Please respond to this post! Direction Propose an alternative on-label, off-labe
Please respond to this post! Direction Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature. Treatment of Depression in Pregnant Women Recommended Treatments The Food and Drug Administration (FDA) does not recommend using any psychotropic medications during pregnancy (Ozkan, 2013). However, the FDA rates the safety of psychotropic medications in pregnancy on a scale from A-D and X. A is considered to have no fetal risks in controlled human studies, and X has a proven fetal risk in humans (Sadock, Sadock, and Ruiz, 2015). Selective Serotonin Reuptake Inhibitors (SSRIs) are frequently used to treat depression in pregnant women. Women that do not continue treatment for depression during pregnancy often relapse, have an increased risk of postpartum depression, or have poor prenatal care resulting in premature birth, low birth weight, and other adverse fetal outcomes. Zoloft (Sertraline) is one of the most used medications in pregnant women and it is rated as a class C drug by the FDA. Studies have shown that SSRIs diffuse through the placenta, enter the cord blood, and remain in the fetus following birth. Heinonen et al (2021) performed a study on nine mothers and seven infants to determine the effects of sertraline on the fetus during pregnancy. Sertraline had low placenta passage and mild adverse effects on the fetus. However, the sertraline concentrations vary between individuals (Heinonen et al., 2021). Heinonen et al (2021) believe it is related to the variability of individuals' P450-enzyme activity, affecting their hepatic metabolization. Olanzapine (Zyprexa) is a medication approved by the FDA to treat schizophrenia (Sahoo et al., 2022). Zyprexa is sometimes used off-label for treatment-resistant depression (Flint et al., 2019). It is also rated as a class C drug in pregnant women (Sahoo et al., 2022). Sahoo et al (2022), found that the use of Zyprexa in pregnant women showed comparable rates of pregnancy complications as women in the general population. Interpersonal therapy (IPT) has been proven to be an effective treatment for depression and can be just as effective as pharmacological therapy. IPT poses no risks to the fetus when pregnant (Ingram et al., 2021). IPT is a low intensity talk therapy. Ingram et al. (2021) found that IPT helped pregnant women identify their triggers for depression, explore relationships, support self-awareness, and have a valuable emotional component. Clinical practice guidelines for adults with depression suggest psychotherapy or a second-generation antidepressant as first-line treatment options. Sertraline is a second-generation antidepressant, and interpersonal therapy is a recommended form of psychotherapy (Guideline Development Panel, 2021). It is essential to inform patients of potential medications' possible risks and benefits. SSRIs, like sertraline. Sertraline can cause nausea, tremors, nervousness, problems sleeping, sexual problems, sweating, agitation, and fatigue. Sertraline can also cause seizures, abnormal bleeding, and withdrawal symptoms, which are less common side effects. Sertraline also has a black box warning of suicide and suicidal ideation (FDA, 2019). Anytime an individual becomes pregnant, they should discuss the additional risks of medications that can occur. Berard et al. (2015) found that using sertraline during pregnancy has an increased risk of atrial/ventricular defects and craniosynostosis. Paulzen et al. (2017) found that sertraline is constantly accessible by the fetus due to its ability to enter the amniotic fluid. However, multiple studies have found that sertraline is relatively safe to use during pregnancy and its concentrations vary among individuals based on their body's ability to metabolize the drug. I would also inform the patient that sertraline is a first-line treatment for depression and is frequently used during pregnancy. It is also essential to discuss the risk of relapse, suicide, and postpartum depression. Olanzapine can cause fatigue, weight gain, low blood pressure, dizziness, dry mouth, tremors, extrapyramidal symptoms, liver function abnormalities, muscle stiffness, severe skin conditions, and increased prolactin levels (). Flint et al. (2019) found that Olanzapine caused low birth weight, spontaneous abortions, stillbirths, prematurity, and postmaturity. References Bérard, A., Zhao, J. P., & Sheehy, O. (2015). Sertraline use during pregnancy and the risk of major malformations. American journal of obstetrics and gynecology, 212(6), 795.e1–795.e12. FDA. (2019). Depression Medicines - Food and Drug Administration. U.S. Food and Drug Administration. Retrieved from Flint, A. J., Meyers, B. S., & Rothschild, A. J. (2019). Continuing olanzapine with sertraline reduces relapse in psychotic depression. The Brown University Psychopharmacology Update, 30(12), 1. Guideline Development Panel for the Treatment of Depressive Disorders, American Psychological Association. (2021). Summary of the Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts. American Psychologist. Advance online publication. Heinonen, E., Blennow, M., Blomdahl-Wetterholm, M., Hovstadius, M., Nasiell, J., Pohanka, A., Gustafsson, L. L., & Wide, K. (2021). Sertraline concentrations in pregnant women are steady and the drug transfer to their infants is low. European Journal of Clinical Pharmacology, 77(9), 1323–1331. Ingram, J., Johnson, D., O’Mahen, H., Law, R., Culpin, I., Kessler, D., Beasant, L., & Evans, J. (2021). ‘Asking for help’: a qualitative interview study exploring the experiences of interpersonal counseling (IPC) compared to low-intensity cognitive behavioral therapy (CBT) for women with depression during pregnancy. BMC Pregnancy and Childbirth, 21(1), 1–8. Ozkan, M. (2013). Psychotropic drug use in pregnancy and lactation. Klinik Psikofarmakoloji Bulteni, 23, S55. Paulzen, M., Goecke, T. W., Stickeler, E., Gruender, G., & Schoretsanitis, G. (2017). Sertraline in pregnancy - Therapeutic drug monitoring in maternal blood, amniotic fluid and cord blood. JOURNAL OF AFFECTIVE DISORDERS, 212, 1–6. Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock's synopsis of psychiatry (11th ed.). Wolters Kluwer. Sahoo, M., Biswas, H., & Singh, V. (2022). Safety profile and adverse effects of use of olanzapine in pregnancy: A report of two cases. Journal of Family Medicine & Primary Care, 11(1), 350–352.

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