Antidepressants, Anxiolytics, Hypnotics

Question 1

***Sertraline vs a past effective antidepressant. Which do you choose?

Answer 1

-sertraline perferred due to being well studied and having safety profiles
-HOWEVER: if a woman is taking an effective antidepressant that is NOT sertraline, SWITCHING IS DISCOURAGED

Question 2

***Why is switching from an effective antidepressant to one more studied discouraged?

Answer 2

-more studied one may not work for mom
-baby then exposed to untreated mental illness AND risks of medication

Question 3

***Venlafaxine DOES NOT likely increase:

Answer 3

-birth defects
-miscarriage, stillbirth, or neonatal death
-cognitive impairment or behavioral problems
-autism

Question 4

***Venlafaxine MAY increase:

Answer 4

-premature labor (but to the same degree as untreated depression)
-postpartum hemorrhage (though more likely due to other confounds, risk is very small to our understanding)

Question 5

***Venlafaxine MAY increase during DELIVERY:

Answer 5

-transient neonatal side effects, including respiratory distress (this may be more prevalent with venlafaxine)
-neonatal persistent pulmonary hypertension (VERY LOW RISK! 2/1000 cases in general population, 3/1000 with venlafaxine)

Question 6

When is dose dependent blood pressure elevation seen with venlafaxine use?

Answer 6

225mg per day

Question 7

***What antidepressants are most associated with preeclampsia?

Answer 7

-venlafaxine
-tricyclics (amitriptyline mostly)

Question 8

*** What is the risk of preeclampsia with venlafaxine or tricyclics (amitriptyline) compared to no meds or SSRIS?

Answer 8

1.5 times more likely

Question 9

how long do neonatal antidepressant withdrawal effects last?

Answer 9

1 to 2 days

Question 10

How much does the risk for persistent pulmonary hypertension raise with antidepressant use?

Answer 10

from 2/1000 baseline risk to 2.9/1000 risk with antidepressants