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Depression in Schwangerschaft und Postpartum

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Akute und therapieresistente Depressionen

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Zusammenfassung

Depressionen bei Frauen sind häufig; sie rezidivieren oftmals in der Schwangerschaft oder im Postpartum. Eine Behandlung — mit oder ohne Pharmaka — ist nötig, um Progredienz und möglicherweise bleibende Schäden für den Fetus zu verhindern. Eine effektive Behandlung ist auch deshalb wichtig, weil Depression in der Schwangerschaft einen Risikofaktor für die Postpartumdepression darstellt.

Die Behandlung während der Schwangerschaft und im Postpartum basiert auf der Zusammenarbeit zwischen der Patientin und ihrem Partner sowie dem Psychiater, dem Geburtshelfer und dem Kinderarzt. Bei Patientinnen mit einer Depression in der Anamnese ermöglicht eine Beratung vor Beginn der Schwangerschaft eine überlegte Risiko- Nutzen-Abwägung sowie das Erstellen eines Behandlungsplans für den Fall eines Rezidivs. Bei schwerer oder rezidivierender Depression ist heute eine Fortsetzung der Pharmakotherapie möglich. Für die Wahl des Wirkstoffs ist ausschlaggebend, dass dessen mögliche Risiken für den Fetus in angemessenem Verhältnis zu den Vorteilen für die antidepressive bzw. rezidivprophylaktische Behandlung der Schwangeren ergeben.

Ein Rezidiv unter der Schwangerschaft kann zunächst mit einer interpersonellen Psychotherapie oder einer kognitiven Verhaltenstherapie behandelt werden, um die Notwendigkeit einer Pharmakotherapie zu verzögern oder sogar zu umgehen. Dieses Vorgehen könnte der Patientin die Akzeptanz einer Medikation erleichtern, wenn sich diese trotz der Psychotherapie als unumgänglich herausstellt.

Die Wirksamkeit der Pharmakotherapie sollte während der Schwangerschaft ständig überprüft werden, weil die Medikamentenspiegel durch physiologische Veränderungen, wie z. B. größeres Verteilungsvolumen und erhöhte renale Clearance, sinken. Demzufolge müssen Blutspiegel von Phasenprophylaktika und trizyklischen Antidepressiva im 2. und 3. Trimenon häufig überprüft werden.

Patientinnen mit einer affektiven Störung müssen nach der Geburt aufmerksam begleitet werden, weil sie in dieser Phase anfällig für Rezidive oder Progredienz ihrer Depression sind. Die Zusammenarbeit mit Geburtshelfer und Kinderarzt bietet vielfache Möglichkeiten, die Depression zu diagnostizieren und eine Behandlung einzuleiten.

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Authors
  1. D. Yaeger
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  2. L.L. Altshuler
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Editors and Affiliations

  1. Klinik für Psychatrie und Psychotherapie, Charité — Universitätsklinik Berlin, Campus Charité Mitte (CCM), Schumannstr. 20/21, 10117, Berlin

    Michael Bauer  & Mazda Adli  & 

  2. Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité — Universitätsklinik Berlin, Campus Charité Mitte (CCM), Luisenstr. 57, 10117, Berlin

    Anne Berghöfer

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Yaeger, D., Altshuler, L. (2005). Depression in Schwangerschaft und Postpartum. In: Bauer, M., Berghöfer, A., Adli, M. (eds) Akute und therapieresistente Depressionen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-28049-9_9

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