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DOI: 10.1055/s-2003-43140
© Georg Thieme Verlag Stuttgart · New York
Diagnostik und Therapie depressiver Episoden in Schwangerschaft und Postpartumperiode
Publication History
Publication Date:
24 October 2003 (online)
![](https://www.thieme-connect.de/media/psychoneuro/200309/lookinside/thumbnails/10.1055-s-2003-43140-1.jpg)
Zusammenfassung
Die Schwangerschaft stellt für Frauen mit einer bipolaren Erkrankung eine Zeit erhöhten Risikos für depressive Episoden dar. Insbesondere, wenn stimmungsstabilisierende Medikamente mit Beginn der Schwangerschaft abrupt abgesetzt werden, steigt die Wahrscheinlichkeit des Auftretens einer depressiven Episode. Andererseits ist eine Pharmakotherapie vor allem in den ersten drei Monaten der Schwangerschaft mit einem erhöhten Teratogenitätsrisiko verbunden und die Therapie einer Depression in den letzten Schwangerschaftsmonaten kann beim Kind zu perinatalen Komplikationen führen. Ähnliches gilt auch für die postpartale Periode - Frauen mit einer bipolaren Erkrankung entwickeln mehr als doppelt so häufig wie nicht psychisch kranke Frauen eine Postpartum-Depression und auch das Risiko einer postpartalen Psychose ist erhöht. In diesem Beitrag sollen die relevanten Aspekte ante- und postnataler Depressionen diskutiert werden, damit ärztlicherseits die für die Patientin und das Kind sicherste Entscheidung getroffen werden kann.
Summary
The onset of bipolar disorder often occurs in women during their childbearing years. Many women with bipolar disorder are concerned that pregnancy will worsen their mood symptoms or that mood stabilizing treatment will harm their child. In fact, women with bipolar disorder have an increased risk of worsening mood symptoms both pre- and postnatally, but reproductive event-related mood episodes are often overlooked nad remain untreated. On the other hand, concern for the fetus or the newborn often leads to inadequate treatment or medication discontinuation. Thus, knowledge about the course of bipolar disorder during pregnancy and the postpartum period is important to ensure the right treatment decisions are made. In addition, the physician should be aware of potential teratogenic risks of antidepressants and perinatal symptoms caused by these agents in order to decide on the safest options for both the patient and her child.
Key Words
bipolar disorder - pregnancy - depression - antidepressants - safety
Literatur
- 1 Zuckerman B, Bauchner H, Parker S, Cabral H. Maternal depressive symptoms during pregnancy, and newborn irritability. J Dev Behav Pediatr. 1990; 11 190-194
- 2 Burt VK, Stein K. Epidemiology of depression throughout the female life cycle. J Clin Psychiatry. 2002; 63 9-15
- 3 Nonacs R, Cohen LS. Depression during pregnancy: diagnosis and treatment options. J Clin Psychiatry. 2002; 63 24-30
- 4 Freeman MP, Smith KW, Freeman SA, McElroy SL, Kmetz GE, Wright R, Keck PE Jr. The impact of reproductive events on the course of bipolar disorder in women. J Clin Psychiatry. 2002; 63 284-287
- 5 Steer RA, Scholl TO, Hediger ML, Fischer RL. Self-reported depression and negative pregnancy outcomes. J Clin Epidemiol. 1992; 45 1093-1099
- 6 Altshuler LL, Hendrick V, Cohen LS. Course of mood and anxiety disorders during pregnancy and the postpartum period. J Clin Psychiatry. 1998; 59 29-33
- 7 Laukaran VH, van den Berg BJ. The relationship of maternal attitude to pregnancy outcomes and obstetric complications. A cohort study of unwanted pregnancy. Am J Obstet Gynecol. 1980; 136 374-379
- 8 Sharma V, Persad E. Effect of pregnancy on three patients with bipolar disorder. Ann Clin Psychiatry. 1995; 7 39-42
- 9 Altshuler LL, Hendrick VC. Pregnancy and psychotropic medication: changes in blood levels. J Clin Psychopharmacol. 1996; 16 78-80
- 10 Spinelli MG. Interpersonal psychotherapy for depressed antepartum women: a pilot study. Am J Psychiatry. 1997; 154 1028-1030
- 11 Hendrick V, Altshuler L. Management of major depression during pregnancy. Am J Psychiatry. 2002; 159 1667-1673
- 12 Hendrick V, Stowe ZN, Altshuler LL, Hwang S, Lee E, Haynes D. Placental passage of antidepressant medications. Am J Psychiatry. 2003; 160 993-996
- 13 Hendrick V, Smith LM, Suri R, Hwang S, Haynes D, Altshuler L. Birth outcomes after prenatal exposure to antidepressant medication. Am J Obstet Gynecol. 2003; 188 812-815
- 14 Bromiker R, Kaplan M. Apparent intrauterine fetal withdrawal from clomipramine hydrochloride. JAMA. 1994; 272 1722-1723
- 15 Cowe L, Lloyd DJ, Dawling S. Neonatal convulsions caused by withdrawal from maternal clomipramine. Br Med J. 1982; 284 1837-1838
- 16 McElhatton PR, Garbis HM, Elefant E, Vial T, Bellemin B, Mastroiacovo P, Arnon J, Rodriguez-Pinilla E, Schaefer C, Pexieder T, Merlob P, Dal Verme S. The outcome of pregnancy in 689 women exposed to therapeutic doses of antidepressants. A collaborative study of the European Network of Teratology Information Services (ENTIS). ReprodToxicol. 1996; 10 285-294
- 17 Chambers CD, Johnson KA, Dick LM, Felix RJ, Jones KL. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med. 1996; 335 1010-1015
- 18 Einarson A, Fatoye B, Sarkar M, Lavigne SV, Brochu J, Chambers C, Mastroiacovo P, Addis A, Matsui D, Schuler L, Einarson TR, Koren G. Pregnancy outcome following gestational exposure to venlafaxine: a multicenter prospective controlled study. Am J Psychiatry. 2001; 158 1728-1730
- 19 Schimmell MS, Katz EZ, Shaag Y, Pastuszak A, Koren G. Toxic neonatal effects following maternal clomipramine therapy. J Toxicol Clin Toxicol. 1991; 29 479-484
- 20 Rasgon NL, Altshuler LL, Gudeman D, Burt VK, Tanavoli S, Hendrick V, Korenman S. Medication status and polycystic ovary syndrome in women with bipolar disorder: a preliminary report. J Clin Psychiatry. 2000; 61 173-178
- 21 Cohen LS, Heller VL. On the use of anticonvulsants for manic depression during pregnancy. Psychosomatics. 1990; 31 462-464
- 22 Markovitz PJ, Calabrese JR. Use of anticonvulsants for manic depression during pregnancy Psychosomatics. 1990; 31 118
- 23 Viguera AC, Cohen LS, Baldessarini RJ, Nonacs R. Managing bipolar disorder during pregnancy: weighing the risks and benefits. Can J Psychiatry. 2002; 47 426-436
- 24 Sabers A, Gram L. Newer anticonvulsants: comparative review of drug interactions and adverse effects Drugs. 2000; 60 23-33
- 25 Ferrill MJ, Kehoe WA, Jacisin JJ. ECT During Pregnancy: Physiologic and Pharmacologic Considerations. Convuls Ther. 1992; 8 186-200
- 26 American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders American Psychiatric Press. Washington, DC. 1996;
- 27 O'Hara MW, Schlechte JA, Lewis DA, Wright EJ. Prospective study of postpartum blues Biologic and psychosocial factors. Arch Gen Psychiatry. 1991; 48 801-806
- 28 Suppes T, Baldessarini RJ, Faedda GL, Tondo L, Tohen M. Discontinuation of maintenance treatment in bipolar disorder: risks and implications. HarvRev Psychiatry. 1993; 1 131-144
- 29 Ahokas A, Kaukoranta J, Wahlbeck K, Aito M. Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17beta-estradiol: a preliminary study. J ClinPsychiatry. 2001; 62 332-336
- 30 Parry BL. Reproductive factors affecting the course of affective illness in women. Psychiatr ClinNorth Am. 1998; 12 207-220
- 31 Nonacs R, Cohen LS. Postpartum mood disorders: diagnosis and treatment guidelines. J ClinPsychiatry. 1998; 59 34-40
- 32 Chandra PS, Venkatasubramanian G, Thomas T. Infanticidal ideas and infanticidal behavior in Indian women with severe postpartum psychiatric disorders. J Nerv Ment Dis. 2002; 190 457-461
- 33 Wickberg B, Hwang CP. Counselling of postnatal depression: a controlled study on a population based Swedish sample. J AffectDisord. 1996; 39 209-216
- 34 Ernst CL, Goldberg JF. The reproductive safety profile of mood stabilizers, atypical antipsychotics, and broad-spectrum psychotropics. J Clin Psychiatry. 2002; 63 42-55
- 35 Ahokas A, Kaukoranta J, Aito M. Effect of oestradiol on postpartum depression. Psychopharmacology. 1999; 146 108-110
Korrespondenzadresse:
PD. Dr. med. Stephanie Krüger
Center for Addiction and Mental Health
Clarke Institute of Psychiatry
Mood and Anxiety Disorders Division and PET Center
University of Toronto, Canada
Email: Stephanie_Krueger@camh.net