在怀孕前和怀孕期间切换抗抑郁药的模式和剂量调整
Robiyanto Robiyanto1,2, Marjolein Roos3, Jens H J Bos3
1Unit of PharmacoTherapy, Epidemiology, & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands. r.robiyanto@rug.nl.
Archives of women's mental health
|August 5, 2023
概括
越来越多的孕妇在整个怀孕期间继续服用抗抑郁药物,特别是SSRI和SNRI. 很少有转换药物,剂量调整是最小的,符合荷兰的指导方针.
科学领域:
- 药物监督 药物监督 药物监督
- 生殖健康 生殖健康
- 临床药房 临床药房
背景情况:
- 在怀孕期间使用抗抑郁药会导致复杂的临床决策.
- 了解药物模式对于孕产妇和胎儿的健康至关重要.
- 荷兰国家指导方针为孕妇抗抑郁药物管理提供了信息.
研究的目的:
- 分析怀孕妇女的抗抑郁药 (AD) 切换模式和剂量调整.
- 评估从怀孕前到怀孕期间的AD延续和停止的趋势.
- 评估与荷兰国家指导方针相关的药物管理.
主要方法:
- 对已开出的抗抑郁药处方进行了回顾性分析.
- 使用了来自格罗宁根大学的IADB.nl怀孕子集.
- 评估了2001-2020年期间的继续,停止和转换率.
- 计算了定义每日剂量 (DDD) 的平均值,并使用对对 t 测试来检测剂量变化.
主要成果:
- 在2001-2005年至2016-2020年期间,AD延续率,特别是SSRI和SNRIs,显著增加.
- 在整个研究期间,抗抑郁药物转换率保持在持续较低的水平 (2.0% - 2.3%).
- 大多数女性继续接受怀孕前的抗抑郁药单一治疗,剂量调整最小 (<10%的DDD变化).
- 在单独怀孕中持续使用SSRI在研究持续时间内翻了一番.
结论:
- 孕妇通常更愿意保持他们既定的抗抑郁药治疗,而不是切换药物.
- 低的切换率和轻微的剂量修改表明在怀孕期间治疗的稳定性.
- 这些发现与荷兰国家关于在怀孕期间使用抗抑郁药物的建议一致.
相关概念视频
01:23Antidepressant Drugs: MAOIs and Other Agents
274
Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
274
01:28Antidepressant Drugs: Tricyclics, SSRIs, and SNRIs
438
Tricyclic Antidepressants (TCAs), including Desipramine (Norpramin), Imipramine (Tofranil), Clomipramine (Anafranil), and Amitriptyline (Elavil), inhibit serotonin and norepinephrine reuptake and also block other receptors. They are used for depression, pain conditions, and insomnia. Common adverse effects include anticholinergic effects, sedation, orthostatic hypotension, and weight gain. They have a narrow therapeutic window and so require plasma-level monitoring. Abrupt discontinuation can...
438
01:25Antidepressant Drugs: Overview
570
Antidepressant drugs are a class of medications primarily used for treating various mood disorders, including major depression, anxiety disorders, and other related conditions. These medicines work by modulating the neurotransmitter balance within the brain, alleviating depressive symptoms. Antidepressants can be broadly categorized into several groups according to their mechanism of action and chemical structure: Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine...
570
01:23Nonlinear Pharmacokinetics: Dependence of Elimination Half-Life and Dose Clearance
197
The elimination half-life and drug clearance of drugs following nonlinear kinetics can vary with dosage. The Michaelis-Menten parameters and drug concentration influence these factors. As the dose increases, the elimination half-life tends to lengthen, resulting in a reduction in clearance and a disproportionately larger area under the curve. The total clearance can be derived from the Michaelis-Menten equation for drugs following a one-compartment model.
A study on guinea pigs examined the...
A study on guinea pigs examined the...
197
01:21Factors Affecting Drug Response: Overview
2.0K
When it comes to infants and young children, they are typically administered smaller doses of medication in comparison to adults. This is primarily because their organ functions still need to fully develop, meaning their bodies are not as efficient at metabolizing or eliminating drugs. Additionally, their blood-brain barrier is more permeable than in adults. As a result, high concentrations of drugs can easily penetrate the central nervous system (CNS), potentially leading to neurological...
2.0K
01:24Mania and Antimanic Drugs: Overview
238
Mania, a psychological condition characterized by elevated mood, increased energy, and reduced sleep need, is part of the bipolar disorder cycle. The exact cause of mania isn't entirely known, but it is thought to be a combination of genetic, environmental, and neurological factors. Bipolar disorder involves alternating manic and depressive episodes. Mood stabilizers like lithium, antipsychotics, and anticonvulsants help manage these episodes. Lithium carbonate is particularly effective as...
238