The Journal of clinical psychiatry
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Review Comparative Study
Course of mood and anxiety disorders during pregnancy and the postpartum period.
Because the onset of mood and anxiety disorders often occurs during the childbearing years, many women may be taking psychotropic medications for these disorders when they conceive. These medications easily diffuse across the placenta, and their impact on the fetus is of concern. But discontinuation may lead to relapse, in which case psychiatric symptoms may affect the fetus. ⋯ Limited data suggest heightened vulnerability to relapse of mood and anxiety disorders in women during the postpartum period. Pregnancy appears to exacerbate symptoms of obsessive-compulsive disorder, while panic disorder patients may remain well after discontinuing medication. Future studies should address the prevalence and relapse rates of mood and anxiety disorders, particularly after medication discontinuation, among pregnant women.
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Alzheimer's disease affects multiple domains of human brain function and has neuropsychological, neuropsychiatric, and neurologic manifestations. Behavioral changes should be assessed as part of a comprehensive evaluation of the effects of cholinergic treatment of Alzheimer's disease. ⋯ Assessment of drug-related behavioral changes can be affected by spontaneous remission of neuropsychiatric symptoms, differing baseline severity of behavioral abnormalities, uncertain magnitude of expected treatment effects, and by the influence of disease stages, concurrent medications, and comorbid conditions. Cholinergic therapies ameliorate behavioral alteration in Alzheimer's disease, and changes in behavior should be monitored when such therapy is initiated.
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Combinations of antidepressants with both serotonergic and noradrenergic activity may be especially effective and thus useful in treating refractory patients and severely depressed patients. In the current report, studies of combinations of serotonin selective reuptake inhibitors (SSRIs) and noradrenergic tricyclics or of SSRIs and bupropion are reviewed, and practical issues pertaining to their use are discussed.
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Depression is one of the most costly illnesses in the United States today. While managed care often focuses on the costs of treatment, the costs of nontreatment are usually ignored. ⋯ When comorbid with other medical problems, especially cardiovascular disease, depression greatly increases mortality, morbidity, and expense. Sophisticated pharmacoeconomic analyses can guide our cost/benefit studies, but the real cost savings and highest quality care will come by investing in educating primary care physicians regarding the recognition and treatment of psychiatric illness as it presents in their clinical practices.
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Although psychotropic drugs have not been tested or approved by the Food and Drug Administration for use during pregnancy, some women continue to take these medications while they are pregnant, particularly since mood and anxiety disorders cluster in women during childbearing years. The relative risks and benefits of drug therapy for these women must be weighed with each patient and treatment limited to those situations in which risks to mother and fetus from the disorder are presumed to exceed the risk of drug treatment. ⋯ Of growing concern is the risk of untreated psychiatric disorder as it may potentially affect fetoplacental integrity and fetal central nervous system development. Coordination of care with the patient, her husband or partner, and the obstetrician is essential, as is careful medical record documentation when treating pregnant patients with psychiatric disorders.