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The aim of the article is to review systematically current researches investigating the relationship between intrauterine exposure to antidepressants and neonatal hypoglycemia. This paper included studies published in electronic databases from January 2005 to July 2020. The searched keywords were as follows: antidepressants, pregnancy, selective serotonin reuptake inhibitors (SSRIs), citalopram, fluoxetine, paroxetine, escitalopram, sertraline, fluvoxamine, selective serotonin-norepinephrine reuptake inhibitors (SNRIs), venlafaxine, tricyclic antidepressants (TCAs), neonatal outcomes, neonatal hypoglycemia, imipramine, clomipramine, amitriptyline, bupropion, trazodone, and mirtazapine. This review examined 10 relevant studies. The odds ratio/risk ratio reported in the studies were 1.33-1.73 for any antidepressant, 1.30-1.35 for SSRI, 1.42-2.11 for SNRI, and 2.07 for TCAs. The risk of neonatal hypoglycemia in infants exposed to maternal TCAs appears to be slightly higher compared to infants exposed to maternal SSRIs. Data from current studies consistently show that exposure to maternal antidepressants during pregnancy may be related to increased risk of neonatal hypoglycemia in infants.

Objective: A review of current meta-analyses examining the relationship between maternal use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy and congenital anomalies. Methods: P...

Objectives:The number of forensic cases in childhood and adolescence is increasing. However, the data on the characteristics of the forensic psychiatric evaluations in the field of child and adolescent psychiatry in our country are extremely limited. The aim of this study was to investigate the sociodemographic characteristics of children and adolescents who had applied to the child psychiatry outpatient clinic in Konya in the last 5 years.Materials and Methods:In this study, archive files and reports of 523 cases referred to Necmettin Erbakan University Meram School of Medicine Department of Child and Adolescent Psychiatry between January 2014 and February 2019 were analyzed retrospectively. The age, gender, family structure, educational background, place of residence, intelligence levels and reasons for referring these children, the type of crime committed by the offenders, and the types of abuse in the victims were evaluated.Results:Of the cases admitted to our forensic psychiatry outpatient clinic, 33.7% (n=176) were evaluated for delinquency, 39.8% (n=208) for sexual abuse and 26.6% (n=139) for other reasons. The frequency of referral was significantly higher in the sexual abuse category in girls and in the delinquency category in boys (p

Background The present study compared the impact of maternal major depression, anxiety disorders and their comorbidities on gestational age and birth weight of infants. Methods A total of 1119 women consisting of 26 women with only major depression, 125 women with only anxiety disorder, 36 women with major depression plus an anxiety disorder and 932 women without any psychiatric disorders were included in the study. Psychiatric diagnoses were determined by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Results The comorbid group had the highest proportion of newborns with preterm birth and low birth weight. Moreover, these newborns had the lowest birth weight and gestational age. Limitations Cross-sectional study design. Conclusions The study results suggest that comorbidity between major depression and anxiety disorders during pregnancy may have noteworthy negative effects on birth weight and gestational age.

Item does not contain fulltext OBJECTIVE: To evaluate the associations of depressive symptoms and antidepressant use during pregnancy with the risks of preterm birth, low birth weight, small for gestational age (SGA), and low Apgar scores. DATA SOURCES: MEDLINE, EMBASE, ClinicalTrials.gov, and PsycINFO up to June 2016. METHODS OF STUDY SELECTION: Data were sought from studies examining associations of depression, depressive symptoms, or use of antidepressants during pregnancy with gestational age, birth weight, SGA, or Apgar scores. Authors shared the raw data of their studies for incorporation into this individual participant data meta-analysis. TABULATION, INTEGRATION, AND RESULTS: We performed one-stage random-effects meta-analyses to estimate odds ratios (ORs) with 95% CIs. The 215 eligible articles resulted in 402,375 women derived from 27 study databases. Increased risks were observed for preterm birth among women with a clinical diagnosis of depression during pregnancy irrespective of antidepressant use (OR 1.6, 95% CI 1.2-2.1) and among women with depression who did not use antidepressants (OR 2.2, 95% CI 1.7-3.0), as well as for low Apgar scores in the former (OR 1.5, 95% CI 1.3-1.7), but not the latter group. Selective serotonin reuptake inhibitor (SSRI) use was associated with preterm birth among women who used antidepressants with or without restriction to women with depressive symptoms or a diagnosis of depression (OR 1.6, 95% CI 1.0-2.5 and OR 1.9, 95% CI 1.2-2.8, respectively), as well as with low Apgar scores among women in the latter group (OR 1.7, 95% CI 1.1-2.8). CONCLUSION: Depressive symptoms or a clinical diagnosis of depression during pregnancy are associated with preterm birth and low Apgar scores, even without exposure to antidepressants. However, SSRIs may be independently associated with preterm birth and low Apgar scores. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42016035711.

Objective This study aimed to compare data on mood and anxiety disorders of pregnant women before and during the COVID-19 pandemic. Methods The study sample included 253 women evaluated on their first postpartum day during the COVID-19 pandemic. Mood and anxiety disorders were determined by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Data from sample was compared with data from previous study that was completed and published prior to the COVID-19 pandemic. Results The prevalence rate of mood and anxiety disorders during the COVID-19 pandemic was 7.1% and 13.0%, respectively. The most common specific disorder was generalized anxiety disorder (7.1%). Compared to period before the COVID-19 pandemic, the prevalence of mood and anxiety disorders in the current sample was not significantly different. Conclusion Results of this study suggest that pregnant women may have not be under higher risk for mood and anxiety disorders during the COVID-19 pandemic compared to before the pandemic.

Purpose The study aimed to investigate efficacy of citalopram in pregnant women with panic disorder. Methods The study data with 22 patients were retrospectively collected from clinical registers. The study was conducted in patients with and without comorbid major depression. The patients were evaluated using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, the Clinical Global Impression-Improvement Scale, the Hamilton Depression Rating Scale, and the Hamilton Rating Scale for Anxiety. Findings The Hamilton Depression Rating Scale and the Hamilton Rating Scale for Anxiety scores were significantly reduced after treatment with citalopram at 20 mg/d for 8 weeks. The response rate based on Clinical Global Impression-Improvement Scale was 68.2%. Patients with comorbid major depression seemed to have a lower response rate compared with nondepressed patients. Implications The current study suggests that citalopram may be beneficial for in pregnant women with panic disorder.

Purpose This review examined the current literature about the potential relationship between the use of antidepressants during pregnancy and neonatal seizures. Methods PubMed was searched for English language reports published between January 1, 1996, and October 31, 2018, by using combinations of the following key words: pregnancy, neonatal outcome, neonatal convulsion, neonatal seizure, SSRI, selective serotonin norepinephrine reuptake inhibitor (SNRI), tricyclic antidepressant (TCA), antidepressants, sertraline, fluoxetine, paroxetine, citalopram, escitalopram, fluvoxamine, venlafaxine, mirtazapine, duloxetine, bupropion, amitriptyline, imipramine, and clomipramine. Findings A total of 9 relevant studies that met the review criteria were examined. The prevalence rates of neonatal seizures in the antidepressant groups and control groups were 0.30% to 0.91% and 0.10% to 0.30%, respectively. The use of selective serotonin reuptake inhibitors was associated with up to 5-fold increase in the risk of neonatal seizures. Compared with the controls, higher risks were reported in newborns of pregnant women using any antidepressant or tricyclic antidepressants albeit in a limited number of studies. Exposure to antidepressants in the third trimester of pregnancy appeared to be associated more with neonatal seizures compared with earlier exposure. Implicatons Although an increased risk of neonatal seizures in newborns antenatally exposed to antidepressants especially selective serotonin reuptake inhibitors may be suggested, the available studies have severe methodological limitations to enable any firm conclusion.

Background In this study, we aimed to investigate the course of obsessive-compulsive disorder (OCD) and the demographic and clinical correlates associated with significant changes in symptom severity in postpartum women. Methods Data were collected form 37 consecutive postpartum women who were diagnosed with OCD during psychiatric interviews by means of the Structured Clinical Interview for DSM-IV (SCID-I). Psychiatric assessments were carried out on the first day after delivery and at 6 to 8 weeks in the postpartum period. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was administered at both assessments while the Hospital Anxiety and Depression Scale (HADS), Coping orientation to problems Experienced (COPE) and Multidimensional Scale of Perceived Social Support (MSPSS) and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), were administered to the participants at the first assessment. Results The mean score of Y-BOCS was significantly reduced from the baseline to the 6–8 week postpartum period. The proportion of patients with a decreaseof at least 35% in the total score of Y-BOCS during the postpartum period was 43.2%. When the patient groups with and without ≥35% decrease in the total score of Y-BOCS were compared, the group showing the decrease had a higher score of COPE-supression of competing activities, COPE-humor and TEMPS-A-hyperthymic affective temperament and more frequently reported a decrease in the severity of OCD symptoms after a previous childbirth. Logistic regression analysis indicated that the last two variables could accurately predict a ≥ 35 decrease in the severity of OCD symptoms during the postpartum period. Limitations The study has relatively small sample size. Conclusions The current results suggest that patients with OCD who exhibit hyperthymic affective temperament character and a decrease in symptoms following a previous childbirth may experience a significant alleviation in the severity of obsessive-compulsive symptoms during the postpartum period.

Objective: We aimed to assess the association between cord blood brain-derived neurotrophic factor (BDNF) concentration and maternal depression during pregnancy. Methods: A total of 48 pregnant women, admitted for elective caesarean section to Department of Obstetrics and Gynecology, The Konya Research and Training Hospital and Konya Necmettin Erbakan University Meram Medical Faculty, were included in this study. The study group included 23 women diagnosed as having depression during pregnancy and the control group included 25 pregnant women who did not experience depression during pregnancy. Results: The groups had similar sociodemographic characteristics. Cord blood BDNF concentration was significantly lower in babies born to mothers with major depression as compared with those in the control group. We didn't find any correlation between the umbilical cord blood BDNF levels and BDI scores. Conclusion: The results suggest that the existence of major depression in pregnant women may negatively affect fetal circulating BDNF levels. © 2019 Korean College of Neuropsychopharmacology. All rights reserved.

Objective: To examine whether olanzapine and quetiapine are useful in the prevention of a new mood episode during the postpartum period. Methods: Data on 23 patients (n=14 for olanzapine and n=9 for quetiapine) with bipolar disorder who met the criteria for this study were retrospectively gathered. The diagnosis of bipolar disorder was determined by means of the DSM-IV. Results: The mean follow-up period was 33.95±12.07 weeks. Six (26.1%) of 23 patients experienced recurrent mood episodes during the postpartum period. Four of these six patients were taking olanzapine and two were taking quetiapine. Patients with recurrent mood episodes had a significantly stronger family history of bipolar disorder, higher number of past episodes, and earlier onset and longer duration of illness compared to patients without recurrent mood episodes. Conclusion: Monotherapy with olanzapine or quetiapine can be considered as an alternative to mood stabilizers in preventing the development of new mood episodes after childbirth.

Objective: The aim of this study was to examine the lactation status and prevalence of use of psychotropic medications in perinatal psychiatric patients. Methods: Clinical data collated for a period of 8 years were retrospectively retrieved from patient registers. The sample included a total of 263 postpartum patients who were followed up for at least 4 weeks. Psychiatric diagnoses were ascertained by a structured clinical interview. Results: The most commonly administered psychotropic medications were paroxetine (43.3%), sertraline (31.9%), olanzapine (12.2%), and quetiapine (6.1%). Of the 242 patients who received psychotropic medication, 41 (16.9%) discontinued breastfeeding. The discontinuation in most cases was not due to psychiatrist's recommendation or adverse events due to medications. Conclusion: Paroxetine and sertraline are frequently used by postpartum psychiatric patients in our clinical sample. In addition, the results suggesting that most psychiatric patients included in this study can continue breastfeeding during pharmacotherapy should be confirmed by data derived from further clinical samples.

This article reviewed the results of 21 recent meta-analyses examining the relationship between maternal use of antidepressants during pregnancy and negative outcomes in newborns and children. PubMed was searched for meta-analyses published in English between January 1, 2011, and November 30, 2019, by using combinations of the keywords pregnancy, antidepressants, review, meta-analysis, selective serotonin reuptake inhibitors, selective serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, neonatal outcomes, autism spectrum disorders, attention deficit hyperactivity disorder (ADHD), preterm birth, low birth weight, spontaneous abortion, persistent pulmonary hypertension, infant, newborn, children, and offspring. The present review included a total of 21 relevant meta-analyses that met the inclusion criteria. Most of the meta-analyses reported that compared to non-users, the risks of preterm birth, low birth weight, spontaneous abortion, persistent pulmonary hypertension, autism spectrum disorders, and ADHD in offspring of antidepressant users were significantly higher. Some meta-analyses also noted that the elevated risks were no longer statistically significant when pregnant women with psychiatric diagnoses treated with an antidepressant were compared with control patients who remained untreated. Although this review of current meta-analyses suggests a moderately increased risk of neonatal and childhood outcomes assessed with maternal use of antidepressants, it is difficult to ascertain whether these outcomes are independent of underlying maternal psychiatric disorders.

Objective: To investigate the course of panic disorder and its demographic and clinical correlates during the postpartum period. Methods: Data were collected from 38 consecutive postpartum women diagnosed with panic disorder. Psychiatric assessments were carried out on the first day after delivery and at 6-8 weeks postpartum. During the first assessment, the Panic and Agoraphobia Scale (PAS), Hospital Anxiety and Depression Scale (HADS), Coping Orientation to Problems Experienced (COPE), Multidimensional Scale of Perceived Social Support (MSPSS), and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were administered to the participants. PAS was also administered at the second assessment. Results: The mean PAS score reduced significantly from baseline to the second assessment. Logistic regression analysis indicated that a shorter duration of panic disorder independently predicted a ≥ 50-point decrease in the severity of panic symptoms during the postpartum period. Conclusion: These findings suggest that patients with a short duration of illness may experience significant alleviation in the severity of panic symptoms during the postpartum period.

Background Stroke patients with development of delirium have unfavorable outcomes, higher mortality, longer hospitalizations, and a greater degree of dependence after discharge. Studies suggest that delirium is associated with abnormal immunological responses and a resultant increase in inflammatory markers. Objective Our aim was to determine whether there is an entity relationship between delirium, inflammation and acute ischemic stroke (AIS). Methods Sixty AIS patients admitted to the hospital were consecutively recruited. Delirium was diagnosed with the clinical assessment according to the Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of Interleukin-1 beta (IL-1 beta), Interleukin 18 (IL-18), Tumor Necrosis Factor-alpha (TNF-alpha), Brain-Derived Neurotrophic Factor (BDNF), and Neuron Specific Enolase (NSE) at admission. Results Eleven (18.3%) of 60 patients were diagnosed with delirium, and the majority ( n = 8, 72.7%) was the hypoactive type. Delirious and non-delirious patients had similar demographic and clinical features. Delirious patients had significantly higher lengths of hospital stay, National Institutes of Health Stroke Scale (NIHSS) at admission and discharge compared to non-delirious patients. In addition, there was no significant statistical difference between delirious and non-delirious patients with AIS in respect of levels of TNF-alpha, IL-1 beta, IL-18, BDNF and NSE. This study suggests that delirium is not scarce in patients with AIS admitted to the non-intensive stroke unit, and that delirium developing after AIS seems not to be associated with serum TNF-alpha, IL-1 beta, IL-18, BDNF and NSE but is associated with length of hospital stay and stroke severity.

Background: Increased interest in the relationship between affective disorder and long-term health consequences has generated recent examinations of depression and stroke. Observations suggest that depressive disorder is associated with abnormal physiological and immunological responses and a resultant increase in inflammatory markers. Given the high prevalence of stroke and associated costs for the community, it is important to understand the mechanisms that may impact on the outcome to achieve the best possible prognosis. Aims: The view that inflammatory factors contribute to depression is predicated on findings that circulating cytokines and other inflammatory factors are increased in depressed patients. Therefore, it has been hypothesized that inflammation could be one of the mechanisms by which depression increases risk for ischemic stroke. Our aim was to determine whether there is any relationship between major depression and tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-18, brain-derived neurotrophic factor (BDNF), and neuron-specific enolase (NSE) in patients with acute ischemic stroke (AIS). Study Design: This was as a cross-sectional design. Materials and Methods: This study has a cross-sectional design, and it was conducted in Necmettin Erbakan University, the Meram Faculty of Medicine in Konya, Turkey, between 2014 and 2015. Fifty-three AIS patients admitted to the hospital within the first 24 h after stroke onset were recruited. Major depression was ascertained by means of the structured clinical interview for the diagnostic and statistical manual of mental disorders, Fourth Edition/Clinical Version. The enzyme-linked immunosorbent assay was used to measure the serum levels of TNF-α, IL-1 β, IL-18, BDNF, and NSE at admission. Results: A total of 53 patients with a mean age of 65.9 years were recruited. Of these patients, 17 (32.1%) had major depression. Depressive and nondepressive patients had similar demographical and clinical features. There was no significant statistical difference between depressive and nondepressive patients with AIS with respect to levels of TNF-α, IL-1 β, IL-18, BDNF, and NSE. Conclusion: This study suggests that in patients who have experienced AIS, there is no significant relationship between major depression and basal proinflammatory cytokines (TNF-α, IL-1 β, IL-18), BDNF, and NSE.

Purpose This study aimed to review the current literature examining a potential relationship between the use of antipsychotic drugs during pregnancy and gestational diabetes mellitus (GDM). Methods PubMed was searched for English language reports between January 1, 1996, and March 31, 2018, by using combinations of the following key words: antipsychotics, pregnancy, FGAs, SGAs, GDM, obstetric outcomes, pregnancy outcomes, obstetric complications, maternal complications, clozapine, olanzapine, risperidone, aripiprazole, amisulpirde, ziprasidone, quetiapine, haloperidol, chlorpromazine, zuclopenthixol, and flupenthixol. Studies but not case reports, case series, or reviews published in a peer-reviewed journal were eligible for inclusion. Results A total of 10 relevant studies that met the review criteria were examined. Data from these studies indicated that the prevalence rates of GDM in pregnant women using antipsychotic drugs and the nomedication group were 2.6% to 22% and 0.95% to 10.7%, respectively. Most comparative studies reported that antipsychotic treatment during pregnancy was not significantly associated with increased in risk of GDM. In addition, the study results also suggested that underlying maternal psychopathologies might affect the risk of GDM. Implications Findings from some studies suggesting a higher risk of GDM in pregnant women who were administered antipsychotic drugs were not confirmed by results of many other studies. The current evidence suggests no significant relationship between antipsychotic drugs, including second- and first-generation antipsychotics, and the risk of GDM.

Background Psychotropic drugs are frequently used to treat postpartum women with psychiatric diagnoses, especially psychotic disorder, major depression, and bipolar mood episodes. Pharmacotherapy in breastfeeding mothers is a major challenge. Study question This article presents a new safety scoring system for the use of psychotropic drugs during lactation. Study design The scoring system is based on the following 6 safety parameters: reported total sample, reported maximum relative infant dose, reported sample size for relative infant dose, infant plasma drug levels, prevalence of reported any adverse effect, and reported serious adverse effects. The total score ranges from 0 to 10. Higher scores represent a higher safety profile. Results According to this scoring system, sertraline and paroxetine, respectively, had the highest scores representing "very good safety profile." Citalopram, olanzapine, and midazolam were assigned to "good safety profile." Among drugs evaluated in this article, trifluoperazine, aripiprazole, amisulpride, clozapine, doxepin, zaleplon, and zolpidem are not recommended owing to safety scores ≤3. Conclusions Most psychotropic drugs examined in this article have "moderate" or "low" safety profile.

Obsessive-compulsive disorder (OCD) is frequently observed during pregnancy and the postpartum period. A major challenge in the management of OCD is the safety of the fetus and breastfed infants. Unfortunately, there are no randomized controlled studies to guide treatment of OCD in these periods. The present chapter presents the risks of untreated OCD and recommendations for pharmacological approach regarding treatment of active symptoms or prophylaxis during the perinatal period.

Lactating women may experience psychiatric disturbances such as depression, anxiety, and insomnia, which require benzodiazepines or Z-drugs for treatment. The most important aspect of treatment during the lactation period is to achieve balance between improvement of maternal psychiatric symptoms and safety of breastfed infants. If the decision to administer a benzodiazepine is made, lorazepam appears to be the most preferable agent with respect to the safety of infants. Limited available data suggest that zaleplon, zopiclone, and zolpidem may be compatible with breastfeeding. These medications should be used at as low doses as possible and for a short time. Moreover, the infants exposed to these drugs via breast milk should be carefully monitored.

Aim: Because of the fact that the frequency of both anxiety disorders and premenstrual dysphoric disorder (PMDD) are high in women and that studies investigating PMDD comorbidity in patients diagnosed with anxiety disorder are limited, this study was aimed to investigate PMDD comorbidity and related factors in patients with anxiety disorders. Materials and Methods: 183 subjects who were followed up with a diagnosis of anxiety disorder in Necmettin Erbakan University Meram Medical Faculty Psychiatry Outpatient Clinic were included in the study and were evaluated with Sociodemographic Data Form, Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). PMDD comorbidity was investigated according to The Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV-TR) criteria by making psychiatric interviews. Results: 57 (31.2%) of 183 subjects diagnosed with PMDD constituted the PMDD group and the remaining 126 patients constituted the non-PMDD group. The mean BAI scores of the PMDD group were significantly higher than those of the non PMDD group, whereas the mean age of the PMDD group was significantly lower than that of the non PMDD group. The BMI of the PMDD group was significantly higher than that of the non PMDD group. Conclusion: PMDD is common in patients followed up with a diagnosis of anxiety disorder and what is associated with PMDD is be young age as well as excessive chocolate consumption.

PURPOSE This study examined the prevalence of major depression and generalized anxiety disorder (GAD) in pregnant women with and without a diagnosis of oligohydramnios. DESIGN AND METHODS The study sample included 53 pregnant women with a diagnosis of oligohydramnios and 80 healthy pregnant women subjects. Major depression and GAD were diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). FINDINGS Pregnant women with oligohydramnios had higher scores of depressive and anxiety symptom, and a higher prevalence rate of major depression (24.5% vs. 6.2%) and GAD (30.2% vs. 3.2%). PRACTICE IMPLICATIONS The results of the present study suggest that oligohydramnios appears to be associated with both major depression and GAD in pregnant women.

Peripheral edema is observed as an adverse effect of the usage of antipsychotics in the literature. This case report describes a 36-year-old female patient with the diagnosis of paranoid schizophrenia who presented with pretibial edema following initiation of long-acting injectable paliperidone palmitate. Pretibial edema developed within the second week of treatment and completely disappeared after its discontinuation.

Objective This review examined the efficacy of mood stabilizers and antipsychotics in patients with bipolar disorder during pregnancy and the postpartum period. Methods PubMed was searched for reports between 01 January 1996 and 31 December 2019 by using combinations of key words bipolar disorder, pregnancy, postpartum period, puerperium, prophylaxis, mood stabilizers, antipsychotics, lithium, lamotrigine, valproate, carbamazepine, oxcarbazepine, olanzapine, risperidone, quetiapine, aripiprazole, haloperidol, and chlorpromazine. Results The present reports included a total of 256 patients using lithium (n = 143), lamotrigine (n = 73), valproate (n = 17), olanzapine (n = 17), quetiapine (n = 4) and haloperidol (n = 1) during pregnancy or the postpartum period. Recurrence rates in pregnant patients using lithium (n = 79) and lamotrigine (n = 17) were 22.7 % and 41.2 %, respectively. According to very limited data, none of the patients using valproate (n = 2), quetiapine (n = 3) or olanzapine (n = 6) experienced a new episode during pregnancy. A recurrence was reported in 12 (70.6 %) of 17 patients using valproate during the postpartum period. The same recurrence rates in patients using lithium (n = 123), lamotrigine (n = 63), olanzapine (n = 17) and quetiapine (n = 3) were 20.3 %, 7.9 %, 11.7 %, and 33.3 %, respectively. Conclusions This review suggests that lithium, lamotrigine and olanzapine seem to be effective in preventing new mood episodes in patients with bipolar disorder during the perinatal period.

Serotonin syndrome is an important clinical condition that can occur after excessive central serotonergic activity, generally secondary to the use of combinations of antidepressants. Selective serotonin reuptake inhibitors and bupropion are frequently used in the treatment of major depression in clinical practice. Few cases of serotonin syndrome due to the use of serotonergic antidepressants and bupropion have been reported in the literature. The current case report presents a patient who underwent the serotonin syndrome after the administration of paroxetine and bupropion.

Antipsychotic medications are frequently used in clinical practice. Clozapine is considered to be the most effective antipsychotic treatment in patients with treatment-resistant schizophrenia. Although clozapine has been available in the market for a long time, safety data on its usage during the lactation period are very limited. The current report presents the short-term clinical outcome of infants exposed via breastfeeding to maternal clozapine at 75-mg/day.

This study aimed to compare pregnant and non-pregnant women in terms of the current prevalence of mood and anxiety. The study sample included 1154 women evaluated on the first day postpartum and 328 control subjects. Mood and anxiety disorders were determined by structured psychiatric interview. The prevalence rate of any mood or anxiety disorder was 18.2% during pregnany. Generalized anxiety disorder, obsessive-compulsive disorder, panic disorder and comorbidity among anxiety disorders were more prevalent during pregnancy compared to the control subjects. The present results suggest that pregnant women may be at increased risk of depression and anxiety disorders.

Objective The objective of the present study was to compare neonatal outcomes including gestational age, birth weight and hospitalization of newborns of pregnant women with treated with antidepressants and untreated panic disorder. Methods The study sample included 146 pregnant women (44 patients with panic disorder treated with antidepressants, 52 patients with untreated panic disorder, and 50 healthy controls). Panic disorder was diagnosed by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Results The highest proportions of preterm birth (28.8%), low birth weight (34.6%) and requirement of neonatal care (25.0%) were observed in infants of untreated patients. Pharmacotherapy group and control subjects had similar neonatal outcomes. Compared with infants of healthy subjects and the pharmacotherapy group, infants of untreated patients had significantly lower birth weight and gestational age at delivery. In addition, newborns of untreated patients had higher rate of hospitalization at the neonatal care unit. Conclusion Our results suggest that treatment with pharmacotherapy of panic disorder during pregnancy may have beneficial effects on the risk of negative neonatal outcomes due to maternal panic disorder in the infants.

This study reviewed the current literature examining the potential relationship between use of antidepressants during pregnancy and attention-deficit/hyperactivity disorder (ADHD) in children.PubMed was searched for English language reports between January 1, 1995, and July 31, 2017, by using combinations of the key words pregnancy, antidepressants, selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), children, offspring, and ADHD. Studies that reported association between ADHD in children and use of antidepressant in pregnant women were included in the review.A total of 7 relevant studies that met the review criteria were examined. The studies reported that compared with nonusers adjusted risks of ADHD in children were 1.2 to 1.6 for the use of any antidepressant, 0.91 to 1.66 for selective serotonin reuptake inhibitors, 1.1 to 1.4 for selective serotonin-norepinephrine reuptake inhibitors, and 1.1 to 1.8 for tricyclic antidepressants. There was some scientific evidences suggesting a connection between antidepressant use during all trimesters of pregnancy and increased risk of ADHD in children. In addition, the study results suggest that underlying maternal anxiety or depressive disorders may also contribute to increased risk of ADHD.Although some studies have suggested a moderately increased risk of ADHD in children with maternal antidepressant use during pregnancy, based on limitations and results of the studies, this review concluded that there is no strong evidence to suggest a causal link.

The aim of this study was to investigate the efficacy of prophylactic treatment with antidepressants for the prevention of postpartum exacerbation in depressive or anxiety symptoms. The study included data on 33 patients who were followed from pregnancy to the postpartum period at the Department of Psychiatry of a university Hospital. Psychiatric diagnoses were determined by means of a structured clinical interview. The severity of depressive and anxiety symptoms were assessed by means of Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A), respectively. Prophylactic treatment was initiated within the first 3 days after the delivery. The patients were assessed again with HAM-D and HAM-A at 4-week postpartum. Postpartum prophylaxis was carried out with administration of sertraline at 50 mg/day (n = 7, 21.2%), paroxetine at 20 mg/day (n = 24, 72.7%), and escitalopram at 10 mg/day (n = 2, 6.1%). Statistical analyses indicated that the mean HAM-D and HAM-A scores before (9.45 ± 7.01 and 10.09 ± 6.42, respectively) and after (9.09 ± 6.65 and 9.54 ± 5.97, respectively) the delivery were not significant. Results of the present study suggest that prophylactic use of antidepressants following parturition may be useful in the prevention of postpartum exacerbation of symptoms in women with depression or anxiety disorders.

Schizophrenia and related psychoses are characterized by high recurrence rates and a serious impact on social functions. Many patients with these conditions, therefore, require prophylactic treatment during the postpartum period. Antipsychotic medication is the main treatment strategy for these disorders. Compared with single use of antipsychotics, data on the safety of combined antipsychotics on the breastfed infants are very limited. The current report presents adverse events in an infant exposed to a combination of risperidone and haloperidol through breast milk.

Selective serotonin reuptake inhibitors (SSRIs), especially sertraline and paroxetine, are first-line antidepressants in the treatment of postpartum depression in breastfeeding women as these drugs are well tolerated by most breastfed infants. Although some women with these diagnoses require additional antidepressants to SSRIs, the safety of combined usage of SSRIs and mirtazapine is currently unknown. This report includes short-term safety data of breastfed infants exposed to paroxetine plus low-dose mirtazapine.

Postpartum depression is frequently observed in women. First-line antidepressants in treatment of postpartum depression are selective serotonin reuptake inhibitors (SSRIs). Although SSRIs are well tolerated by most breastfed infants, some adverse events may arise in exposed infants. This report presents the case of an infant of a breastfeeding woman using citalopram without any problem after sertraline and paroxetine were discontinued due to adverse events in the infant.

WOS:000362920300006, Objective: The prevalence rate of obsessive-compulsive disorder (OCD) was found to be higher in women during pregnancy and puerperium than that estimated in the general population. Additionally, the symptomatology of OCD shows several variations during the lifetime of women. Objective of the current study was to examine the clinical characteristics and comorbidity with other anxiety and mood disorders of pregnancy-onset obsessive-compulsive disorder (POCD) and to investigate factors related to POCD. Method: The study sample was composed of three groups. The first group (POCD group) included 20 consecutive pregnant women meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for OCD, showing an onset of OCD during their current pregnancy. The second group (non-OCD group) consisted of 207 consecutive pregnant women without any mood or anxiety disorders to assess factors associated with POCD. In addition, the study included a control group to compare the symptoms of POCD and non-pregnancy-onset OCD. The control group was composed of 40 nonpregnant female outpatients with OCD. Type and severity of obsessive-compulsive symptoms were assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). OCD and other anxiety or mood disorders were determined by means of the Structured Clinical Interview for DSM-IV (SCID-I). Comorbid axis II disorders were diagnosed with the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Results: The mean onset time of OCD in the POCD group was 13.3±6.35 (week5-28) gestational weeks. OCD occurred during the first trimester of pregnancy in 9 women (45%), during the second trimester in 10 (50%) women, and during the third trimester in 1 (5%) woman. The most common obsessions were contamination (n16, 80%) and symmetry/exactness (n6, 30%), and the most common compulsions were cleaning/ washing (n16, 80%) and checking (n12, 60%) in POCD. Thirteen (65%) of the pregnant OCD patients met the criteria for a mood or anxiety disorder. Generalized anxiety disorder was the most frequently diagnosed axis I disorder (40%, n8). The independent factors associated with POCD were cigarette smoking (p0.002), the existence of an anxiety disorder at onset of pregnancy (p0.000), and obsessive-compulsive personality disorder (p0.003). Conclusion: The present study suggests that POCD presents similar clinical characteristics with nonpregnancy-onset OCD. Mood or anxiety disorder comorbidity is observed in more than half of the women with POCD. Additionally, pregnant women who have at least one of 3 factors (cigarette smoking, the existence of an anxiety disorder at onset of pregnancy, and obsessive-compulsive personality disorder) seem to be at risk for POCD.

The management of bipolar disorder in pregnant and postpartum women is one of the most difficult issues in clinical practice. Data on the efficacy of mood stabilizers, except lithium and antipsychotics, in the maintenance treatment of bipolar disorders during pregnancy and postpartum period are very limited. This report presents results of prophylaxis with olanzapine and quetiapine with regard to affective episodes in pregnancy to the postpartum period.

Primary pharmacological agents for depression and anxiety disorders are antidepressants, especially selective serotonine reuptake inhibitors. The aim of this study was to examine the features and prevalence of adverse effects of paroxetine and sertraline in breastfed infants.The study had a retrospective cohort design. Five-year clinical data of 72 patients were included in the study. Psychiatric diagnoses were ascertained by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.The prevalence rate of adverse events in the infants was 12.5%. Insomnia (88.9%), restlessness (55.6%), and constant crying (22.2%) were the most frequent adverse events. A switch between paroxetine and sertraline performed in five patients, who reported an adverse event in their breastfed infants, resulted in cessation of the adverse events.The results suggest that the prevalence rate of adverse events in the infants exposed to sertraline or paroxetine is relatively low and mostly mild.

Manic episodes of bipolar disorder and psychotic exacerbations of schizophrenia, for which the antipsychotic drugs are most commonly prescribed, are frequently seen in the postpartum period. Despite the existence of single use of antipsychotics, data on safety of combined antipsychotics on the breastfed infants are limited. This report presents the clinical outcome of 2 infants exposed to combined antipsychotic during the lactation period.

Objective The relationship between maternal psychiatric disorders and fetal neurodevelopment is unclear. Obsessive–compulsive disorder (OCD) is relatively frequent during pregnancy. The study aimed to investigate whether maternal OCD during pregnancy affects fetal circulating tumor necrosis factor-alpha (TNF-α) levels, an important pro-inflammatory cytokine, by comparing cord blood TNF-α levels in newborn infants of women with and without OCD. Methods The study sample included 7 women with OCD and 30 healthy women. OCD and other psychiatric diagnoses were screened by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The blood sample for the determination of TNF-α level was obtained from the umbilical cord during delivery. Results Cord blood TNF-α levels in newborn infants exposed to maternal OCD were significantly higher compared to non-exposed infants. Maternal anxiety symptom level was found to positively correlate with cord blood TNF-α levels in newborn infants of women with OCD. Conclusion The study results imply that maternal OCD during pregnancy may lead to neuroinflammation in the developing fetal brain through higher levels of circulating TNF-α.

Objective It is unclear whether antidepressant treatment has a preventive effect on negative neonatal outcomes due to major depression in pregnant women. The objective of the present study was to compare women with major depression treated with antidepressants, untreated women with major depression, and healthy women during pregnancy with respect to birth weight and preterm birth. Methods The study sample included a total of 23 women taking antidepressant medication, 36 women who were not taking antidepressant medication for major depression during pregnancy, and 30 healthy women. Major depression was diagnosed via the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Results The study groups were similar with respect to sociodemographic characteristics. Compared with infants of healthy control subjects, infants of untreated major depressed women had significantly lower birth weight and shorter gestational age at delivery. There is no significant difference between infants of major depressed women treated with antidepressants and infants of healthy subjects for these variables. Conclusions Our results suggest that antidepressants may have beneficial effects on the risk of low birth weight and preterm birth in the infants of depressed women.

Objective Hypertension in pregnant women is an important medical problem, which can cause morbidity and mortality in the fetus. This study reviewed the current literature examining the potential relationship between use of antidepressants during pregnancy and preeclampsia or gestational hypertension. Methods PubMed was searched for English-language reports between January 1, 1995, and December 31, 2015, by using combinations of key words pregnancy, pregnancy complications, preeclampsia, gestational hypertension, and antidepressants. Studies that reported the diagnosis of preeclampsia or gestational hypertension and use of antidepressant were included in the review. Results A total of 7 relevant studies that met the review criteria were examined. The studies reported that compared with nonusers adjusted relative risk of preeclampsia or gestational hypertension in antidepressant users was 1.28 to 1.53 for any antidepressant, 1.05 to 3.16 for selective serotonin reuptake inhibitors, 1.49 to 1.95 for selective serotonin-norepinephrine reuptake inhibitors, and 0.35 to 3.23 for tricyclic antidepressants. Consistently, antidepressant use during the second trimester of pregnancy was associated with increased risk of preeclampsia or gestational hypertension. However, possible contribution of severity, type, and comorbidity of underlying anxiety or depressive disorders is unclear in the current studies. Conclusions Although some studies have suggested a moderately increased risk in pregnancy-specific hypertensive disorders with antidepressant treatment, the current data do not allow a definitive conclusion on this topic, because the studies have many methodological limitations. In addition, the effects of untreated depression or anxiety disorders cannot be disentangled from the results.

Objective: The incidence of mild to severe levels of spontaneous bleeding due to the usage of selective serotonin reuptake inhibitors (SSRIs) is relatively low. Although the exact mechanism is not known, it is thought that inhibition of the serotonin transporter together with a decrease in platelet serotonin could be responsible for the bleeding. Therefore, the use of SSRIs in conjunction with anti-aggregants may predispose to or exacerbate the risk of bleeding. In this case report, we describe a 44-year-old female patient with a diagnosis of anxiety disorder who spontaneously developed periorbital purpura during treatment with sertraline. Conclusion: Abnormal bleeding after treatment with an SSRI should be kept in mind, and alternative non-SSRI drugs of choice in such cases would be more appropriate. More extensive and comprehensive studies focusing on hemostasis and bleeding disorders are needed for SSRIs such as sertraline.