Mirtazapine in pregnancy and lactation – A systematic review

Smit, Mirte; Dolman, Koert M.; Honig, Adriaan

doi:10.1016/j.euroneuro.2015.06.014

Cited by 60 publications

(42 citation statements)

References 39 publications

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“…Another meta-analysis of 390 cases of neonates exposed to mirtazapine found no associated increased rates in major defects [57]. Limited data are available regarding mirtazapine and lactation; however, the same meta-analysis suggests that use of mirtazapine during breastfeeding is safe due to the relatively low infant dosage [58]. …”

Section: Mirtazapinementioning

confidence: 99%

Hyperemesis Gravidarum: A Review of Recent Literature

et al. 2017

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Background: In the United States, hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalizations in pregnancy overall. In approximately 0.3-3% of pregnancies, hyperemesis gravidarum is prevalent and this percentage varies on account of different diagnostic criteria and ethnic variation in study populations. Despite extensive research in this field, the mechanism of the disease is largely unknown. Although cases of mortality are rare, hyperemesis gravidarum has been associated with both maternal and fetal morbidity. The current mainstay of treatment relies heavily on supportive measures until improvement of symptoms as part of the natural course of hyperemesis gravidarum, which occurs with progression of gestational age. However, studies have reported that severe, refractory disease manifestations have led to serious adverse outcomes and to termination of pregnancies. Summary: Despite extensive research in the field, the pathogenesis of hyperemesis gravidarum remains unknown. Recent literature points to a genetic predisposition in addition to previously studied factors such as infectious, psychiatric, and hormonal contributions. Maternal morbidity is common and includes psychological effects, financial burden, clinical complications from nutritional deficiencies, gastrointestinal trauma, and in rare cases, neurological damage. The effect of hyperemesis gravidarum on neonatal health is still debated in literature with conflicting results regarding outcomes of birth weight and prematurity. Available therapy options remain largely unchanged in the past several decades and focus on parenteral antiemetic medications, electrolyte repletion, and nutritional support. Most studies of therapeutic options do not consist of randomized control studies and cross-study analysis is difficult due to considerable variation of diagnostic criteria. Key Messages: Hyperemesis gravidarum carries a significant burden on maternal health and US health care. Most published research on pathogenesis is observational and suggests multifactorial associations with hyperemesis gravidarum. Precise, strictly defined criteria for clinical diagnosis are likely to benefit meta-analyses of further research studies regarding pathogenesis as well as therapeutic options.

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Section: Mirtazapinementioning

confidence: 99%

Hyperemesis Gravidarum: A Review of Recent Literature

et al. 2017

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“…Preterm birth, but not intrauterine growth retardation, was reported following TCA exposure. A significant decrease in pregnancy duration was reported in three studies, including 266 cases among women exposed to mirtazapine (Smit et al, 2016). However, another previous study on 746 exposures failed to demonstrate shorter pregnancy following TCAs exposure (McElhatton et al, 1996).…”

Section: Prematuritymentioning

confidence: 90%

“…Adjustment for confounders did not alter the crude results. No difference between mirtazapine-exposed, SSRI-exposed, and general control pregnancies, 14 (18%) of 76 infants who exposed until delivery had withdrawal symptoms Smit et al, 2016 Meta-analysis of 31 studies, 390 cases including those reported by Lennestat et al, 2007 No increase in the rate of major anomalies -9 malformed infants…”

Section: Tricyclic and Tetracyclic Antidepressantsmentioning

confidence: 95%

Antidepressants, Antipsychotics, and Mood Stabilizers in Pregnancy: What Do We Know and How Should We Treat Pregnant Women with Depression

Ornoy¹,

Weinstein-Fudim²,

Ergaz³

2017

Birth Defects Research

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Depression is generally treated with antidepressants, but may often need antipsychotics and mood stabilizers. We discuss the updated data regarding the safety in pregnancy of antidepressants and antipsychotics, except selective serotonin reuptake inhibitors, and their possible impact on the long-term development of the offspring. Several earlier studies demonstrated a slight increase in the rate of major anomalies following maternal tricyclic antidepressant treatment, but most current literature shows their relative safety in pregnancy. Data on the development of the offspring are also reassuring. The antipsychotic drugs are also safe for the developing fetus and do not seem to induce developmental delay. Both groups of drugs may cause perinatal withdrawal symptoms and difficulties in neonatal adaptation. The mood stabilizers, lithium, and several anti-epileptic drugs, may adversely affect the developing embryo and fetus. While valproic acid, carbamazepine, and topiramate are teratogenic and may also affect postnatal development, the newer antiepileptic and mood stabilizers, lamotrigine and levetiracetam, seem to be safe in pregnancy and apparently have no long-term neurodevelopmental damage. Lithium may increase the rate of cardiac anomalies, especially of Ebstein's anomaly, and may warrant a mid-trimester fetal echocardiography. Although data on the development of the offspring are reassuring, we should remember that most studies were carried out during early childhood, at a time when inattention, learning difficulties, behavioral and psychiatric problems are not yet identifiable. When considering medical treatment for depression in women at child-bearing age, we have to weigh the severity of the symptoms and their impact on the developing fetus and child. Birth Defects Research 109:933-956, 2017.© 2017 Wiley Periodicals, Inc.

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“…Ketamine is not shown to be effective in therapy of postpartum depression (27). Recent studies show that the use of optimal doses of reboxetine, bupropion and mirtazapine in the antepartum period do not lead to congenital malformations, but these medications, as well as SSRIs, can be associated with spontaneous abortion (28). The use of bupropion in the first trimester at a daily dose of up to 250 mg increases the risk of ventricular septal defects (29) and hyperkinetic disorder (ADHD) in children (30).…”

Section: Antidepressantsmentioning

confidence: 99%

“…Monoamine oxidase inhibitors (MAOIs) should be avoided in the peripartum period due to the high risk of fetal congenital malformations, as well as sedation, insomnia and hypertensive crises of the mother. Recent data from literature indicate the absence of teratogenic potential of moclobemide used in the antepartum period in full therapeutic dose (28).…”

Section: Antidepressantsmentioning

confidence: 99%

Therapy of peripartum mental disorders

Stanković¹,

Stojanov²,

Antonijević³

2019

Acta fac medic Naissensis

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S U M M A R YDuring the peripartum period, women are at a greater risk of developing a mental disorder or experiencing an exacerbation of the pre-existing mental disorders. Therapeutic interventions are based primarily on psychotherapy, but if the symptoms are severe and pose a risk to the mother and the child, then the use of drugs, hospitalization or electroconvulsive therapy is considered. Cognitive-behavioral psychotherapy is the first line of treatment in postpartum blues and postpartum depression, panic disorder, generalized anxiety disorder, and mild to moderate obsessive-compulsive disorder. More recent conceptions regarding the use of drugs during the postpartum period indicate that medications should be prescribed if the risk of using them is lower than the risk of complications caused by the symptoms of mental disorders. Nortriptyline or desipramine are recommended from the group of tricyclic antidepressants, but newer generation antidepressants are shown to be safer during pregnancy. Fluvoxamine, paroxetine and sertraline can be used in postpartum period during breastfeeding, while fluoxetine and citalopram should be avoided. The use of first-generation antipsychotics haloperidol and trifluoperazine is recommended in the antepartum period, during which some of second-generation antipsychotics such as quetiapine, olanzapine, risperidone and aripiprazole can also be used. Clozapine should be avoided during breast-feeding. The use of mood stabilizers during pregnancy requires a thorough knowledge of the recommendations, and it is not advised to use them during the postpartum if the patient is breastfeeding. From the group of benzodiazepines, it is recommended to uselorazepam. Every form of therapeutic approach has proven to be more effective in the presence of emotional support from partners and other family members.

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Mirtazapine in pregnancy and lactation – A systematic review

Cited by 60 publications

References 39 publications

Hyperemesis Gravidarum: A Review of Recent Literature

Hyperemesis Gravidarum: A Review of Recent Literature

Antidepressants, Antipsychotics, and Mood Stabilizers in Pregnancy: What Do We Know and How Should We Treat Pregnant Women with Depression

Therapy of peripartum mental disorders

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