Q: 28 years old female with post-partum severe unipolar depression is admitted to ICU with severe psychosis requiring restraints to prevent harm. What advantage Aripiprazole has over other antipsychotics in this situation?
Answer: There is no hard and fast rule for choice of anti-psychotic in post-partum unipolar severe depression associated with psychosis. Aripiprazole is usually considered the first choice as it can be given as a disintegrating tablet or oral solution. Many of these patients may not allow the insertion of "IV" or may harm themselves by pulling their intravenous (IV) line. The dose is 10-15 mg and can be given every 2 hours, though it is not preferred to go beyond the total dose of 30 mg over the 24 hours period. The patient usually calms down with the first couple of doses. The peak plasma concentration occurs within 3-5 hours. Aripiprazole is less sedative in comparison to other antipsychotics, causes minimal prolongation of QTc interval and/or orthostatic hypotension.
Olanzapine is another good choice though it has decreased clearance in females and in patients who are non-smokers.
#psychiatry
#Ob-Gyn
Further readings:
1. Osborne LM. Recognizing and Managing Postpartum Psychosis: A Clinical Guide for Obstetric Providers. Obstet Gynecol Clin North Am. 2018;45(3):455-468. doi:10.1016/j.ogc.2018.04.005
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