Risk-benefit Analysis of Antidepressants Use during Breastfeeding to Treat Postpartum Depression | Chapter 6 | Medical Science: Recent Advances and Applications Vol. 5

 

Postpartum depression is classified as a major depressive disorder, and the causes are not well known. Postpartum depression affects approximately 14.5% of women, and it can affect both mother and infant. Therefore, rapid attention and treatment are imperative. The causes of postpartum depression are not well known; but there are many factors that may increase the risk of developing the disease. Women should be carefully evaluated after childbirth for depressive or anxiety symptoms with adequate screening tools and methods to avoid diagnostic errors; especially when dealing with women who present risk factors. The pharmacological approach often represents one of the most realistic options for treatment. However, women may be reluctant to take antidepressants because of the fear of adverse effects on the infant, since most drugs pass into breast milk. The objective of this review is to evaluate the risk-benefit of using antidepressants during breastfeeding to treat postpartum depression.

 

An electronic search was performed by using the PubMed database from January 2001 through December 2010. The search was limited to articles in the English language and to articles that relate to human research. Manual searches of bibliographies were also conducted to identify additional pertinent studies.

 

The use of antidepressants that do not appear in infants’ plasma, for which use during breastfeeding is better documented and at standard therapeutic doses is recommended, such as sertraline and paroxetine. Fluoxetine has a long half-life, which can lead to a long infant exposure through breast milk, and citalopram can cause adverse effects in infants exposed through breast milk. Therefore, citalopram and fluoxetine should not be used as first-line treatments. If these drugs are used by a nurse, they should take the lowest effective dosage, and their infants should be monitored. 

 

This study focused on emphasising the importance of postpartum depression treatment, always considering its repercussions for the breastfed infants. Studies are needed with larger samples to properly evaluate the short and long-term effects of antidepressants on infants exposed through breast milk, so that clinicians can create standard decisions regarding the treatment of postpartum depression, without putting infants at risk.

 

Author (s) Details

Leal, Vânia
Pharmacy Department, Coimbra Health School, Polytechnic University of Coimbra, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal.

 

Fonseca, Ana Paula
Pharmacy Department, Coimbra Health School, Polytechnic University of Coimbra, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal and H&TRC - Health & Technology Research Center, Coimbra Health School, Polytechnic University of Coimbra, S. Martinho do Bispo, 3046-854 Coimbra, Portugal.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v5/5520

A Review on Depressive Disorders in Cancer Patients | Chapter 16 | Issues and Development in Health Research Vol. 3

 Cancer transitions from a deadly condition to a chronic one. This viewpoint has widened the scope of treatment from just treating the disease to also managing cancer-related symptoms, such as mental problems. Affective disorders (depression and anxiety) are the most common types of concomitant mental illness in cancer patients. While there is no proof that depression causes cancer, it may have an impact on the disease's progression and a person's capacity to participate in therapy. Depressive syndromes are linked to a lower quality of life, more difficulties managing disease progression, and earlier admission to inpatient or hospice care.

An adjustment disorder with low mood, also known as reactive depression, is the most frequent form of depressive symptomatology in cancer patients. It is often under-recognized and under-treated. Severe depressive symptoms are of clinical concern since they are linked to higher distress, longer hospital stays, physical disorders, poorer treatment compliance and adherence to therapy, disability, and an increased desire for premature death or suicide. Suicidal remarks might range from a casual remark made out of irritation or dissatisfaction with a treatment plan to a serious expression of despair in a life-threatening situation.

Due to the difficulties in differentiating biological or physical symptoms from symptoms of sickness or toxic side effects of treatment, diagnosing depression is challenging. Recognizing the presence of depression and determining the right level of assistance, which can range from brief counselling or support groups to medication and/or psychotherapy, is an important element of cancer care. At least half of all cancer patients will be able to adjust successfully. Whether or whether a patient satisfies the diagnostic criteria for major depression, pharmacotherapy for depression in advanced cancer patients should be directed by a focus on symptom reduction. Each patient's depressive symptom profile and potential dual benefit for depression and cancer-related symptoms such as anorexia, sleeplessness, fatigue, neuropathic pain, and hot flashes can help choose the best antidepressant for them. Tricyclic/heterocyclic antidepressants, monoamine oxidase inhibitors, and reversible inhibitors of monoamine oxidase A are rarely used in cancer patients due to their poor impact profiles and risk of mortality in overdose. Depression must be diagnosed and treated promptly and accurately in order to improve quality of life while also reducing negative impacts on cancer progression, length of hospital stay, treatment adherence and efficacy, and possibly prognosis and survival.

Author (S) Details

I. Chernicova
State Medical University, Rostov-on-Don, Russia.

S. Savina
Medical Center “Hippocrates”, Rostov-on-Don, Russia.

B. Zaydiner
Cancer Center, Rostov-on-Don, Russia.

View Book :- https://stm.bookpi.org/IDHR-V3/article/view/3310