PeriPAN Case of the Month – May 2024

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Each month, OBs and PCPs call PeriPAN with a wide variety of mental health questions. Find out how PeriPAN helped a Psychiatric Nurse Practitioner during this consultation.

Patient:

30-year-old female

Reason for PeriPAN Consultation:

Seeking medication guidance

Explanation of the Case and Outcome of the Call:

Patient has several ongoing and acute stressors. Father of this baby is a new romantic partner so there is some understandable distress as they adjust to an unexpected but desired pregnancy. Patient has a history of depression and anxiety through her young adult and adult life. Patient has done well in the past and now on paroxetine 40mg and also engaged in support psychotherapy on and off for years. She is 14 weeks pregnant.  

Nurse Practitioner had planned to have her taper paroxetine over the course of several weeks and then start sertraline. She has a couple of antidepressant trials over the past years (sertraline, venlafaxine, paroxetine, fluoxetine) and she reports the best response to paroxetine. A past trial of sertraline for three months at max dose of 150mg resulted in no improvement in symptoms. Her mood is currently stable. 

Take Home Point:

Mood currently stable on paroxetine, so do not taper and switch to another antidepressant. Continue paroxetine 40mg daily. Monitor PHQ9 and GAD7 periodically.