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

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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.

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Authors and Affiliations

  1. Division of Behavioral Medicine, Department of Psychiatry, Columbia University Medical Center, 630 W. 168th Street, PH 1540G, New York, NY, 10032, USA

    Lauren M. Osborne

  2. Payne Whitney Women’s Program, Departments of Psychiatry and Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA

    Catherine A. Birndorf

  3. Department of Psychology, The Pennsylvania State University, University Park, PA, USA

    Lauren E. Szkodny

  4. Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA

    Katherine L. Wisner

Authors
  1. Lauren M. Osborne
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  2. Catherine A. Birndorf
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  3. Lauren E. Szkodny
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  4. Katherine L. Wisner
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Correspondence to Lauren M. Osborne.

Additional information

Previously presented as a poster, “Case report on nortriptyline levels in a postpartum woman,” at the 4th World Congress of Women’s Mental Health, March 2011

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Osborne, L.M., Birndorf, C.A., Szkodny, L.E. et al. Returning to tricyclic antidepressants for depression during childbearing: clinical and dosing challenges. Arch Womens Ment Health 17, 239–246 (2014). https://doi.org/10.1007/s00737-014-0421-z

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  • DOI: https://doi.org/10.1007/s00737-014-0421-z

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