Returning to tricyclic antidepressants for depression during childbearing: Clinical and dosing challenges

Lauren M. Osborne*, Catherine A. Birndorf, Lauren E. Szkodny, Katherine L. Wisner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Managing depression and anxiety during pregnancy and the postpartum period is challenging. Both pharmacological treatment and the lack thereof can pose threats to a fetus. SSRIs are the drugs of choice for use during pregnancy, but there is considerable evidence for the safety and efficacy of older antidepressants during pregnancy as well. This study highlights a single case of the use of the tricyclic nortriptyline during pregnancy and postpartum. The subject involved had an unexpectedly high ratio of serum level to drug dose during the postpartum period. We monitored the subject for a significantly greater portion of the postpartum period than has been done in previous studies, and explored medical and lifestyle changes that could account for the level-to-dose ratios we observed. Differences in smoking patterns, coupled with the patient's status as a genetic poor metabolizer, were the most likely explanations.

Original languageEnglish (US)
Pages (from-to)239-246
Number of pages8
JournalArchives of Women's Mental Health
Volume17
Issue number3
DOIs
StatePublished - Jun 2014

Keywords

  • Anxiety
  • Depression
  • Nortriptyline
  • Pharmacokinetics
  • Pregnancy
  • Tricyclic antidepressants

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Psychiatry and Mental health

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