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Analyses of Pharmacokinetic, Pharmacogenetic and Psychometrics Correlates of Antidepressants Use during Pregnancy and the Post-Partum Period

Published online by Cambridge University Press:  01 September 2022

R. Cafaro ,
F. Giorgetti ,
L. Giacovelli ,
S. Vanzetto ,
L. Cerolini ,
A. Colombo  and
B. Dell’Osso
R. Cafaro*
Affiliation:
University of Milan, Department Of Biomedical And Clinical Sciences “luigi Sacco”, Milan, Italy
F. Giorgetti
Affiliation:
University of Milan, Department Of Biomedical And Clinical Sciences “luigi Sacco”, Milan, Italy
L. Giacovelli
Affiliation:
University of Milan, Department Of Biomedical And Clinical Sciences “luigi Sacco”, Milan, Italy
S. Vanzetto
Affiliation:
University of Milan, Department Of Biomedical And Clinical Sciences “luigi Sacco”, Milan, Italy
L. Cerolini
Affiliation:
University of Milan, Department Of Biomedical And Clinical Sciences “luigi Sacco”, Milan, Italy
A. Colombo
Affiliation:
University of Milan, Department Of Biomedical And Clinical Sciences “luigi Sacco”, Milan, Italy
B. Dell’Osso
Affiliation:
University of Milan, Department Of Biomedical And Clinical Sciences “luigi Sacco”, Milan, Italy
*
*Corresponding author.

Abstract

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Introduction

About 15% of women experience a depressive episode during pregnancy, and 19% during the postpartum. Studies on safety of Antidepressants use during pregnancy have given controversial results. Obstetric-gynecological changes of pregnancy determine modifications in the pharmacokinetics of medications, through an altered metabolism of the CYP enzymes. Patient’s therapeutic response might also be influenced by polymorphisms of the genes encoding CYP enzymes.

Objectives

In this perspective, we evaluated the correlation between pharmacokinetics, pharmacogenetics and psychopathological measures, analyzing SSRIs or SNRIs concentrations during the three trimesters of pregnancy, at birth and at postpartum, in order to define efficacy, tolerability and safety of Antidepressants (ADs) in the treatment of affective and anxiety disorders during pregnancy.

Methods

87 patients were enrolled at the Depressive Disorders Treatment Centre (CTDD) of the Department of Psychiatry of Sacco University Hospital (Milano, Italy). Plasma concentrations of ADs were measured during first (T1), second (T2), third (T3) trimester, at birth (T4) and at postpartum (T5). Psychometric assessments were carried out. The genotype of hepatic CYP isoforms were also analysed.

Results

ADs mainly metabolized by CYP2C19 (es. Sertraline) are less frequently below therapeutic range than ADs metabolized by CYP2D6. In fact, the metabolic activity of CYP2C19 is slowed down during pregnancy. The majority of ADs concentrations below therapeutic range were found in women with an accelerated metaboslism, carrier of a CYP polymorphism.

Conclusions

Our results underline that the systematic use of pharmacokinetic and pharmacogenetic analyses during pregnancy could constitute a valid support in the management of therapy in the last phases of pregnancy.

Disclosure

No significant relationships.

Keywords

psychopharmacologyPregnancyPerinatal psychiatry
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S234
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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