title: Returning to tricyclic antidepressants for depression during childbearing: clinical and dosing challenges.
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.
authors.affiliation: Division of Behavioral Medicine, Department of Psychiatry, Columbia University Medical Center, 630 W. 168th Street, PH 1540G, New York, NY, 10032, USA, lmo17@columbia.edu.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Osborne
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Birndorf
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Szkodny
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Wisner
mesh_terms: D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage* / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy*; D003866:Depressive Disorder / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D012959:Socioeconomic Factors; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors