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Objective: Studies about obsessive-compulsive disorder (OCD) during the postmenopausal period have been insufficient. The purpose of the current study was therefore to examine the prevalence rate, clinical characteristics, and comorbidity of OCD in postmenopausal women. Methods: A total of 269 consecutive postmenopausal women admitted to a gynaecology outpatient clinic were included in the study. OCD and comorbid disorders was diagnosed by means of the Structured Clinical Interview for DSM-IV. The Yale-Brown Obsessive- Compulsive Scale was used to determine the types of obsessions and compulsions. Results: The prevalence rate of OCD was 7.1% in the sample. Two women (0.7%) reported that OCD developed during the postmenopausal period. The most common obsessions were contamination and symmetry/exactness, whereas the most common compulsions were cleaning/washing and checking. OCD was unrelated to variables examined in the present study. The comorbidity rate of other psychiatric disorders was 63.2% in OCD patients. The most common comorbid disorder was generalized anxiety disorder. Conclusions: OCD was not rare in postmenopausal women admitted to a gynaecology outpatient clinic. In addition, OCD appears to be frequently comorbid with depressive or other anxiety disorders in the postmenopausal period. [ABSTRACT FROM AUTHOR]

Objective: There are three aims of this study:- 1) to examine the incidence of interferon alpha (IFN-a) induced major depression, 2) to examine theassociations between IFN-a induced major depression and clinical and sociodemographic characteristics and 3) to examine the impact of IFN-a on the quality of life in patients with chronic hepatitis C virus infection.Method: Thirty-six patients with chronic hepatitis C virus infection were evaluated by using the Structured Clinical Interview for DSM-IV, the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS) and the World Health Organization Quality of Life Scale-Brief (WHOQOL-BREF) before the treatment and 8 weeks after interferon alpha treatment.Results: Major depression developed in 10 (27.8%) of 36 patients during treatment with IFN-a. During the IFN-a treatment, HDRS and HARS scoressignificantly increased, and WHOQOL-BREF subscale scores of physical health, psychological health and environment significantly decreased. It was found that HDRS scores significantly increased in patients receiving IFN-a even if major depression did not develop at 8 weeks after the treatment. IFN-a induced major depression was associated with higher basal scores of HDRS and HARS, and lower basal scores of WHOQOL-BREF.Conclusion: IFN-a treatment is associated with an increased risk for major depression and it has a negative effect on the quality of life in patients with chronic hepatitis C virus infection. The mental status of all patients were evaluated before and after the IFN-a treatment. [ABSTRACT FROM AUTHOR]

Objective. This study aims to investigate the current prevalences of mood and anxiety disorders, as well as the sociodemographic and clinical features associated with these disorders in multiple sclerosis (MS). Method. A total of 74 patients with relapsing-remitting MS (42 patients in exacerbation phase, 32 patients in remission phase) were included in the study. Mood and anxiety disorders were diagnosed by means of the Structured Clinical Interview for DSM-IV (SCID-I). The Expanded Disability Status Scale (EDSS) was used to determine degree of disability due to MS. Results. Forty-five (60.8%) patients met the criterion of at least one mood or anxiety disorder. Major depression (33.8%) was the most common psychiatric diagnosis. Generalized anxiety disorder (18.9%), specific phobia (18.9%) and obsessive-compulsive disorder (OCD) (14.9%) were other frequent psychiatric disorders. Major depression, panic disorder and OCD were significantly more common among patients in the exacerbation phase compared to patients in the remission phase. The predictors of any depressive disorder were presence of exacerbation phase of MS and higher disability level, and the predictors of any anxiety disorder were presence of exacerbation phase of MS and shorter disease duration. Conclusions. Our results suggest that the patients with relapsing-remitting MS, particularly during exacerbation phase have high prevalence of mood and anxiety disorders. [ABSTRACT FROM AUTHOR]

We presented the results on the efficacy of paroxetine in postpartum women with generalized anxiety disorder (GAD) in current study. We included data on 33 patients to our study retrospectively. 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 (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A). The patients had significant improvement in both HAM-D and HAM-A scores following paroxetine treatment for 8 wk. The response and remission rates were 78.8 and 63.6%, respectively. Both rates were significantly higher the subgroup of patients without comorbid depression compared to patients with comorbid depression. Based on the findings of the present study, we suggest that paroxetine may be beneficial for in postpartum women with GAD.

Abstract: Many women with bipolar disorder experience episodes of illness or relapses over the perinatal period, especially in the immediate postpartum period. Risks associated with treated/untreated psychopathologies and fetal exposure to bipolar medications make the management of bipolar disorder during these periods challenging for clinicians and patients. In light of the available effectiveness and reproductive safety data, the current clinical update based on the opinions of a group of international perinatal psychiatry authors recommends general considerations and specific management strategies for each possible clinical scenario, including mixed features, predominant polarity, diagnosis of subtypes of bipolar disorder, severity of previous episodes, and risk of recurrence of mood episodes., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The prescription of antidepressant drugs during pregnancy has been steadily increasing for several decades. Meta-analyses (MAs), which increase the statistical power and precision of results, have gained interest for assessing the safety of antidepressant drugs during pregnancy., Objective: We aimed to provide a meta-review of MAs assessing the benefits and risks of antidepressant drug use during pregnancy., Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search on PubMed and Web of Science databases was conducted on 25 October, 2021, on MAs assessing the association between antidepressant drug use during pregnancy and health outcomes for the pregnant women, embryo, fetus, newborn, and developing child. Study selection and data extraction were carried out independently and in duplicate by two authors. The methodological quality of included studies was evaluated with the AMSTAR-2 tool. Overlap among MAs was assessed by calculating the corrected covered area. Data were presented in a narrative synthesis, using four levels of evidence., Results: Fifty-one MAs were included, all but one assessing risks. These provided evidence for a significant increase in the risks for major congenital malformations (selective serotonin reuptake inhibitors, paroxetine, fluoxetine, no evidence for sertraline; eight MAs), congenital heart defects (paroxetine, fluoxetine, sertraline; 11 MAs), preterm birth (eight MAs), neonatal adaptation symptoms (eight MAs), and persistent pulmonary hypertension of the newborn (three MAs). There was limited evidence (only one MA for each outcome) for a significant increase in the risks for postpartum hemorrhage, and with a high risk of bias, for stillbirth, impaired motor development, and intellectual disability. There was inconclusive evidence, i.e., discrepant results, for an increase in the risks for spontaneous abortion, small for gestational age and low birthweight, respiratory distress, convulsions, feeding problems, and for a subsequent risk for autism with an early antidepressant drug exposure. Finally, MAs provided no evidence for an increase in the risks for gestational hypertension, preeclampsia, and for a subsequent risk for attention-deficit/hyperactivity disorder. Only one MA assessed benefits, providing limited evidence for preventing relapse in severe or recurrent depression. Effect sizes were small, except for neonatal symptoms (small to large). Results were based on MAs in which overall methodological quality was low (AMSTAR-2 score = 54.8% ± 12.9%, [19-81%]), with a high risk of bias, notably indication bias. The corrected covered area was 3.27%, which corresponds to a slight overlap., Conclusions: This meta-review has implications for clinical practice and future research. First, these results suggest that antidepressant drugs should be used as a second-line treatment during pregnancy (after first-line psychotherapy, according to the guidelines). The risk of major congenital malformations could be prevented by observing guidelines that discourage the use of paroxetine and fluoxetine. Second, to decrease heterogeneity and bias, future MAs should adjust for maternal psychiatric disorders and antidepressant drug dosage, and perform analyses by timing of exposure., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

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., (Copyright © 2022 Elsevier Inc. 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: 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., Competing Interests: Financial Disclosure Hanan El Marroun disclosed that she received a NARSAD Young Investigator Grant 27853 from the Brain & Behavior Research Foundation. Money was paid to her institution under grant agreement 733206 (LifeCycle) from the European Union's Horizon 2020 Research and Innovation Program and from Erasmus University Rotterdam Fellowship 2014. They also disclosed receiving funding from Stichting Volksbond Rotterdam, ongoing, paid to the institution. Frank M.M.A. van der Heijden disclosed receiving funding from Janssen-Cilag, and Recordati. J. Jo Kim disclosed their institution received funding from the Patient-Centered Outcomes Research Institute and the National Institute of Mental Health. Marius Lahti-Pulkkinen received funding from the Academy of Finland. Dawn Misra disclosed receiving funding from the NIH. Kate E. Pickett disclosed that money was paid to her institution from UKRI and Wellcome Trust. Henning Tiemeier disclosed money was paid to their institution from the Dutch Research Medical Council. Heather J. Zar disclosed that money was paid to her institution from the Bill & Melinda Gates Foundation and the SA MRC. The other authors did not report any potential conflicts of interest., (Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

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., Competing Interests: Conflict of Interest: The author has no conflict of interest to declare., (© Copyright 2021 authors.)

Objective: This study aimed to examine the role of central and peripheral neuropeptides in olanzapine-induced weight gain and metabolic changes., Materials and Methods: Thirty patients who would receive olanzapine treatment were evaluated at the beginning of the treatment at the 2 nd and 8 th weeks. Weight, waist circumference, the central neuropeptides pro-opiomelanocortin (POMC) and neuropeptide Y (NPY), and the peripheral adipokine leptin and the peripheral peptide cholecystokinin (CCK) levels were measured in each control. In addition, biochemical parameters such as fasting blood glucose (FBG), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total and direct bilirubin, very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, and triglyceride (TG) were measured., Results: There were statistically significant differences weight and waist circumference levels compared to the initial levels. As observed in previous studies in the literature, changes in biochemical parameters including AST, ALT, total and direct bilirubin, LDL, TG, total cholesterol, and HDL levels were statistically significant. Levels of the neuropeptides POMC and NPY tended to increase at early stages and decrease at later stages of the treatment, while CCK and leptin levels kept increasing throughout the treatment period. The changes in POMC and CCK levels were statistically significant., Conclusion: The results suggest that POMC and CCK may play a role in olanzapine-related weight gain., (2021 authors.)

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., (© 2020, The American College of Clinical Pharmacology.)

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.

Objective: To evaluate the efficacy of cognitive behavioral therapy in the treatment of generalized anxiety disorder during pregnancy and its effects on gestational age and birth weight., Methods: The sample included 28 untreated patients and 23 patients treated with CBT. Psychiatric diagnoses were determined through the Structured Clinical Interview for the DSM-IV. Symptom severity was assessed with standardized rating scales., Results: Post-treatment levels of anxiety symptoms were significantly lower than baseline. There was no significant difference in gestational age or newborn birth weight between the cognitive behavioral therapy group and the untreated group., Conclusions: Cognitive behavioral therapy appears to be a safe and effective treatment for generalized anxiety disorder during pregnancy.

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., Competing Interests: The author has no conflict of interest to declare., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

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: PubMed was searched for meta-analyses published in English language between January 2010 and April 2020 by using the following combinations of key words: meta-analysis, pregnancy, antidepressant, SSRI, citalopram, escitalopram, fuloxetine, paroxetine, sertraline, fluvoxamine, neonatal outcome, birth outcome, congenital malformation, congenital anomaly, birth defect, cardiac malformation and heart defect. Results: A total of 15 meta-analyses met the search criteria. These meta-analyses consistently suggested a significant positive association between the use of SSRIs in general and paroxetine and fluoxetine in particular and the risk of major congenital anomalies. The data also showed a consistency in increased cardiovascular defects in infants due to maternal use of paroxetine. The risk of cardiovascular defects in infants of women using SSRIs in general and fluoxetine and sertraline in particular was controversial. Conclusion: Further large-scale prospective observational studies and meta-analyses on the effects of individual SSRIs other than paroxetine, especially escitalopram and fluvoxamine, are required to reach definitive conclusions.

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.

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., (Copyright © 2020 Elsevier B.V. All rights reserved.)

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.

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., (Copyright © 2019. Published by Elsevier B.V.)

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.

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.

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.

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., (Copyright © 2019 Elsevier B.V. All rights reserved.)

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.

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.

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.

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., (Copyright © 2018 Elsevier B.V. All rights reserved.)

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., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: This study reviewed the current literature examining the potential relationship between use of antidepressants during pregnancy and attention-deficit/hyperactivity disorder (ADHD) in children., Methods: 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., Results: 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., Implications: 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.

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.

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.

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., (© 2016 Wiley Periodicals, Inc.)