Diagnostik und Therapie depressiver Episoden in Schwangerschaft und Postpartumperiode

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

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