《哺乳女性抗抑郁药物的应用》内容预览:

    A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocolsfor managing common medical problems that may impact breastfeeding success. These protocolsserve only as guidelines for the care of breastfeeding mothers and infants and do not delineatean exclusive course of treatment or serve as standards of medical care. Variations intreatment may be appropriate according to the needs of an individual patient.

    BACKGROUNDWith estimates of between 5% and 25% ofwomen experiencing depression in the postpartumyear,1–3 it is critical that healthcareproviders consider all treatment options, includingthe risks and benefits for nursing mothers.Many healthcare providers recognize theshort- and long-term negative effects that postpartumdepression can have on mothers andinfants.4–6 Despite this, postpartum depressionoften goes undetected and untreated.2 Postpartumdepression is a treatable illness.

    Treatmentoptions include psychotherapy (cognitivebehavioral,interpersonal psychotherapy),7–9antidepressants,8,10,11 or a combination of medicationand therapy.8 The choice and approachto treatment can be influenced by many factors,including the mother’s wish to breastfeed.Women may not receive medication, or receiveinadequate doses, because they are breastfeeding,or may decide not to breastfeed becausethey are concerned about medication use duringlactation. Full consideration must be givento the risks of untreated depression, risks of themedication to the infant and mother, and thebenefits of treatment.

    This Protocol discussesthe importance of actively screening for and,when present, making the diagnosis of postpartumdepression, how treatment can be determined,and specifically addresses the medicationsfor which there is sufficient evidenceto make recommendations and provide data(selective serotonin reuptake inhibitors [SSRIs]and tricyclic antidepressants [TCAs]/heterocyclics).We recognize that this is a complex issue,and that there are many other factors thatimpact the care of women with postpartum depression,but which are beyond the scope ofthis protocol to discuss.

    CLINICAL APPROACH TO IDENTIFYINGPOSTPARTUM DEPRESSIONPostpartum depression is often missed byproviders and mothers.2,12–14 The symptomsof depression—depressed mood, sleep disruption,weight loss, fatigue, difficulty concentrating,anxiety, loss of interest in usual activities—ABM Protocols44can be difficult for mothers and providers todistinguish from the normal experiences ofnew mothers. It is also important to differentiatemothers suffering from postpartum depressionfrom those with postpartum blues asmisdiagnosis of such mothers can lead to unnecessarytreatment. To distinguish symptomsof depression from the “baby blues,” the timing(2 weeks in duration, all day nearly everyday) and the severity (functional impairment)must be evaluated.15For many women, acknowledgement offeelings other than happiness following thebirth of their infant can be devastating andembarrassing.

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