Department of Psychiatry, University of Western Ontario, London, ON, Canada.
Bipolar Disord. 2010 May;12(3):335-40. doi: 10.1111/j.1399-5618.2010.00809.x.
No studies to date have assessed the pharmacological management of treatment-resistant postpartum depression. We reviewed the pharmacological treatment of postpartum depression in patients diagnosed with treatment-resistant 'unipolar' depression.
We conducted a chart review of patients treated consecutively at a perinatal clinic. Treatment-resistant postpartum depression was defined as a failure to respond to at least one adequate antidepressant trial. Patients were diagnosed using the DSM-IV criteria, and the Clinical Global Impression-Improvement (CGI-I) rating scale was used to assess response to various pharmacological interventions.
The majority of patients (57%, 34/60) referred for postpartum depression actually suffered from bipolar disorder. All patients were on antidepressants at the time of referral, but by the end of the study 37% (22/60) continued on antidepressants alone or in combination with other medications. CGI-I ratings showed appreciable improvement in depression at the end of six months following the initial consultation. Very much improvement was noted in 65% (39/60) of patients, and 22% (13/60) were considered much improved. The most common change in medication was a switch to or addition of an atypical neuroleptic.
Retrospective design, small sample size, and lack of a control group.
Management of treatment resistance in women with postpartum depression should be considered within the context of types of mood disorders. Atypical neuroleptics and mood stabilizers used alone or as adjuncts should be considered in the treatment of resistant postpartum depression in patients with a bipolar diathesis.
目前尚无研究评估治疗抵抗性产后抑郁症的药物治疗。我们回顾了诊断为治疗抵抗性“单相”抑郁症患者的产后抑郁症的药物治疗。
我们对一家围产期诊所连续治疗的患者进行了病历回顾。治疗抵抗性产后抑郁症定义为对至少一种充分抗抑郁药试验无反应。患者的诊断采用 DSM-IV 标准，临床总体印象-改善（CGI-I）评分用于评估各种药物干预的反应。
大多数（57%，34/60）转诊为产后抑郁症的患者实际上患有双相情感障碍。所有患者在转诊时都在服用抗抑郁药，但在研究结束时，37%（22/60）继续单独或联合使用其他药物。CGI-I 评分显示，在初始咨询后六个月，抑郁症状明显改善。65%（39/60）的患者有非常大的改善，22%（13/60）的患者被认为有很大改善。药物最常见的变化是改用或添加非典型抗精神病药。
回顾性设计、样本量小以及缺乏对照组。
在产后抑郁症女性中治疗抵抗的管理应考虑到各种心境障碍的类型。对于具有双相素质的患者，应考虑单独使用或作为辅助治疗的非典型抗精神病药和心境稳定剂来治疗耐药性产后抑郁症。
