Keywords
Trastorno depresivo mayor
Embarazo de alto riesgo
Malformación fetal
Epilepsia
Hipotiroidismo
Fenitoína
Embarazo de alto riesgo
Malformación fetal
Epilepsia
Hipotiroidismo
Fenitoína
How to Cite
Beltrán Mera, N. A., Archila Santamaría, D. C., & Cuadros Mendoza, C. A. (2020). Depresión en embarazo en una paciente con múltiples comorbilidades. Médicas UIS, 21(3), 201–210. Retrieved from https://revistas.uis.edu.co/index.php/revistamedicasuis/article/view/12315
Abstract
El embarazo es un período de bienestar emocional tanto para la madre como para su familia; sin embargo, en el existe una gran vulnerabilidad emocional, la cual sumada a otros estresores, predispone al desarrollo de trastornos mentales, siendo la depresión una complicación frecuente en este período y en el postparto. Por tal
razón es importante evaluar la comorbilidad que la paciente embarazada tiene para el desarrollo de este trastorno, con el fi n de llevar a cabo un oportuno diagnóstico y un adecuado manejo multidisciplinario teniendo en cuenta el perfi l de riesgo-benefi cio. Este artículo pretende abordar desde diferentes tópicos la condición clínica de una paciente con embarazo de alto riesgo por malformación congénita, quien presenta múltiples comorbilidades relacionadas con el desarrollo de depresión mayor, las cuales se analizaran detenidamente buscando ofrecer una comprensión integral de la condición de la paciente y las difi cultades terapéuticas que se enfrentaron. (MED.UIS. 2008;21(3):201-10)
References
1. Buehler BA, Hanson JW. Fetal hydantoin syndrome. In: Buyse ML, editor. Birth defects encyclopedia. Cambridge: Blackwell Scientific Publications. 1990;1:714-5.
2. Buehler BA, Delimont D, Van Waes M, Finnel RH. Prenatal prediction of risk of the fetal hydantoin syndrome. N Engl J Med. 1990;322:1567-72.
3. American Psychiatric Association. DSM-IV. Manual diagnostico y estadístico de los trastornos mentales. Barcelona: Masson. 1995.
4. Sadock BJ, Sadock VA. Kaplan-Sadock Sinopsis de psiquiatría, ciencias de la conducta/psiquiatría clínica. 9º ed. Barcelona: Waverly Hispànica S.A. 2004
5. Tellez-Zenteno JF, Patten SB, Jette N, Williams J, Wiebe S, Williams J. Psychiatric comorbidity in epilepsy: a population-based analysis. Epilepsia. 2007;48:2336–44.
6. Kanner, AM. Depression in epilepsy: a complex relation with unexpected consequences. Curr Opin Neurol. 2008,21:190–4.
7. Hasler G, Bonwetsch R, Giovacchini G, Toczek M, Bagic A, Luckenbaugh D, et al. 5-HT(1A) receptor binding in temporal lobe epilepsy patients with and without major depression. iol Psychiatry. 2007;62:1258–64.
8. Forsgren L, Nystrom L. An incident case referent study of epileptic seizures in adults. Epilepsy Res. 1999;6:66–81.
9. Hesdorffer DC, Hauser WA, Annegers JF, Casino G. Major depression is a risk factor for seizures in older adults. Ann Neurol. 2000;47:246–9.
10. Hesdorffer DC, Hauser WA, Olafsson E. Depression and suicidal attempt as risk factor for incidental unprovoked seizures. Ann Neurol. 2006;59:35–41.
11. Hitiris N, Mohanraj R, Norrie J, Sills G, Brodie M. Predictors of pharmacoresistant epilepsy. Epilepsy Res. 2007;75:192–6.
12. Kwan P, Brodie M. Neuropsychological effects of epilepsy and antiepileptic drugs. Lancet. 2001;357:216-22.
13. Fenwick PBC. Antiepileptic drugs and their psychotropic effects. Epilepsia. 1992;33 Suppl 6:S33-6.
14. Brent DA, Crumrine PK, Varna RR y cols. Phenobarbital and Phenytoin treatment and major depressive disorder in children with epilepsy. Pediatrics. 1987;80:909-17.
15. Ring HA, Crellin R, Kirker S, Reynolds EH. Vigabatrin and depression. J Neurol Neurosurg Psychiatry. 1993;56:925-8.
16. Leppik IE. Tiagabine: The safety lanscape. Epilepsia. 1995;36 Suppl 6: S10-3.
17. Aldenkamp AP, Baker G, Mulder OG y cols. A multicenter, randomized clinical study to evaluate the effect on cognitive function of topiramate compared with valproate as add-on
herapy to carbamacepine in patients with partial onset seizures. Epilepsia. 2000;41:1167-78.
18. Lambert MV, Robertson MM. Depression in epilepsy: etiology, phenomenology and treatment. Epilepsia. 1999;40 Supl 10:S21-47.
19. Prange AJ, Haggerty JJ, Browne JL, Rice JD. Marginal hypothyroidism in mental illness: Preliminary assesments of prevalence and significance. In: Bunney Jr, Hippius H, Laakmann G, Schmauss M, editors. Neuropsychopharmacology. Berlin: Springer-Verlag; 1990;352-61.
20. Joffe RT, Levitt AJ. Major depression and subclinical (grade 2) hypothyroidism. Psychoneuroendocrinology. 1992;17:215-21.
21. Cohen KL, Swigar ME. Thyroid function screening in psychiatric patients. JAMA. 1979;242:254-7. 22. McLarty DG, Ratcliffe WA, Ratcliffe JG, Shimmins JG, Goldberg A. A study of
hyroid function in psychiatric in-patients. Br J Psychiatry. 1978;133:211-8.
23. Gloger S, Fardella C, Santis R, Bitran J. Relevancia del estudio tiroideo en pacientes con trastornos psiquiátricos. Rev Med Chil. 1997;125:1351-6.
24. Kirkegaard, Faber J. The role of thyroid hormones in depression. Eur J Endocrinol. 1998;138:1-9.
25. Torres-Gutiérrez M. Impacto emocional del embarazo de alto riesgo. Rev Colomb Psiquiatr. 2004;23(3).
26. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol. 2004;103:698-709.
27. Evans J, Heron J, Francomb H, Oke S, Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323(7307):257-60.
28. Hall S, Bobrow M, Marteau T. Psychological consequences for parents of false negative results on prenatal screening for Down’s syndrome: retrospective interview study. BMJ. 2000;320:407-12.
29. Polnay JC, Davidge A, Lyn CH, Smyth AR. Parental attitudes: antenatal diagnosis of cystic fibrosis. Arch Dis Child. 2002;87:284-6.
30. Sklansky M, Tang A, Levy D, Grossfeld P, Kashani I, Shaughnessy R, et al. Maternal psychological impact of fetal echocardiography. J Am Soc Echocardiogr. 2002;15(2):159-66.
31. Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G. Perinatal risks of untreated depression during pregnancy. Can J Psychiatry. 2004;49(11):726-35.
32. Altshuler LL, Cohen LS, Szuba MP, Burt VK, Gitlin M, Mintz J. Pharmacologic management of psychiatric illness in pregnancy: dilemmas and guidelines. Am J Psychiatry.
996;153:592–606.
33. Cohen L, Altshuler L. Pharmacologic management of psychiatric illness during pregnancy and the postpartum period. In: Rosenbaum J, editor. Psychiatric clinics of North America:
nnual of drug therapy. Philadelphia: WB Saunders. 1997:21–60.
34. GlaxoSmithKline. Epidemiological study: preliminary report on bupropion in pregnancy and the occurrence of cardiovascular and major congenital malformation. Accessed June 1,
007, at http://ctr.gsk.co.uk/Summary/ paroxetine/studylist. asp.
}
35. Berard A, Ramos E, Rey E, Blais L, St-Andre M, Oraichi D. First trimester exposure to paroxetine and risk of cardiac malformations in infants: the importance of dosage. Birth efects
es B Dev Reprod Toxicol. 2007;80:18-27.
36. Diav-Citrin O, Shechtman S, Weinbaum D, Wajnberg R, Avgil M, Di Gianantonio E, et al. Paroxetine and fluoxetine in pregnancy: a multicenter, prospective, controlled study
abstract]. Reprod Toxicol. 2005;20:459.
37. Nordeng H, Lindemann R, Perminov KV, Reikvam A. Neonatal withdrawal syndrome after in utero exposure to selective serotonin reuptake inhibitors. Acta Paediatr. 2001;90(3):288–91.
38. Chambers CD, Johnson K, Dick L, Felix RJ, Jones KL. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med. 1996;335(14):1010–5.
39. Spencer M. Fluoxetine hydrochloride (Prozac) toxicity in the neonate. Pediatrics. 1993;92:721–2.
40. Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, et al. Selective serotoninreuptake inhibitors and risk of persistent pul-monary hypertension of the
ewborn. N Engl J Med. 2006;354(6):579-87.
41.McMahon TJ, Hood JS, Nossaman BD, Kadowitz PJ. Analysis of responses to serotonin in the pulmonary vascular bed of the cat. J Appl Physiol. 1993;75:93-102.
42. Abman SH. New developments in the pathogenesis and treatment of neonatal pulmonary hypertension. Pediatr Pulmonol. 1999;18 suppl:s201-4.
43. Chambers CD, Hernandez-Diaz S, Van-Marter LJ, Werler MM. Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn. N Engl J ed. 2006;354:579-87.
44. Kulin N, Pastuszak A, Sage S. Pregnancy outcome following maternal use of the newselective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA.
998;279:609–10.
45. McElhatton P, Garbis H, Elefant E, Vial T, Bellemin B, Mastroiacovo P, et al. The outcome of pregnancy in 689 women exposed to therapeutic doses of antidepressants. A
llaborative study of the European Network of Teratology Information Services (ENTIS). Reprod Toxicol. 1996;10(4):285–94.
2. Buehler BA, Delimont D, Van Waes M, Finnel RH. Prenatal prediction of risk of the fetal hydantoin syndrome. N Engl J Med. 1990;322:1567-72.
3. American Psychiatric Association. DSM-IV. Manual diagnostico y estadístico de los trastornos mentales. Barcelona: Masson. 1995.
4. Sadock BJ, Sadock VA. Kaplan-Sadock Sinopsis de psiquiatría, ciencias de la conducta/psiquiatría clínica. 9º ed. Barcelona: Waverly Hispànica S.A. 2004
5. Tellez-Zenteno JF, Patten SB, Jette N, Williams J, Wiebe S, Williams J. Psychiatric comorbidity in epilepsy: a population-based analysis. Epilepsia. 2007;48:2336–44.
6. Kanner, AM. Depression in epilepsy: a complex relation with unexpected consequences. Curr Opin Neurol. 2008,21:190–4.
7. Hasler G, Bonwetsch R, Giovacchini G, Toczek M, Bagic A, Luckenbaugh D, et al. 5-HT(1A) receptor binding in temporal lobe epilepsy patients with and without major depression. iol Psychiatry. 2007;62:1258–64.
8. Forsgren L, Nystrom L. An incident case referent study of epileptic seizures in adults. Epilepsy Res. 1999;6:66–81.
9. Hesdorffer DC, Hauser WA, Annegers JF, Casino G. Major depression is a risk factor for seizures in older adults. Ann Neurol. 2000;47:246–9.
10. Hesdorffer DC, Hauser WA, Olafsson E. Depression and suicidal attempt as risk factor for incidental unprovoked seizures. Ann Neurol. 2006;59:35–41.
11. Hitiris N, Mohanraj R, Norrie J, Sills G, Brodie M. Predictors of pharmacoresistant epilepsy. Epilepsy Res. 2007;75:192–6.
12. Kwan P, Brodie M. Neuropsychological effects of epilepsy and antiepileptic drugs. Lancet. 2001;357:216-22.
13. Fenwick PBC. Antiepileptic drugs and their psychotropic effects. Epilepsia. 1992;33 Suppl 6:S33-6.
14. Brent DA, Crumrine PK, Varna RR y cols. Phenobarbital and Phenytoin treatment and major depressive disorder in children with epilepsy. Pediatrics. 1987;80:909-17.
15. Ring HA, Crellin R, Kirker S, Reynolds EH. Vigabatrin and depression. J Neurol Neurosurg Psychiatry. 1993;56:925-8.
16. Leppik IE. Tiagabine: The safety lanscape. Epilepsia. 1995;36 Suppl 6: S10-3.
17. Aldenkamp AP, Baker G, Mulder OG y cols. A multicenter, randomized clinical study to evaluate the effect on cognitive function of topiramate compared with valproate as add-on
herapy to carbamacepine in patients with partial onset seizures. Epilepsia. 2000;41:1167-78.
18. Lambert MV, Robertson MM. Depression in epilepsy: etiology, phenomenology and treatment. Epilepsia. 1999;40 Supl 10:S21-47.
19. Prange AJ, Haggerty JJ, Browne JL, Rice JD. Marginal hypothyroidism in mental illness: Preliminary assesments of prevalence and significance. In: Bunney Jr, Hippius H, Laakmann G, Schmauss M, editors. Neuropsychopharmacology. Berlin: Springer-Verlag; 1990;352-61.
20. Joffe RT, Levitt AJ. Major depression and subclinical (grade 2) hypothyroidism. Psychoneuroendocrinology. 1992;17:215-21.
21. Cohen KL, Swigar ME. Thyroid function screening in psychiatric patients. JAMA. 1979;242:254-7. 22. McLarty DG, Ratcliffe WA, Ratcliffe JG, Shimmins JG, Goldberg A. A study of
hyroid function in psychiatric in-patients. Br J Psychiatry. 1978;133:211-8.
23. Gloger S, Fardella C, Santis R, Bitran J. Relevancia del estudio tiroideo en pacientes con trastornos psiquiátricos. Rev Med Chil. 1997;125:1351-6.
24. Kirkegaard, Faber J. The role of thyroid hormones in depression. Eur J Endocrinol. 1998;138:1-9.
25. Torres-Gutiérrez M. Impacto emocional del embarazo de alto riesgo. Rev Colomb Psiquiatr. 2004;23(3).
26. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol. 2004;103:698-709.
27. Evans J, Heron J, Francomb H, Oke S, Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323(7307):257-60.
28. Hall S, Bobrow M, Marteau T. Psychological consequences for parents of false negative results on prenatal screening for Down’s syndrome: retrospective interview study. BMJ. 2000;320:407-12.
29. Polnay JC, Davidge A, Lyn CH, Smyth AR. Parental attitudes: antenatal diagnosis of cystic fibrosis. Arch Dis Child. 2002;87:284-6.
30. Sklansky M, Tang A, Levy D, Grossfeld P, Kashani I, Shaughnessy R, et al. Maternal psychological impact of fetal echocardiography. J Am Soc Echocardiogr. 2002;15(2):159-66.
31. Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G. Perinatal risks of untreated depression during pregnancy. Can J Psychiatry. 2004;49(11):726-35.
32. Altshuler LL, Cohen LS, Szuba MP, Burt VK, Gitlin M, Mintz J. Pharmacologic management of psychiatric illness in pregnancy: dilemmas and guidelines. Am J Psychiatry.
996;153:592–606.
33. Cohen L, Altshuler L. Pharmacologic management of psychiatric illness during pregnancy and the postpartum period. In: Rosenbaum J, editor. Psychiatric clinics of North America:
nnual of drug therapy. Philadelphia: WB Saunders. 1997:21–60.
34. GlaxoSmithKline. Epidemiological study: preliminary report on bupropion in pregnancy and the occurrence of cardiovascular and major congenital malformation. Accessed June 1,
007, at http://ctr.gsk.co.uk/Summary/ paroxetine/studylist. asp.
}
35. Berard A, Ramos E, Rey E, Blais L, St-Andre M, Oraichi D. First trimester exposure to paroxetine and risk of cardiac malformations in infants: the importance of dosage. Birth efects
es B Dev Reprod Toxicol. 2007;80:18-27.
36. Diav-Citrin O, Shechtman S, Weinbaum D, Wajnberg R, Avgil M, Di Gianantonio E, et al. Paroxetine and fluoxetine in pregnancy: a multicenter, prospective, controlled study
abstract]. Reprod Toxicol. 2005;20:459.
37. Nordeng H, Lindemann R, Perminov KV, Reikvam A. Neonatal withdrawal syndrome after in utero exposure to selective serotonin reuptake inhibitors. Acta Paediatr. 2001;90(3):288–91.
38. Chambers CD, Johnson K, Dick L, Felix RJ, Jones KL. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med. 1996;335(14):1010–5.
39. Spencer M. Fluoxetine hydrochloride (Prozac) toxicity in the neonate. Pediatrics. 1993;92:721–2.
40. Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, et al. Selective serotoninreuptake inhibitors and risk of persistent pul-monary hypertension of the
ewborn. N Engl J Med. 2006;354(6):579-87.
41.McMahon TJ, Hood JS, Nossaman BD, Kadowitz PJ. Analysis of responses to serotonin in the pulmonary vascular bed of the cat. J Appl Physiol. 1993;75:93-102.
42. Abman SH. New developments in the pathogenesis and treatment of neonatal pulmonary hypertension. Pediatr Pulmonol. 1999;18 suppl:s201-4.
43. Chambers CD, Hernandez-Diaz S, Van-Marter LJ, Werler MM. Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn. N Engl J ed. 2006;354:579-87.
44. Kulin N, Pastuszak A, Sage S. Pregnancy outcome following maternal use of the newselective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA.
998;279:609–10.
45. McElhatton P, Garbis H, Elefant E, Vial T, Bellemin B, Mastroiacovo P, et al. The outcome of pregnancy in 689 women exposed to therapeutic doses of antidepressants. A
llaborative study of the European Network of Teratology Information Services (ENTIS). Reprod Toxicol. 1996;10(4):285–94.
Downloads
Download data is not yet available.