Viswanathan Meera, Middleton Jennifer Cook, Stuebe Alison M, Berkman Nancy D, Goulding Alison N, McLaurin-Jiang Skyler, Dotson Andrea B, Coker-Schwimmer Manny, Baker Claire, Voisin Christiane E, Bann Carla, Gaynes Bradley N
RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center Chapel Hill USA.
RTI International Research Triangle Park Chapel Hill North Carolina USA.
Psychiatr Res Clin Pract. 2021 May 4;3(3):123-140. doi: 10.1176/appi.prcp.20210001. eCollection 2021 Fall.
The authors systematically reviewed evidence on pharmacotherapy for perinatal mental health disorders.
The authors searched for studies of pregnant, postpartum, or reproductive-age women with mental health disorders treated with pharmacotherapy in MEDLINE, EMBASE, PsycINFO, the Cochrane Library, and trial registries from database inception through June 5, 2020 and surveilled literature through March 2, 2021. Outcomes included symptoms; functional capacity; quality of life; suicidal events; death; and maternal, fetal, infant, or child adverse events.
164 studies were included. Regarding benefits, brexanolone for third-trimester or postpartum depression onset may be associated with improved depressive symptoms at 30 days when compared with placebo. Sertraline for postpartum depression may be associated with improved response, remission, and depressive symptoms when compared with placebo. Discontinuing mood stabilizers during pregnancy may be associated with increased recurrence of mood episodes for bipolar disorder. Regarding adverse events, most studies were observational and unable to fully account for confounding. Evidence on congenital and cardiac anomalies for treatment compared with no treatment was inconclusive. Brexanolone for depression onset in the third trimester or the postpartum period may be associated with risk of sedation or somnolence, leading to dose interruption or reduction when compared with placebo.
Evidence from few studies supports the use of pharmacotherapy for perinatal mental health disorders. Although many studies report on adverse events, they could not rule out underlying disease severity as the cause of the association between exposures and adverse events. Patients and clinicians need to make informed, collaborative decisions on treatment choices.
作者系统回顾了围产期精神障碍药物治疗的证据。
作者在MEDLINE、EMBASE、PsycINFO、Cochrane图书馆以及从数据库建立至2020年6月5日的试验注册库中检索了接受药物治疗的患有精神障碍的孕妇、产后或育龄妇女的研究，并对截至2021年3月2日的文献进行了监测。结局包括症状、功能能力、生活质量、自杀事件、死亡以及孕产妇、胎儿、婴儿或儿童不良事件。
纳入了164项研究。在益处方面，与安慰剂相比，孕晚期或产后抑郁症发作使用布雷沙诺龙可能在30天时与抑郁症状改善有关。产后抑郁症使用舍曲林与安慰剂相比可能与反应改善、缓解及抑郁症状改善有关。孕期停用心境稳定剂可能与双相情感障碍心境发作复发增加有关。在不良事件方面，大多数研究为观察性研究，无法完全解释混杂因素。与未治疗相比，治疗导致先天性和心脏异常的证据尚无定论。孕晚期或产后抑郁症发作使用布雷沙诺龙与安慰剂相比可能与镇静或嗜睡风险有关，导致剂量中断或减少。
少数研究的证据支持使用药物治疗围产期精神障碍。尽管许多研究报告了不良事件，但它们无法排除潜在疾病严重程度作为暴露与不良事件之间关联的原因。患者和临床医生需要就治疗选择做出明智的共同决策。
