Discussion post response
Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references. References must be evidenced based, peer reviewed, less than 5 years old and US based.
Depression in
women throughout pregnancy.
The presence of
depression with the prenatal stage, in conjunction with the possible risks that
are related with subjection regarding medication within utero, may lead to a
several concerns that can lead to meticulous consideration and informed
decision making. With depression being the most common psychiatric condition
within pregnancy, it is crucial for healthcare providers to logically implement
appropriate interventions to assist in the distress as well as to ensure fetal
safety (Raffi et al., 2019).
FDA-approved
drug- Sertraline (Zoloft).
The medication Sertraline (Zoloft) is a selective serotonin reuptake inhibitor
(SSRI) which is FDA-approved for the management of depression in woman who are
pregnant. (O’Conner et al., 2019). The medication has a category C, which means
that it is known to be safe for mother and fetal exposure and the benefits of
the medication exceed the possible risks (Leeks & Arif, 2023). In the case
of implementing this medication for the management of depression in women who
are pregnant, there should be a comprehensive risk assessment to compare
possible risks versus the benefits of the medication for management. Initially,
the prescriber should assess the severity level of the depression in each case.
Where there is a result of mild to moderate depression, there are options of
nonpharmacological management such as cognitive behavioral therapy (CBT), which
can be recommended as first line prior to medication (McDonald & Alhusen,
2022). Although, in the cases of severe depression, pharmacological management
should be initiated to assist symptoms that may lead to potential harm to
mother and baby. Additionally, the practitioner must educate the patient on
possible risks with the implementation of the medication Sertraline throughout
pregnancy. Research has shown that the use of this medication carries a
decreased risks of congenital malformations and adverse outcomes in comparison
to similar antidepressant medications (Kolding et al., 2023). Nonetheless, the
use of this medication does not come without risks completely due to this
medication does cross the placental barrier. The possible risks that are
associated with the use of the medication are neonatal adaptation syndrome and
serious adverse effects like congenital malformations.
Off-label Drug-
Bupropion (Wellbutrin).
The off-label medication chosen is Bupropion (Wellbutrin), which is not
FDA-approved for the management of depression throughout pregnancy. There is
limited research on the safety of this medication throughout pregnancy, but
many systematic reviews and meta-analysis propose that bupropion has a
decreased risk of fetal outcomes like premature birth and congenital
abnormalities (Turner et al., 2019). The medication Bupropion is suggested as
an off-label medication in the management of depression throughout pregnancy
while many other antidepressants are not as well-tolerated (Kimmel et al.,
2018). In addition, depression that is not managed and untreated has the
potential to lead to adverse effects and possible development problems with
baby. The implementation of bupropion for the management of depression in women
who are pregnant requires a detailed risk assessment, with consideration in
mind of the limited data regarding safety, the fetal exposure, and potential
neonatal withdrawal. If the medication bupropion is considered safe and
implemented, there must be monitoring and continued evaluations to ensure
safety concerns are addressed for better outcomes for mother and baby.
Non-pharmacological
Intervention- Cognitive-Behavioral Therapy (CBT).
The American Association of Obstetricians and Gynecologists (ACOG) and the
American Psychiatric Association (APA) suggest that CBT in the management of
depression for women who are pregnant (McDonald & Alhusen, 2022). CT and
the evidence-based approaches implemented assist in identifying and modifying
negative thoughts and behaviors which lead to the symptoms of depression.
Research has shown when comparing CBT to SSRIs and placebo, CBT has shown
effectiveness in the reduction of depression symptoms in women who are pregnant
and without the possibility of risks that medications come with (Nillni et al.,
2018). Additionally, CBT can be modified for an individual who is pregnant
dealing with the stressors that are associated with pregnancy, which results
this approach being a great noninvasive resource for management of depression
in women who are pregnant.
Clinical
Practice Guidelines
There are many clinical practice guidelines for the management of depression in
women who are pregnant that have been suggested by professional organizations
such as the American College of Obstetricians and Gynecologists (ACOG) and the
American Academy of Pediatrics (AAP). These guidelines suggest
non-pharmacological management as a first line intervention for mild to
moderate depression, which consists of cognitive-behavioral therapy (McDonald
& Alhusen, 2022). The consideration to implement antidepressants should
only be initiated when non-pharmacological management approaches are not
effective or when the depression is severe. In these such cases mentioned, the
guidelines suggest that the choice of antidepressant be based on the available
safety data and individual patient factors. In addition, the guidelines suggest
regularly assessments and continued evaluations to assess how the patient is
responding to the management in the case of potential alterations to the dosage
and efficacy (Betcher & Wisner, 2020).
