Initial Approach
Pregnancy and postpartum may be moments of happiness and optimistic anticipation, as well as stress and difficulty. Pregnancy and childbirth are accompanied by several physiological and behavioral changes, and both mothers and dads must confront a number of new obstacles during this time. Consequently, pregnancy and the postpartum period are heightened risk periods for the establishment or recurrence of a mental disease.
The first step in finding the correct diagnosis for this patient and her family would be to do a thorough history and physical examination, which would include an assessment of the patient’s mental state. In addition, if required, the NP would issue orders for imaging and laboratory tests (Biaggi et al., 2016).
It is vital to obtain a thorough patient history in order to develop an understanding of the patient’s prior delivery experiences and her present mental state.
With the use of the physical exam, the patient’s present state of health may be determined, and possible issues can also be identified. As a consequence of the mental health examination, the nurse practitioner will obtain insight into the patient’s present degree of anxiety and depression (Biaggi et al., 2016). Laboratory and imaging examinations will help rule out the likelihood that the patient’s symptoms are caused by physical causes.
Would You Prescribe an Antidepressant?
The nurse practitioner would prescribe an antidepressant to the patient.
Because antidepressants are available in such a broad variety of formulations, the precise drug prescribed to a patient depends on their individual circumstances and medical history.
Antidepressant medicine is effective for treating both anxiety and depression. Additionally, they can enhance the quality of sleep and increase one’s energy levels (Connelly et al., 2018).
These antidepressants are often an option during pregnancy: Certain serotonin reuptake inhibitors are selective (SSRIs). SSRIs, including citalopram (Celexa) and sertraline, are usually regarded as safe during pregnancy (Zoloft) (Mughal et al., 2021). High dosages of tranquilizers such as diazepam, alprazolam, and clonazepam should be avoided by pregnant women, since they might induce neonatal sedation and respiratory distress. You can continue to use them in tiny dosages for brief durations.
In order to establish a treatment plan that makes sense, we must thoroughly evaluate the clinical history and preferences of each lady. Ideally, this talk should occur well before a woman becomes pregnant, so that she has adequate time to weigh her options and make any necessary adjustments (Connelly et al., 2018).
In order to reduce the risk of recurrence, the American Psychiatric Association Consensus Guidelines urge that patients continue to take the dose of medicine that was effective in treating their original episode of depression during all subsequent phases of therapy. Reducing a patient’s drug dosage after attaining symptom remission has not been extensively investigated, although the scant evidence available shows that lower dosages increase the chance of recurrence.
Pharmacodynamics, Pharmacokinetics and Contraindications
The precise antidepressant prescribed to a patient would be determined by the patient’s individual circumstances and medical history. A woman using antidepressants during the postpartum period may experience negative side effects such as increased body fat, poor sexual function, and decreased milk supply.
Antidepressants are known to have a multitude of possible side effects, with weight gain, sexual dysfunction, and reduced milk production being the most prevalent. Because dealing with these side effects can be difficult for new moms, it is vital to have a discussion about them with the patient and her family prior to starting the drug (Mackiewicz et al., 2020).
It has been shown with both SSRIs and tricyclic antidepressants that, during pregnancy, increased drug metabolism may result in decreased blood levels of antidepressants, particularly during the second half of pregnancy. While we do not necessarily recommend increasing antidepressant dosages in the absence of clinical need, it should be noted that reducing antidepressant dosages during pregnancy, in conjunction with these metabolic changes, may result in significant decreases in antidepressant serum levels, thereby increasing the risk of relapse. During pregnancy, it is important to carefully monitor for depression symptoms, and an increase in antidepressant dose may be considered if symptoms reoccur.
Plan of Care
The patient and her family would be informed of the pharmacodynamics, pharmacokinetics, contraindications, pregnancy-related concerns, legal and ethical considerations, testing (if appropriate), side effects, and link to trimester of the selected antidepressant (Mughal et al., 2021).
The nurse practitioner would create a care plan for the family that promotes attachment and considers the positive and negative aspects of the family’s functioning as a unit. This may require working with a psychiatrist or in cooperation with one, as well as engaging in psychotherapy.
Before commencing therapy with the chosen antidepressant, it is essential to inform the patient and her family of the potential adverse effects that may occur. In addition, the NP would develop a care plan for the family that would take the family’s strengths and limitations into consideration. This may require working with a psychiatrist or in cooperation with one, as well as engaging in psychotherapy (Connelly et al., 2018).
Guidelines for best practice in the treatment of pregnant women with opioid use disorder recommend the use of medication-assisted therapy in conjunction with more comprehensive care, including behavioral and mental health therapies.
A person-centered approach to care is advantageous for those at risk for or experiencing prenatal depression. It emphasizes getting to know the complete person, their health experiences, and the importance of their spouse and family in their lives (including the role they may play in supporting the person to achieve health)
Conclusion
Pregnant and postpartum women make decisions concerning their treatment during the perinatal period. Their views, values, and social conditions may impact these decisions. It is the duty of nurses and the interprofessional team to enable informed decision-making by partnering with individuals and families (where relevant) and by providing evidence-based information.
References
Biaggi, A., Conroy, S., Pawlby, S., & Pariante, C. M. (2016). Identifying the women at risk of antenatal anxiety and depression: A systematic review. Journal of Affective Disorders, 191(191), 62–77. https://doi.org/10.1016/j.jad.2015.11.014
Connelly, C. D., Hazen, A. L., Baker-Ericzén, M. J., Landsverk, J., & Horwitz, S. M. (2018). Is Screening for Depression in the Perinatal Period Enough? The Co-Occurrence of Depression, Substance Abuse, and Intimate Partner Violence in Culturally Diverse Pregnant Women. Journal of Women’s Health, 22(10), 844–852. https://doi.org/10.1089/jwh.2012.4121
Mackiewicz Seghete, K. L., Graham, A. M., Shank, T. M., Alsup, S. L., Fisher, P. A., Wilson, A. C., & Feldstein Ewing, S. W. (2020). Advancing Preventive Interventions for Pregnant Women Who Are Opioid Using via the Integration of Addiction and Mental Health Research. Current Addiction Reports, 7(1), 61–67. https://doi.org/10.1007/s40429-020-00296-x
Mughal, S., Azhar, Y., Siddiqui, W., & May, K. (2021). Postpartum Depression (Nursing). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568673/
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