Your patient is excited to be pregnant. She is currently on sertraline, and has been stable on this for many years. She is very insistent that she would like to stop her medication. What should you do?
A 30-year old woman with a history of moderate depression presents to your clinic after completing a pregnancy test at home, which was positive. This patient is excited to be pregnant, albeit surprised. She is currently on sertraline, and has been stable on this for many years.
She has a prior history of moderate depression, and during her last episode 2 years ago, she experienced some passive suicidal thoughts, but has never had a suicide attempt. She is concerned about the possible effects of her medication on the fetus, and is very insistent that she would like to stop her medication as soon as possible. What should you do?
Answer H. Any or all of the above except (B) would be reasonable options to discuss with this patient.
Perinatal patients offer a uniquely appropriate population for a truly integrative approach, in that utilizing complementary and alternative therapies to augment the efficacy of a patient’s current treatments can be an effective way to reduce fetal/infant exposure to a psychotropic. To our knowledge, there are no contraindications to adding any of the recommended modalities to currently available medications.
The literature supports a number of integrative treatment approaches for perinatal MDD. Exercise and yoga have good evidence to support their use, and there is encouraging research supporting mindfulness and massage as well. These stress-reducing and skill-building approaches hold particular promise because the skills acquired could enhance parenting, bonding, and childhood development. In addition, based on good evidence for improving overall pregnancy outcomes, it is worth recommending both group visits and supplementation with omega-3 fatty acids, even though the evidence for efficacy in perinatal depression is still mixed.
For more on this topic, see Perinatal Depression: An Evidence-Based Review of Integrative Treatment, on which this quiz is based.