NRNP 6675 Week 9 Discussion: Prescribing for Older Adults and Pregnant Women Example 1 Disruptive Mood Dysregulation Disorder in Pregnant Women

NRNP 6675 Week 9 Discussion: Prescribing for Older Adults and Pregnant Women Example 1

Disruptive Mood Dysregulation Disorder in Pregnant Women

Extreme and persistent anger and temper outbursts characterize Disruptive Mood Dysregulation Disorder (DMDD). DMDD can greatly influence everyday functioning and social relationships and, therefore, requires prompt management.

Pharmacological and Non-pharmacological Interventions

FDA-approved drug: Sertraline – For pregnant women with DMDD, this selective serotonin reuptake inhibitor (SSRI) is generally safe and licensed to treat major depressive disorder. It helps to lessen irritability and stabilize mood (Gilliam et al., 2019).

Off-label drug: Lamotrigine – Lamotrigine is occasionally used off-label to treat mood problems, even though it is not FDA-approved for DMDD specifically. A study on pregnant, epileptic women who took this drug showed a comparatively reduced risk of birth abnormalities (Naguy & Al-Enezi, 2019). It also has mood-stabilizing effects.

Non-pharmacological intervention: Cognitive-Behavioral Therapy (CBT) is a recognized psychotherapeutic strategy for treating mood problems. It can be modified to help pregnant people with DMDD recognize and alter negative thought patterns and create coping mechanisms for emotional control without needing medication.

Risk Assessment

A thorough risk assessment is essential when choosing a course of treatment for pregnant women with DMDD to protect the health and safety of both the mother and the growing fetus. Improved mood stability and less irritability may result from using FDA-approved medications like Sertraline, improving the woman’s overall quality of life during pregnancy. However, certain risks should be considered, such as possible side effects, including nausea or shifts in sleeping patterns. SSRI use may also be connected with a modest incidence of birth abnormalities, necessitating cautious monitoring.

The benefits of the off-label medication Lamotrigine may include mood stability, but due to DMDD’s lack of FDA approval, caution is advised. Although findings suggest a low risk of birth abnormalities, the lack of data on its safety during pregnancy must be carefully considered. It is crucial to balance the potential advantages of using off-label drugs against the unidentified hazards and risks that could arise.

The risk evaluation must consider non-pharmacological therapies like Cognitive-Behavioral Therapy (CBT), which may offer benefits without imposing drug-related risks. To balance optimizing treatment benefits and limiting possible risks for the mother and the growing baby, collaborative decision-making, including healthcare providers, the pregnant woman, and her support network, is crucial (Zemestani & Fazeli Nikoo, 2019).

Practice Guidelines

There are clinical practice guidelines for DMDD, which can be useful for guiding treatment choices. Usually, the best available data from studies and consensus among experts serve as the foundation for these recommendations. Due to their well-established efficacy and safety profile, they may advise FDA-approved drugs like Sertraline as a first-line treatment for DMDD in pregnant women.

Guidelines may also advise against using off-label medications like Lamotrigine during pregnancy due to the limited knowledge available on their safety. However, since there are no particular recommendations for treating DMDD in pregnant women, it would be necessary to look at more information from studies on the use of drugs during pregnancy, potential dangers and benefits, and non-pharmacological therapies like CBT. Making informed treatment choices for this population requires consulting with psychiatric and maternal-fetal medicine experts.

References

Gilliam, F. G., Black, K. J., Carter, J., Freedland, K. E., Sheline, Y. I., Tsai, W., & Lustman, P. J. (2019). A trial of sertraline or cognitive behavior therapy for depression in epilepsy. Annals of Neurology, 86(4), 552–560. https://doi.org/10.1002/ana.25561

Naguy, A., & Al-Enezi, N. (2019). Lamotrigine Uses in Psychiatric Practice. American Journal of Therapeutics, 26(1), e96–e102. https://doi.org/10.1097/mjt.0000000000000535

Zemestani, M., & Fazeli Nikoo, Z. (2019). Effectiveness of mindfulness-based cognitive therapy for