In women, it is clear that the onset of major depression tends to occur in the child-bearing ages. 1 Studies have shown a similar incidence of major depressive episodes in matched gravid and nongravid women, so pregnancy appears to have neither a protective nor a detrimental effect. 24 In contrast, the postpartum period is one of high risk for the development of a depressive episode, particularly in women with a history of major depression (especially if it had a postpartum component), depressive symptoms during pregnancy, or bipolar disorder. 24 , 25
The intravenous route is not FDA approved and is generally not recommended except when no other alternatives are available. Intravenous administration appears to be associated with a higher risk of QT prolongation and torsade de pointes (TdP) than other forms of administration. The manufacturer recommends ECG monitoring for QT prolongation and arrhythmias if IV administration is required. A dose in the range of 1 to 5 mg IV has been suggested, with the dose being repeated at 30 to 60 minute intervals, if needed. A maximum IV dose has not been established. The lowest effective dose should be used in conjunction with conversion to oral therapy as soon as possible.
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