Use of mirtazapine and olanzapine in treatment of major depressive disorder with psychotic features developed during pregnancy: A case report

Objctive: To contribute to the of treatment of major depressive disorder with psychotic features developing during pregnancy

Case: A 25 year-old, married, female patient was 13 weeks pregnant and diagnosed with major depressive disorder (MDD) with psychotic features. She was a housewife with primary school degree and was admitted to inpatient unit. The obstetrician did not find any fetal anomalies. The patient was put on mirtazapine and olanzapine, doses of which ranged between 15-30mg/day and 5-10 mg/day, respectively during her two months hospitalization. In her follow up, 15 days after discharge, olanzapine dose was decreased to 5 mg/day, but mirtazapine was continued at 30mg/day until delivery. To decrease neural tube defect risk folic acid 5mg/day was prescribed during the treatment, as well. She gave birth to a live and healthy baby on the expected due date during her outpatient treatment. The information regarding the safety of use of mirtazapine and olanzapine during pregnancy primarily rely on case reports. While there were no fetal abnormalities in majority of cases regarding olanzapine use (1,2), there are some reports including hip dysplesia (3), meningocele ve ankyloblepharon (4), atrioventricular channel defect and unilateral pes equinovarus (5). However, more cases and studies are needed to explore, whether these cases were coincidental or due to teratogenic effects of olanzapine. Currently available publications (6,7,8,9) report that major malformation risk in general population does not increase with the use of mirtazapine during pregnancy. The reports from our country are parallel to the reports in the literature (10,11).

Results: Even in majority of cases no fetal abnormalities were reported regarding olanzapine use during pregnancy, large case series are needed to have more evidence for stronger judgments. Also even mirtazapine does not look like a teratogenic agent, is should be used with caution during pregnancy and babies that are exposed to mirtazapine should be followed closely.

References:

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