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Yıl:2014; Cilt: 7; Sayı: 2>> Özet
Türkiye Klinikleri Psikiyatri Özel Dergisi; 2014;7(2):104-114
Gebelikte Duygudurum Bozukluklarının İlaçla Tedavisi
N Aydın
Bakırköy Prof.Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul
Akılcı ilaç kullanımında etkinliği gösterilmiş tedavilerden bireyin özelliklerine en uygun olanının seçilmesi esastır. Doğurganlık çağındaki kadınlarda ise bireysel özelliklerin yanında seçilecek ilacın olası bir gebelik durumunda anne karnındaki fetüse etkilerinin de hesaba katılması gereklidir. Öte yandan duygudurum bozukluğu olan kadınlarda teratojeniteyi önlemek amacıyla yapılan tedavi düzenlemelerinde hastalığın alevlenme riskinin özellikle doğum sonrasında oldukça yüksek olduğu da göz önünde bulundurulmalıdır. Gebelikte genel olarak başta valproik asit olmak üzere lityum ve karbamazepinin kullanılması önerilmemektedir. Daha yeni antiepileptiklerden lamotrijin ve DDD özelliğe de sahip olan yeni kuşak antipsikotikler nisbeten güvenli görünmektedir. İlaç dozlarının yüksekliği ve çok sayıda ilaç kullanılması teratojenite riskini artırmaktadır. Bununla beraber, gebelik nedeniyle ani ilaç kesilmesi hastalığın nüksetme riskinde önemli oranda artışa yol açmaktadır. Gebelikte duygudurum bozukluklarının tedavisinde amaç, hastalığa ve kişiye ait bireysel özellikler gözönüne alınarak hastalığın nüksetmesini önlemektir. Bu yazıda duygudurum bozukluğu olan kadınlarda gebelik planlaması yanısıra plansız gebeliklerde AİK ilkeleri çerçevesinde uygulanabilecek pratiğe yönelik bilgiler sunulması amaçlanmıştır.
Medical Treatment of Mood Disorders in Pregnancy
Due to rational use of drugs, to select the most appropriate drug for individuals characteristics between the ones, which are shown to be effective, is essential. In addition to the individual characteristics, the effects of selected drug's on fetus must be taken into account in a possible pregnancy. On the other hand, treatment interventions in women with mood disorders in order to prevent teratogenicity, enhance the risk of relapse, especially relapses occurring after childbirth should be taken into account. Including valproic acid in particular, the use of lithium and carbamazepine is not recommended during pregnancy. Lamotrigine, as one of the new antiepilepticis, and the new-generation antipsychotics featuring also as mood stabilizers seem to be relatively safe. The high drug doses and multiple drug use increases the risk of teratogenicity. Besides, the abrupt cessation of drugs because of pregnancy leads to a significant increase in the risk of relapse. The main purpose in the treatment of mood disorders in pregnancy is to prevent the relapse of disease as taking the individual characteristics of the patient into account. In this article, it is intended to provide the practical information in pregnancy planning in women with mood disorders as well as the one in unplanned pregnancies within the rational drug use framework.

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