Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan).
Am J Psychiatry. 2021 Mar 1;178(3):247-255. doi: 10.1176/appi.ajp.2020.20020154. Epub 2020 Nov 10.
Mental health care for women includes decision support to prepare for major life events, including preconception planning for treatment during pregnancy and the postpartum period. The authors discuss contraceptive choices and their effectiveness, side effects, and impact on psychiatric symptoms. The Centers for Disease Control and Prevention's recommendations, Medical Eligibility Criteria for Contraceptive Use, provided the structure for review of contraceptive choices.
A search of PsycINFO, PubMed, Embase, and Scopus was conducted for publications on the management of contraception for women with mental illness. Publications were selected if they included, based on the authors' consensus, data supporting evidence-based care important for psychiatrists who treat women desiring contraceptives.
The majority of women choose combined oral contraceptives. Although long-acting reversible contraceptives (implants, intrauterine devices) are associated with low failure rates, favorable safety profiles, rapid return to fertility after removal, and few contraindications, they are chosen by only 14% of women. All methods are acceptable for women with depression, although medical comorbidities may dictate a specific type. The impact of hormonal contraceptives on the risk for depression is controversial; however, clinical studies and randomized placebo-controlled trials of women with psychiatric disorders have generally reported similar or lower rates of mood symptoms in hormonal contraceptive users compared with nonusers. Although interactions between psychotropic drugs and contraceptives are rare, clozapine, anticonvulsants, and St. John's Wort are exceptions.
Proactive management of mental illness, contraception, and pregnancy improves a woman's capacity to function and optimizes her mental and reproductive health.
妇女的心理健康护理包括为重大生活事件做准备的决策支持，包括怀孕和产后期间治疗的孕前规划。作者讨论了避孕选择及其有效性、副作用以及对精神症状的影响。疾病控制和预防中心的建议，即《避孕方法医学标准》，为审查避孕选择提供了结构。
对 PsycINFO、PubMed、Embase 和 Scopus 进行了搜索，以查找有关精神疾病妇女避孕管理的出版物。如果出版物根据作者的共识包括支持基于证据的护理的数据，则选择出版物，这些数据对于治疗希望避孕的妇女的精神科医生很重要。
大多数女性选择复方口服避孕药。虽然长效可逆避孕方法（植入物、宫内节育器）与低失败率、有利的安全概况、取出后快速恢复生育能力以及很少有禁忌症相关，但只有 14%的女性选择它们。所有方法都适用于抑郁症女性，尽管合并症可能需要特定类型。激素避孕药对抑郁症风险的影响存在争议；然而，对精神障碍女性的临床研究和随机安慰剂对照试验通常报告激素避孕药使用者的情绪症状与非使用者相似或更低。尽管精神药物和避孕药之间的相互作用很少见，但氯氮平、抗惊厥药和贯叶连翘是例外。
积极管理精神疾病、避孕和怀孕可以提高女性的功能能力，并优化她的精神和生殖健康。
