ACTA FAC MED NAISS 2019;36(4):269-278

Review article

UDC: 616.89-008-055.26-08

DOI: 10.5937/afmnai1904269S

Therapy of Peripartum Mental Disorders

Miodrag Stanković^1,2, Jelena Stojanov³, Jovana Antonijević¹

¹University of Niš, Faculty of Medicine,Niš, Serbia
²Centre for Mental Health Protection, Clinical Centre Niš, Niš, Serbia
³Special Hospital for Psychiatric Diseases „Gornja Toponica“, Niš, Serbia

summary


During the peripartum period, women are at a greater risk of developing a mental disorder or experiencing an exacerbation of the pre-existing mental disorders. Therapeutic interventions are based primarily on psychotherapy, but if the symptoms are severe and pose a risk to the mother and the child, then the use of drugs, hospitalization or electroconvulsive therapy is considered. Cognitive-behavioral psychotherapy is the first line of treatment in postpartum blues and postpartum depression, panic disorder, generalized anxiety disorder, and mild to moderate obsessive-compulsive disorder. More recent conceptions regarding the use of drugs during the postpartum period indicate that medications should be prescribed if the risk of using them is lower than the risk of complications caused by the symptoms of mental disorders. Nortriptyline or desipramine are recommended from the group of tricyclic antidepressants, but newer generation antidepressants are shown to be safer during pregnancy. Fluvoxamine, paroxetine and sertraline can be used in postpartum period during breastfeeding, while fluoxetine and citalopram should be avoided. The use of first-generation antipsychotics haloperidol and trifluoperazine is recommended in the antepartum period, during which some of second-generation antipsychotics such as quetiapine, olanzapine, risperidone and aripiprazole can also be used. Clozapine should be avoided during breast-feeding. The use of mood stabilizers during pregnancy requires a thorough knowledge of the recommendations, and it is not advised to use them during the postpartum if the patient is breastfeeding. From the group of benzodiazepines, it is recommended to uselorazepam. Every form of therapeutic approach has proven to be more effective in the presence of emotional support from partners and other family members.

Key words: peripartum, psychotherapy, pharmacotherapy