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Abstract(s)
O uso de antidepressivos no tratamento de transtornos depressivos na mulher que planeie engravidar, na mulher grávida ou a amamentar ainda se encontra associado a um certo grau de incerteza. Até à data, a segurança deste tipo de fármacos ainda não se encontra totalmente esclarecida, existindo ainda uma grande percentagem de mulheres que interrompem a terapêutica durante a gravidez. Aquando da prescrição de fármacos antidepressivos é necessário o estabelecimento de uma relação beneficio-risco favorável, pelos efeitos que poderão causar tanto na mulher como no feto.
Esta revisão sumariza os mecanismos de ação dos fármacos antidepressivos, assim como os seus potenciais efeitos adversos. Por outro lado, resume as alterações fisiológicas observadas na gravidez e o seu impacto geral nos parâmetros farmacocinéticos dos fármacos. Com este trabalho foi possível sistematizar as recomendações terapêuticas relativas à prescrição de antidepressivos na fase de pré-conceção e no período perinatal, analisar os efeitos no feto, a curto e longo prazo, após utilização desta classe terapêutica durante o período gestacional, compreender a fisiopatologia e tratamento da depressão pós-parto e determinar quais os fármacos antidepressivos mais seguros na amamentação.
Existem evidências clínicas de que a utilização de antidepressivos no período gestacional se encontra associado a riscos para o bebé em desenvolvimento como: Malformações Congénitas, Síndrome de Abstinência Neonatal, Hipertensão Pulmonar Persistente no Recém-Nascido, Perturbação do Espetro do Autismo e Transtornos Depressivos, comprometendo de certo modo a sua futura qualidade de vida. Além disso, verificou-se que apesar da etiologia da depressão pós-parto ainda não se encontrar totalmente esclarecida, foram recentemente aprovados fármacos com indicação terapêutica específica para esta patologia. A amamentação deve continuar a ser incentivada em mulheres medicadas com antidepressivos, sendo a sertralina e a paroxetina os fármacos com menor taxa de transferência para o leite materno.
The use of antidepressants in the treatment of depressive disorders in women planning to conceive, in pregnant women or in breastfeeding women is, to date, lacking certainty. The safety of this type of drug has not yet been fully understood, and there is still a large percentage of women who have discontinued therapy during pregnancy. When prescribing antidepressant medications, it is necessary to establish a favourable benefit-risk relationship, due to the effects they may have on both the woman and the foetus. This review summarizes the mechanisms of action of antidepressant medications, as well as their potential adverse effects. On the other hand, we summarize the physiological changes observed in pregnancy and their general impact on the pharmacokinetic ranges of medications. With this work it was possible to systematize the therapeutic recommendations regarding the prescription of antidepressants in the pre-conception phase and in the perinatal period. Moreover, the work analyses the effects on the foetus, taking into account the short and long term effects, after using this therapeutic class during the gestational period, bringing to an understandment the pathophysiology and treatment of postpartum depression and determine which antidepressant medications are safest during breastfeeding. The clinical evidence points the use of antidepressants during pregnancy with risks for the developing baby, such as: Congenital Malformations, Neonatal Abstinence Syndrome, Persistent Pulmonary Hypertension in the Newborn, Autism Spectrum Disorder and Depressive Disorders, compromising to a certain extent their future quality of life. Furthermore, although the etiology of postpartum depression is not yet fully understood, medications with specific therapeutic indications for this pathology have recently been approved. Breastfeeding should continue to be encouraged in women taking antidepressants, with Sertraline and Paroxetine being the medications with the lowest transfer rates into breast milk.
The use of antidepressants in the treatment of depressive disorders in women planning to conceive, in pregnant women or in breastfeeding women is, to date, lacking certainty. The safety of this type of drug has not yet been fully understood, and there is still a large percentage of women who have discontinued therapy during pregnancy. When prescribing antidepressant medications, it is necessary to establish a favourable benefit-risk relationship, due to the effects they may have on both the woman and the foetus. This review summarizes the mechanisms of action of antidepressant medications, as well as their potential adverse effects. On the other hand, we summarize the physiological changes observed in pregnancy and their general impact on the pharmacokinetic ranges of medications. With this work it was possible to systematize the therapeutic recommendations regarding the prescription of antidepressants in the pre-conception phase and in the perinatal period. Moreover, the work analyses the effects on the foetus, taking into account the short and long term effects, after using this therapeutic class during the gestational period, bringing to an understandment the pathophysiology and treatment of postpartum depression and determine which antidepressant medications are safest during breastfeeding. The clinical evidence points the use of antidepressants during pregnancy with risks for the developing baby, such as: Congenital Malformations, Neonatal Abstinence Syndrome, Persistent Pulmonary Hypertension in the Newborn, Autism Spectrum Disorder and Depressive Disorders, compromising to a certain extent their future quality of life. Furthermore, although the etiology of postpartum depression is not yet fully understood, medications with specific therapeutic indications for this pathology have recently been approved. Breastfeeding should continue to be encouraged in women taking antidepressants, with Sertraline and Paroxetine being the medications with the lowest transfer rates into breast milk.
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Keywords
Antidepressivos Depressão Gravidez Riscos associados Segurança