FERSH, M. E., & ALBERTINI, E. S. (2018). Pharmacotherapy for Perinatal Depression. Clinical Obstetrics and Gynecology, 61(3), 544–561. https://doi.org/10.1097/GRF.0000000000000365
Miller, E. S., Grobman, W. A., Culhane, J., Adam, E., Buss, C., Entringer, S., Miller, G., Wadhwa, P. D., Keenan-Devlin, L., & Borders, A. (2018). Antenatal depression, psychotropic medication use, and inflammation among pregnant women. Archives of Women’s Mental Health, 21(6), 785–790. https://doi.org/10.1007/s00737-018-0855-9
Mitchell, J., & Goodman, J. (2018). Comparative effects of antidepressant medications and untreated major depression on pregnancy outcomes: A systematic review. Archives of Women’s Mental Health, 21(5), 505–516. https://doi.org/10.1007/s00737-018-0844-z
Molenaar, N. M., Kamperman, A. M., Boyce, P., & Bergink, V. (2018). Guidelines on treatment of perinatal depression with antidepressants: An international review. Australian & New Zealand Journal of Psychiatry, 52(4), 320–327. https://doi.org/10.1177/0004867418762057