Journal
ARCHIVES OF WOMENS MENTAL HEALTH
Volume 17, Issue 3, Pages 239-246Publisher
SPRINGER WIEN
DOI: 10.1007/s00737-014-0421-z
Keywords
Pregnancy; Depression; Anxiety; Nortriptyline; Pharmacokinetics; Tricyclic antidepressants
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Funding
- NIMH NIH HHS [T32 MH015144] Funding Source: Medline
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Managing depression and anxiety during pregnancy and the postpartum period is challenging. Both pharmacological treatment and the lack thereof can pose threats to a fetus. SSRIs are the drugs of choice for use during pregnancy, but there is considerable evidence for the safety and efficacy of older antidepressants during pregnancy as well. This study highlights a single case of the use of the tricyclic nortriptyline during pregnancy and postpartum. The subject involved had an unexpectedly high ratio of serum level to drug dose during the postpartum period. We monitored the subject for a significantly greater portion of the postpartum period than has been done in previous studies, and explored medical and lifestyle changes that could account for the level-to-dose ratios we observed. Differences in smoking patterns, coupled with the patient's status as a genetic poor metabolizer, were the most likely explanations.
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