Archives of Women's Mental Health

, Volume 17, Issue 3, pp 239–246

Returning to tricyclic antidepressants for depression during childbearing: clinical and dosing challenges

  • Lauren M. Osborne
  • Catherine A. Birndorf
  • Lauren E. Szkodny
  • Katherine L. Wisner
Case Report

DOI: 10.1007/s00737-014-0421-z

Cite this article as:
Osborne, L.M., Birndorf, C.A., Szkodny, L.E. et al. Arch Womens Ment Health (2014) 17: 239. doi:10.1007/s00737-014-0421-z


Managing depression and anxiety during pregnancy and the postpartum period is challenging. Both pharmacological treatment and the lack thereof can pose threats to a fetus. SSRIs are the drugs of choice for use during pregnancy, but there is considerable evidence for the safety and efficacy of older antidepressants during pregnancy as well. This study highlights a single case of the use of the tricyclic nortriptyline during pregnancy and postpartum. The subject involved had an unexpectedly high ratio of serum level to drug dose during the postpartum period. We monitored the subject for a significantly greater portion of the postpartum period than has been done in previous studies, and explored medical and lifestyle changes that could account for the level-to-dose ratios we observed. Differences in smoking patterns, coupled with the patient’s status as a genetic poor metabolizer, were the most likely explanations.


PregnancyDepressionAnxietyNortriptylinePharmacokineticsTricyclic antidepressants

Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Lauren M. Osborne
    • 1
  • Catherine A. Birndorf
    • 2
  • Lauren E. Szkodny
    • 3
  • Katherine L. Wisner
    • 4
  1. 1.Division of Behavioral Medicine, Department of PsychiatryColumbia University Medical CenterNew YorkUSA
  2. 2.Payne Whitney Women’s Program, Departments of Psychiatry and Obstetrics and GynecologyWeill Medical College of Cornell UniversityNew YorkUSA
  3. 3.Department of PsychologyThe Pennsylvania State UniversityUniversity ParkUSA
  4. 4.Departments of Psychiatry and Behavioral Sciences and Obstetrics and GynecologyNorthwestern UniversityChicagoUSA