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Antidepressants in pregnancy

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By Joe Weatherly FM/Hospitalist-CoFounder of QuestioningMedicine and PCRAP contributor.
L Ban, J E Gibson, J West, L Fiaschi, R Sokal, L Smeeth, P Doyle, R B Hubbard, L J Tata
OBJECTIVE: To estimate risks of major congenital anomaly (MCA) among children of mothers prescribed antidepressants during early pregnancy or diagnosed with depression but without antidepressant prescriptions. DESIGN: Population-based cohort study. SETTING: Linked UK maternal-child primary care records. POPULATION: A total of 349,127 singletons liveborn between 1990 and 2009. METHODS: Odds ratios adjusted for maternal sociodemographics and comorbidities (aORs) were calculated for MCAs, comparing women with first-trimester selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) and women with diagnosed but unmedicated depression, or women without diagnosed depression...
November 2014: BJOG: An International Journal of Obstetrics and Gynaecology
Chase H Bourke, Zachary N Stowe, Michael J Owens
Pharmacological treatment of any maternal illness during pregnancy warrants consideration of the consequences of the illness and/or medication for both the mother and unborn child. In the case of major depressive disorder, which affects up to 10-20% of pregnant women, the deleterious effects of untreated depression on the offspring can be profound and long lasting. Progress has been made in our understanding of the mechanism(s) of action of antidepressants, fetal exposure to these medications, and serotonin's role in development...
2014: Pharmacological Reviews
Tianyun Zhao, Yuantao Li, Wei Wei, Sinead Savage, Libing Zhou, Daqing Ma
Commonly used anesthetic agents, e.g. ketamine, may be neurotoxic to the developing brain but there has been little attention to the neurobehavioral consequences for offspring when used for maternal anesthesia. We hypothesize that treatment of pregnant rats with ketamine during the second trimester would affect brain development of the offspring. Pregnant rats on gestational day 14, about equal to midtrimester pregnancy in humans, received a sedative dose of ketamine intravenously for 2h. Brain hippocampal morphology of their pups at postnatal days 0 (P0) and P30 was examined by Nissl-staining and the characteristics of dendrites were determined using the Golgi-Cox staining, while cell proliferation in subventricular zone (SVZ) and dentate gyrus (DG) was labeled with bromodeoxyuridine (BrdU)...
August 2014: Neurobiology of Disease
Charlotte Hellgren, Helena Åkerud, Alkistis Skalkidou, Torbjörn Bäckström, Inger Sundström-Poromaa
BACKGROUND: Allopregnanolone (3α-hydroxy-5α-pregnan-20-one) is a neurosteroid which has an inhibitory function through interaction with the GABAA receptor. This progesterone metabolite has strong sedative and anxiolytic properties, and low endogenous levels have been associated with depressed mood. This study aimed to investigate whether the very high serum allopregnanolone levels in late pregnancy covary with concurrent self-rated symptoms of depression and anxiety. METHODS: Ninety-six women in pregnancy weeks 37-40 rated symptoms of depression and anxiety with the Montgomery-Åsberg Depression Rating Scale (MADRS-S) and Spielberger State-Trait Anxiety Inventory...
2014: Neuropsychobiology
James J Newham, Anja Wittkowski, Janine Hurley, John D Aplin, Melissa Westwood
BACKGROUND: Antenatal depression and anxiety are associated with adverse obstetric and mental health outcomes, yet practicable nonpharmacological therapies, particularly for the latter, are lacking. Yoga incorporates relaxation and breathing techniques with postures that can be customized for pregnant women. This study tested the efficacy of yoga as an intervention for reducing maternal anxiety during pregnancy. METHODS: Fifty-nine primiparous, low-risk pregnant women completed questionnaires assessing state (State Trait Anxiety Inventory; STAI-State), trait (STAI-Trait), and pregnancy-specific anxiety (Wijma Delivery Expectancy Questionnaire; WDEQ) and depression (Edinburgh Postnatal Depression Scale; EPDS) before randomization (baseline) to either an 8-week course of antenatal yoga or treatment-as-usual (TAU); both groups repeated the questionnaires at follow-up...
August 2014: Depression and Anxiety
Svetlana Bershadsky, Linda Trumpfheller, Holly Beck Kimble, Diana Pipaloff, Ilona S Yim
Perinatal depression impacts maternal and child health, and little is known about effective interventions. The effects of prenatal Hatha yoga on cortisol, affect and depressive symptoms were investigated in 51 women. Twice during pregnancy, yoga group participants reported on affect and provided a saliva sample before and after a 90-min prenatal Hatha yoga session. Corresponding measures were obtained from yoga and control group participants on days of usual activity. Depressive symptoms were assessed in pregnancy and post partum...
May 2014: Complementary Therapies in Clinical Practice
Christina Schroeder, Danny Wu, Maqdooda Merchant, Jeannette Ferber, Robert Currier, De-Kun Li
INTRODUCTION: The objective of this study was to examine the effect of maternal antidepressant exposure on first- and second-trimester maternal serum markers for aneuploidy. METHODS: We conducted a 10-year retrospective cohort study within a large health care organization. Pregnant women diagnosed with depression who underwent serum screening for aneuploidy were identified. Antidepressant exposure was defined by a filled prescription. Levels of pregnancy-associated plasma protein-A, alpha-fetoprotein, estriol, inhibin, and second-trimester human chorionic gonadotropin (hCG) were obtained, expressed as multiples of the mean...
May 2014: Obstetrics and Gynecology
Jan Wesström, Alkistis Skalkidou, Mauro Manconi, Stephany Fulda, Inger Sundström-Poromaa
OBJECTIVES: Both restless legs syndrome ([RLS], also known as Willis-Ekbom Disease [WED]) and depression are common during pregnancy. However, no prior studies have assessed if pregnant women with RLS have an elevated risk of depression during and/or after pregnancy. METHODS: 1,428 women who were pregnant in gestational week 16-17 were asked to participate in a longitudinal survey. They were followed by web-based questionnaires in gestational week 17 and 32, and 6 weeks after delivery...
May 15, 2014: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
R Mellor, S C Chua, P Boyce
Research indicates that poor sleep quality is linked to and may precede depressive symptomatology in pregnancy, complicating screening for either condition. Pregnancy onset may also contribute to the development of sleep-disordered breathing (SDB). For the first time, the link between SDB and depression was examined in pregnancy. A total of 189 pregnant women completed the Edinburgh Postnatal Depression Scale (EPDS), Pittsburgh Sleep Quality Index (PSQI) for sleep quality and the Berlin Questionnaire for SDB...
August 2014: Archives of Women's Mental Health
Ting Ding, Dong-Xin Wang, Yuan Qu, Qian Chen, Sai-Nan Zhu
BACKGROUND: Postpartum depression is a common psychiatric disorder in parturients after delivery. The etiology remains unclear, and multiple factors may be involved. In this study, we investigated whether epidural labor analgesia was associated with a decreased risk of postpartum depression development. METHODS: Two hundred fourteen parturients who were preparing for a vaginal delivery were enrolled in this prospective cohort study. Epidural labor analgesia was performed in 107 of 214 patients on their request...
August 2014: Anesthesia and Analgesia
L V Toffoli, G M Rodrigues, J F Oliveira, A S Silva, E G Moreira, G G Pelosi, M V Gomes
Fluoxetine is an antidepressant that has been largely used for treatment of depression in pregnancy. In the present study we evaluated the effects of the exposure to fluoxetine during gestation and lactation on DNA methylation of rat brain regions. Female Wistar rats were treated with 5mg/kg of fluoxetine during pregnancy and lactation. In order to assess the effects of fluoxetine in the context of maternal folic acid supplementation we performed an additional combined treatment composed by folic acid (8 mg/kg/day) and fluoxetine (5 mg/kg/day)...
May 15, 2014: Behavioural Brain Research
Rebecca C Knickmeyer, Samantha Meltzer-Brody, Sandra Woolson, Robert M Hamer, J Keith Smith, Kenneth Lury, John H Gilmore
Selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed to pregnant women. Therefore, research on in utero exposure to SSRIs can be helpful in informing patients and clinicians. The aim of this retrospective two-cohort study was to determine whether there is a statistically significant increase in Chiari I malformations (CIM) in children exposed to SSRIs during pregnancy. A total of 33 children whose mothers received a diagnosis of depression and took SSRIs during pregnancy (SSRI-exposed cohort) were matched to 66 children with no history of maternal depression and no SSRI exposure...
October 2014: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
Leila Arbabi, Mohamad Taufik Hidayat Baharuldin, Mohamad Aris Mohamad Moklas, Sharida Fakurazi, Sani Ismaila Muhammad
Postpartum depression (PPD) is a psychiatric disorder that occurs in 10-15% of childbearing women. It is hypothesized that omega-3 fatty acids, which are components of fish oil, may attenuate depression symptoms. In order to examine this hypothesis, the animal model of postpartum depression was established in the present study. Ovariectomized female rats underwent hormone-simulated pregnancy (HSP) regimen and received progesterone and estradiol benzoate or vehicle for 23 days, mimicking the actual rat's pregnancy...
September 1, 2014: Behavioural Brain Research
M Perales, I Refoyo, J Coteron, M Bacchi, R Barakat
Recent studies have estimated the prevalence of depression during pregnancy to be between 10% and 30%, which is higher than that in the postpartum period. Pharmacological treatment during pregnancy is difficult because of the possible side effects of antidepressants on the mother and the fetus. The aim of this study was to examine whether a supervised exercise program (EP) reduces depressive symptoms in pregnant women. A randomized controlled trial was designed. One hundred eighty four healthy pregnant women from Fuenlabrada Hospital were included (31...
March 2015: Evaluation & the Health Professions
Jun Wu, Mary Lynn Davis-Ajami
BACKGROUND: Pregnant women with depression face complicated treatment decisions, either because of the risk associated with not treating depression or because of the risks associated with antidepressant use. Approximately 1 in 5 women experience depressive symptoms during pregnancy. This information suggests that many women may take an antidepressant at some time during pregnancy. Once pregnant women initiate antidepressant prescription pharmacotherapy, medication treatment persistence plays an important role in managing depression, yet little is known regarding antidepressant use behavior in pregnant women...
June 2014: Journal of Managed Care & Specialty Pharmacy
Brett D Thombs, Donna E Stewart
No abstract text is available yet for this article.
June 2014: Journal of Psychosomatic Research
Asher Ornoy, Gideon Koren
There has been an increase in the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. However, in the last 10 years, in spite of a vast literature regarding use in pregnancy there seems to be some confusion as to the possible risk of these drugs, especially related to cardiovascular anomalies. In addition, there are data on developmental follow-up studies that raise the question of possible slight developmental and neurobehavioral problems. The purpose of the present review is therefore to critically summarize the current evidence for the risk/benefit analysis of SSRI use in human pregnancy...
June 2014: Seminars in Fetal & Neonatal Medicine
C H Liu, E Tronick
Aims. Depression requires the presence of either depressed mood or anhedonia, yet little research attention has been focused on distinguishing these two symptoms. This study aimed to obtain the prevalence rates of these two core depression symptoms and to explore the risk factors for each symptom by race/ethnicity. Methods. 2423 White, African American, Hispanic and Asian/Pacific Islander (API) women from the Massachusetts area completed the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2007 to 2008...
June 2014: Epidemiology and Psychiatric Sciences
Cassandra Burton, Shane Gill, Patrick Clarke, Cherrie Galletly
It is important to explore potential safe treatment options for the ongoing treatment of women's depression during pregnancy. One promising treatment is repetitive transcranial magnetic stimulation (rTMS). We report on the case of a woman who became pregnant while receiving regular maintenance rTMS combined with pharmacotherapy treatment for major depressive episode. The patient achieved remission following two acute courses of rTMS and continued with maintenance rTMS treatment over the course of 4 years, during which she became pregnant and gave birth to a healthy infant...
June 2014: Archives of Women's Mental Health
S C Jaques, A Kingsbury, P Henshcke, C Chomchai, S Clews, J Falconer, M E Abdel-Latif, J M Feller, J L Oei
To review and summarise the literature reporting on cannabis use within western communities with specific reference to patterns of use, the pharmacology of its major psychoactive compounds, including placental and fetal transfer, and the impact of maternal cannabis use on pregnancy, the newborn infant and the developing child. Review of published articles, governmental guidelines and data and book chapters. Although cannabis is one of the most widely used illegal drugs, there is limited data about the prevalence of cannabis use in pregnant women, and it is likely that reported rates of exposure are significantly underestimated...
June 2014: Journal of Perinatology: Official Journal of the California Perinatal Association
2014-06-19 03:20:53
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