TY  - JOUR
A1  - Leutritz, Anna Linda
A1  - van Braam, Lara
A1  - Preis, Katharina
A1  - Gehrmann, Andrea
A1  - Scherf-Clavel, Maike
A1  - Fiedler, Katrin
A1  - Unterecker, Stefan
A1  - Kittel-Schneider, Sarah
T1  - Psychotropic medication in pregnancy and lactation and early development of exposed children
JF  - British Journal of Clinical Pharmacology
N2  - There is still limited knowledge about alterations of blood concentrations of psychotropic drugs during pregnancy, the transfer of psychotropic drugs into breastmilk and the effects on exposed children. We investigated changes in concentrations of psychopharmacological medication during pregnancy and lactation in serum and breastmilk at different time points in a naturalistic sample of 60 mothers and observed the development of the exposed children in the first 12 months. We found a decrease in serum concentrations from the first to the second trimester of amitriptyline, duloxetine, escitalopram, quetiapine and sertraline. Citalopram stayed rather stable during pregnancy, sertraline levels interestingly increased again from the second to the third trimester. High concentration-by-dose ratios in breastmilk were found for venlafaxine as well as lamotrigine, low for quetiapine and clomipramine. Similarly, clomipramine and quetiapine showed low milk/serum–penetration ratios. Regarding the birth outcome measures in children, we found no significant differences between in utero exposed compared to nonexposed newborns. There were no significant differences in the development in the first 12 months. Psychotropic medication in the peripartum needs a balancing of risks and benefits and a continuous therapeutic drug monitoring can be a guidance for clinicians to monitor drug alteration patterns, which are likely to occur due to physiological pregnancy-associated changes in pharmacokinetics. Accordingly, therapeutic drug monitoring can optimize a medication in pregnancy and lactation with the lowest effective dose.
KW  - antidepressants
KW  - psychotropic medication
KW  - pregnancy
KW  - peripartum
KW  - mental disorders
KW  - lactation
KW  - child development
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318954
VL  - 89
IS  - 2
SP  - 737
EP  - 750
ER  - 
TY  - JOUR
A1  - Willeke, Kristina
A1  - Janson, Patrick
A1  - Zink, Katharina
A1  - Stupp, Carolin
A1  - Kittel-Schneider, Sarah
A1  - Berghöfer, Anne
A1  - Ewert, Thomas
A1  - King, Ryan
A1  - Heuschmann, Peter U.
A1  - Zapf, Andreas
A1  - Wildner, Manfred
A1  - Keil, Thomas
T1  - Occurrence of mental illness and mental health risks among the self-employed: a systematic review
JF  - International Journal of Environmental Research and Public Health
N2  - We aimed to systematically identify and evaluate all studies of good quality that compared the occurrence of mental disorders in the self-employed versus employees. Adhering to the Cochrane guidelines, we conducted a systematic review and searched three major medical databases (MEDLINE, Web of Science, Embase), complemented by hand search. We included 26 (three longitudinal and 23 cross-sectional) population-based studies of good quality (using a validated quality assessment tool), with data from 3,128,877 participants in total. The longest of these studies, a Swedish national register evaluation with 25 years follow-up, showed a higher incidence of mental illness among the self-employed compared to white-collar workers, but a lower incidence compared to blue-collar workers. In the second longitudinal study from Sweden the self-employed had a lower incidence of mental illness compared to both blue- and white-collar workers over 15 years, whereas the third longitudinal study (South Korea) did not find a difference regarding the incidence of depressive symptoms over 6 years. Results from the cross-sectional studies showed associations between self-employment and poor general mental health and stress, but were inconsistent regarding other mental outcomes. Most studies from South Korea found a higher prevalence of mental disorders among the self-employed compared to employees, whereas the results of cross-sectional studies from outside Asia were less consistent. In conclusion, we found evidence from population-based studies for a link between self-employment and increased risk of mental illness. Further longitudinal studies are needed examining the potential risk for the development of mental disorders in specific subtypes of the self-employed.
KW  - incidence
KW  - mental disorders
KW  - mental health
KW  - mental illness
KW  - prevalence
KW  - self-employed
KW  - small business
KW  - systematic review
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-245085
SN  - 1660-4601
VL  - 18
IS  - 16
ER  -