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首页> 外文期刊>Nordic journal of psychiatry. >Pharmacological treatment of unipolar depression during pregnancy and breast-feedingA clinical overview
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Pharmacological treatment of unipolar depression during pregnancy and breast-feedingA clinical overview

机译：妊娠和哺乳期间单极抑郁症的药理治疗临床概述

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Background: This overview is aimed at clinicians working with patients in the fertile age who suffer from depressive disorders. The study of adverse effects of antidepressants on the foetus is hampered by difficulty in distinguishing between the behavioural changes that are related to the disorder itself and changes that accompany its treatment with antidepressants. The current lack of solid scientific knowledge and the implications, mainly emotional, of treating pregnant or breast-feeding women often raise anxiety and cause concern among patients and clinicians. Methods: Currently available data are evaluated and clinical recommendations given. Results and Conclusions: Citalopram and sertraline can be used during pregnancy, while some controversy remains over in utero exposure to paroxetine and fluoxetine, which might be associated with an increased risk of foetal cardiovascular malformation. Less data is available concerning fluvoxamine and escitalopram use but current data does not indicate a specific risk. Citalopram, paroxetine and sertraline can be used during breast-feeding, while fluoxetine probably should be avoided. Nortriptyline, amitriptyline and clomipramine can be used during pregnancy and lactation, although data are more abundant for SSRI treatment. Venlafaxine can be used during pregnancy, while caution is advised during breast-feeding. Other antidepressants should be avoided because of lack of data on their effect. A strongly indicated lithium therapy should be continued. Close monitoring of lithium levels throughout pregnancy is mandatory, as is detailed foetal echocardiography in weeks 1822 of gestation. Lithium should not be used during breast-feeding. Electroconvulsive therapy (ECT) is a valid option if indicated, both during pregnancy and breast-feeding.
机译：背景：本概述适用于与患有抑郁症的育龄患者一起工作的临床医生。抗抑郁药对胎儿的不良影响的研究因难以区分与疾病本身相关的行为变化和与抗抑郁药治疗相关的变化而受到阻碍。当前缺乏扎实的科学知识以及对孕妇或哺乳期妇女的治疗所产生的影响（主要是情感上的影响）经常会引起焦虑，并引起患者和临床医生的关注。方法：评估当前可获得的数据并给出临床建议。结果与结论：西酞普兰和舍曲林可在妊娠期间使用，而宫内暴露于帕罗西汀和氟西汀的争议仍在争议中，这可能与胎儿心血管畸形的风险增加有关。关于氟伏沙明和依他普仑的使用的可用数据较少，但当前数据并未显示出特定的风险。母乳喂养期间可使用西酞普兰，帕罗西汀和舍曲林，但应避免使用氟西汀。去甲替林，阿米替林和氯米帕明可以在妊娠和哺乳期使用，尽管SSRI治疗的数据更为丰富。文拉法辛可在怀孕期间使用，但在哺乳期间建议谨慎。由于缺乏有关抗抑郁药的数据，应避免使用其他抗抑郁药。强烈建议进行锂疗法。在妊娠期间必须严格监控锂水平，如妊娠1822周的详细胎儿超声心动图检查也是如此。母乳喂养期间不应使用锂。如果有指征，在怀孕和哺乳期间，电抽搐治疗（ECT）是有效的选择。

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