A few weeks after the FDA called into question the association between SSRI exposure and persistent pulmonary hypertension of the newborn or PPHN, BMJ published another article supporting an increased risk of PPHN among infants exposed to SSRIs in utero. This large study is similar to the studies published by Kallen and colleagues using the [...]
Author Archives: MGH Center for Women's Mental Health
Depression in Women: Is There a Role for Vitamin D?
January 24, 2012 – 12:55 pm
Sources of vitamin D include sunlight (ultraviolet B, or UVB, rays), dietary intake, and supplements. Sunlight is the main source of human vitamin D. Vitamin D refers to different forms of a steroid hormone. Vitamin D3 (also called 1, 25-dihydroxycholecalciferol or calcitriol) is produced by the body when ultraviolet light (in the form of UV [...]
SSRIs and PPHN: The FDA Revises Its Warning
January 17, 2012 – 3:29 pm
In 2006, Chambers and colleagues published an article in the New England Journal of Medicine linking SSRI use during late pregnancy to an increased risk of persistent pulmonary hypertension in the newborn (PPHN). Based on these findings, the “Usage in Pregnancy” section on the labels for SRRI antidepressants was updated to include the following warning: “Infants exposed [...]
PTSD and Pregnancy
December 20, 2011 – 10:43 am
Understanding posttraumatic stress disorder (PTSD) during pregnancy is important given that PTSD is relatively common and persistent in nature. PTSD will occur in approximately 10% of women in their lifetime, with one-third of episodes lasting more than five years. Given the relatively high prevalence of PTSD in young women and the chronic nature of the [...]
Clinical Case: Would You Use Gabapentin (Neurontin) During Pregnancy?
December 13, 2011 – 6:22 pm
Ms. P is a 32-year-old married woman who presented for consultation regarding the use of medication during pregnancy. She had been taking fluoxetine (Prozac) 20 mg for many years for the treatment of recurrent major depression and generalized anxiety. In addition, she was prescribed gabapentin (Neurontin) for sleep. During the consultation, we reviewed the risks [...]
Escitalopram (Lexapro) and Pregnancy
December 5, 2011 – 1:50 pm
Both citalopram and escitalopram are antidepressants belonging to the SSRI class. While escitalopram (marketed in the U.S. as Lexapro) contains only the S-stereoisomer (or enantiomer) of the drug citalopram, Celexa or generic citalopram is a racemic mixture of the S-citalopram and its mirror image, R-citalopram, which is less effective as an antidepressant. Thus far, there have [...]
Autoimmune Thyroid Disease More Prevalent in Women with Postpartum Psychosis
November 8, 2011 – 6:13 pm
Postpartum psychosis is the most severe form of postpartum psychiatric illness, occurring in approximately 1 to 2 per 1000 women after childbirth. Although bipolar disorder is a risk factor for postpartum psychosis, a substantial number of women who develop postpartum psychosis have no history of psychiatric illness and experience psychiatric illness only in the context [...]
Light Therapy: A Good Alternative to Medications during Pregnancy?
October 20, 2011 – 4:08 pm
Depression during pregnancy is common and has major health implications for the mother, the fetus and the family. On this website, we have reviewed numerous treatments for affective disorders in pregnancy, including psychotropic medications and several forms of psychotherapy. We have not had much data to support the use of light therapy for antepartum depression, [...]
Antidepressant Treatment During Pregnancy: One Woman’s Experience (Part IV)
October 18, 2011 – 6:02 pm
Part 4: The Postpartum Period This is a continuation of the case presented in a previous post. After discussing the risks and benefits of staying on fluoxetine after delivery versus changing to venlafaxine ER, Ms. D decided to resume venlafaxine ER while remaining on fluoxetine. Like her previous experiences with venlafaxine ER, she responded quickly [...]
Antidepressant Treatment During Pregnancy: One Woman’s Experience (Part III)
September 19, 2011 – 10:17 am
Part 3: Planning for the Postpartum Period This is a continuation of the case presented in a previous post. Ms. D continued to be somewhat symptomatic but much more stable during the rest of her pregnancy while on the combination of fluoxetine and clonazepam. There was a discussion regarding the option of increasing her dose [...]
Antidepressant Treatment During Pregnancy: One Woman’s Experience (Part II)
September 14, 2011 – 3:25 pm
Part 2: Pregnancy This is a continuation of the case presented in a previous post. After discussing the risk of relapse, as well as the risks and benefits of using various antidepressants during pregnancy, Ms. D decided that she would like to come off venlafaxine and try to remain off psychiatric medications during her pregnancy. [...]
Antidepressant Treatment During Pregnancy: One Woman’s Experience (Part 1)
August 29, 2011 – 1:25 pm
Part 1: Pre-Pregnancy Planning This post is the first installment of a four part series. In this series, we will follow a patient from the pre-pregnancy planning phase to the postpartum period, and many key points discussed in previous blog posts will be reviewed. Please remember that every patient is different and this case should [...]
Sleep Medications: What Information Do We Have on Reproductive Safety?
August 1, 2011 – 12:04 pm
It is estimated that up to 95% of women experience some type of sleep disturbance during pregnancy. While for many women the insomnia is relatively benign and may respond to simple interventions, other women experience more severe insomnia which has a significant impact on their quality of life and ability to function. Various non-benzodiazepine hypnotic [...]
Autism Spectrum Disorders and SSRIs
July 18, 2011 – 5:37 pm
It is now estimated that autism spectrum disorders (ASD) affect about 1% to 2% of the population. Data derived from twin and sibling studies indicate that ASD is highly heritable. While genetic factors clearly play an important role, other studies point to an interplay between environmental and genetic factors in the etiology of this disorder. [...]
What is the Impact of Depression During Pregnancy?
July 12, 2011 – 4:32 pm
In a recent study by Gerardin and colleagues, the authors note that more research has been done to demonstrate the consequences of postpartum depression than depression during pregnancy (also called antenatal or prenatal depression). Infants born to mothers with depression during pregnancy have been demonstrated to have lower scores on motor behavior and more crying [...]
Serotonin Reuptake Inhibitors and Fertility (Part 2): What Can Basic Science Tell Us?
July 5, 2011 – 12:42 pm
Serotonin (5-HT) is one of the neurotransmitters involved in mood regulation and has been implicated in the development of mood and anxiety disorders. Serotonin transporters (SERT) facilitate the transfer of serotonin into neurons; serotonin reuptake inhibitor (SSRI) antidepressants bind to these transporters and appear to exert their effect on mood by inhibiting the reuptake of [...]
Serotonin Reuptake Inhibitors and Fertility (Part 1): A Clinical Perspective
July 1, 2011 – 9:34 am
We previously reported that paroxetine, a selective serotonin reuptake inhibitor (SSRI), may affect sperm motility and may thus have a negative impact on male fertility. Many women who are planning a pregnancy question whether SSRIs and other antidepressants may affect fertility; this is obviously a particularly important issue for those who are having difficulty conceiving. [...]
Generalized Anxiety in Pregnancy
June 21, 2011 – 9:16 am
Few studies have focused on anxiety disorders in the perinatal period. While various studies have measured levels of anxiety or distress during pregnancy, most studies have relied upon self-report questionnaires to assess for anxiety. In contrast, few studies have used standardized diagnostic criteria to determine the prevalence of anxiety disorders in pregnant populations. In a [...]
Clinical Case: Should SSRIs Be Tapered Prior To Delivery?
June 13, 2011 – 1:26 pm
Ms. T is a 33 year old woman with a history of recurrent depression who is 32 weeks pregnant with her first pregnancy. She has remained on her citalopram (Celexa) throughout pregnancy and has been well. Her gynecologist has encouraged her to enquire about coming off the Celexa prior to delivery in order to avoid [...]
Postpartum Depression and Poor Sleep Quality Occur Together
June 6, 2011 – 12:52 pm
In a new mother, sleep is disrupted by repeated awakenings of the infant, but hormonal factors also seem to play a role. Immediately after childbirth, levels of the reproductive hormones, estrogen and progesterone, drop precipitously. It is believed that, because these hormones modulate neurotransmitter systems in the brain responsible for sleep quality, this dramatic hormonal [...]
In Utero Exposure to Antipsychotics
May 17, 2011 – 4:47 pm
May 2011, ObGyn News, Lee S. Cohen, MD Reprinted with permission from Ob. Gyn. News Copyright by International Medical News Group, an Elsevier company Previous columns on the reproductive safety of psychiatric medications have focused on the attendant risks of fetal exposure to antidepressants, benzodiazepines, and mood stabilizers such as lithium and sodium valproate. [...]
Choice of Antidepressant May Affect Survival in Women on Tamoxifen for Breast Cancer
May 2, 2011 – 9:54 am
Tamoxifen is a SERM (selective estrogen receptor modulator) used in women with breast cancer; it reduces the risk of relapse and improves overall survival. Tamoxifen may also be used to reduce the risk of breast cancer in women at high risk for the disease. In order to be fully effective, tamoxifen must be metabolized to [...]
Anxiety During Pregnancy: How Does it Affect the Developing Fetal Brain?
April 11, 2011 – 11:13 am
During fetal life, neurons proliferate, migrate and form connections, providing the structure of the developing brain. Neurons reach their final destinations by the 16th week of gestation, while branching and making appropriate connections occur even before that time (1). The brain continues to develop during the entire pregnancy, with most of the synapse formation in [...]
Cognitive-Behavioral Therapy for Infertile Women: Is it Better than Medication?
April 4, 2011 – 4:22 pm
Research indicates that women undergoing infertility treatment experience high rates of psychological distress (1). Additionally, it is believed that stress and depression have an impact on fertility, as it has been shown that certain psychological interventions may improve pregnancy rates in infertile women (2-4). In a recent study, Faramarzi and colleagues compared the effects of [...]
Atomoxetine Improves Memory and Attention in Peri- and Postmenopausal Women
March 28, 2011 – 3:17 pm
Many peri- and post-menopausal women describe problems with memory and attention. Data regarding the use of estrogen replacement therapy to improve cognitive functioning has been mixed. Furthermore, recent concerns regarding the long-term risks of ERT have limited its use. A recent report from C. Nell Epperson and colleagues from the University Of Pennsylvania School Of [...]
Methadone and Breastfeeding
March 21, 2011 – 10:26 am
Up until 2001, the American Academy of Pediatrics (AAP) recommended that methadone was compatible with breastfeeding in women taking less than 20 mg per day. Because most women on methadone maintenance therapy typically require 50 to 15o mg of methadone per day during pregnancy, this meant that most women on methadone were not able to [...]
Making Individual Decisions Regarding the Use of Antidepressants During Pregnancy
March 14, 2011 – 3:19 pm
Women face difficult choices when deciding whether or not to continue psychiatric medications during pregnancy. This choice can be especially difficult for women taking newer medications which lack adequate reproductive safety data. It is not uncommon for women on newer medications with less reproductive safety data available to attempt to change to a better studied [...]
New FDA Warning on the Use of Antipsychotic Medications in Pregnancy
March 9, 2011 – 11:00 am
On February 22, 2011, the U.S. Food and Drug Administration (FDA) informed healthcare professionals that drug labels for the entire class of antipsychotic drugs have been updated to include warnings regarding the use of antipsychotic drugs during pregnancy. The new drug labels now contain more details on the potential risk for abnormal muscle movements (extrapyramidal [...]
New Research from the CWMH: Escitalopram (Lexapro) for Hot Flashes
February 3, 2011 – 10:46 am
For decades, estrogen has been used to treat menopausal symptoms, including night sweats and hot flashes. However, after studies reported that estrogen increases the risk of cardiovascular disease and breast cancer, many patients and clinicians have looked into alternative treatments for hot flashes, including selective serotonin reuptake inhibitors (SSRIs). According to a new study published [...]
Antiepileptic Drugs in Breastfeeding: Neurodevelopmental Outcomes
January 24, 2011 – 10:56 am
Because breastfeeding has many psychological and medical benefits for both the mother and her child, many women would like to breastfeed. However, all medications taken by the mother are secreted into the breast milk. While various studies have addressed the safety of antiepileptic drugs (AEDs) in nursing infants, none have systematically assessed the long-term effects [...]
Tragedy and Coping
January 11, 2011 – 10:12 am
On Saturday, January 8, a gunman opened fire at a local community event in Tucson, Arizona, targeting U.S. congresswoman Gabrielle Giffords. Giffords was shot in the head and underwent immediate surgery, and there were a total of at least 18 other victims that were killed or wounded. The dead included bystanders and colleagues of the [...]
American Academy of Pediatrics Recommends Screening for Postpartum Depression
January 10, 2011 – 1:10 pm
Postpartum depression is experienced by 10-15% of women and carries risks to both mother and baby. Untreated maternal depression is associated with negative outcomes for children including behavioral problems, cognitive or developmental delays and impaired attachment. Treatment of a mother’s depression can improve not only her own functioning and quality of life, but can improve [...]
Zolpidem (Ambien) in Pregnancy: Is it Safe?
November 22, 2010 – 5:04 pm
It is estimated that up to 95% of women experience some type of sleep disturbance during pregnancy. While for many women the insomnia is relatively benign and may respond to simple interventions, other women experience more severe insomnia which has a significant impact on their quality of life and ability to function. While zolpidem (Ambien), [...]
ACOG Focuses on Smoking Cessation in Pregnant and Postpartum Women
November 10, 2010 – 12:02 pm
In the November issue of Obstetrics & Gynecology, The American College of Obstetricians and Gynecologists (ACOG) has issued recommendations to providers regarding efforts to support smoking cessation in pregnant and postpartum women. The article states that while about half of women smokers stop smoking during pregnancy, about 13% of women in the United States continue [...]
Antidepressants and Weight Gain
November 4, 2010 – 10:12 am
Many individuals have the experience of weight gain while receiving treatment with an antidepressant, and often wonder if selective serotonin reuptake inhibitors (SSRIs) are associated with weight gain. This is an excellent, complex, and clinically important question. Depression, anxiety, appetite, and weight: There is a relationship between appetite and depression, with changes in appetite representing [...]
MGH Psychiatry Academy Event Announcement
November 2, 2010 – 9:23 am
Mood Disturbance and Associated Symptoms Across the Reproductive Lifecycle of Women Saturday, November 20, 2010 9:15 am to 3:15 pm The precise relationship between psychiatric symptoms and female reproductive function remains to be clarified. Investigators continue to examine questions related to premenstrual symptoms of worsening of mood and anxiety, affective instability during pregnancy, as well [...]
Serotonin Reuptake Inhibitor (SRI) Use Associated with Reduced Intention to Breastfeed
October 26, 2010 – 9:38 am
Given the potential health benefits of breastfeeding on both mother and baby, the U.S. Public Health Service for Healthy People 2010 set a goal to have 75% of mothers breastfeed in the early postpartum period and 50% of mothers to continue breastfeeding to 6 months by the year 2010 (US Dept of Health and Human [...]
MGH Psychiatry Academy Event Announcement
October 13, 2010 – 3:16 pm
Mood Disturbance and Associated Symptoms Across the Reproductive Lifecycle of Women Saturday, November 20, 2010 9:15 am to 3:15 pm The precise relationship between psychiatric symptoms and female reproductive function remains to be clarified. Investigators continue to examine questions related to premenstrual symptoms of worsening of mood and anxiety, affective instability during pregnancy, as well [...]
Risk of Depression is High in the Parents of Young Children
October 5, 2010 – 2:29 pm
The New York Times published an interesting article on the high risk of depression among new parents. While we are now more aware of depression in mothers after delivery and making greater efforts to screen for postpartum depression, the article points out that both parents are at risk for depression and that the risk extends [...]
MGH Psychiatry Academy Event Announcement
October 4, 2010 – 3:40 pm
Mood Disturbance and Associated Symptoms Across the Reproductive Life Cycle of Women Saturday, November 20, 2010 9:15 am to 3:15 pm The precise relationship between psychiatric symptoms and female reproductive function remains to be clarified. Investigators continue to examine questions related to premenstrual symptoms of worsening of mood and anxiety, affective instability during pregnancy, as [...]
Clinical Update: Use of Stimulant Medications in Pregnancy
September 27, 2010 – 3:04 pm
Approximately 4% of the adult population suffers from ADHD. Attention and executive functioning difficulties also occur in those with mood and psychotic disorders and require treatment strategies similar to those used to address ADHD symptoms. First line medications most often used to treat ADHD in adults are Dextroamphetamine (Dexedrine, Adderall) and Methylphenidate (Concerta, Ritalin, Metadate). [...]
Omega-3 Fatty Acids: The Basics for Clinicians and Patients
September 21, 2010 – 2:00 pm
Omega-3 Fatty Acids: The Basics for Clinicians and Patients Omega-3 fatty acids have broad general health benefits across areas in medicine. They are anti-inflammatory and have well-established cardiovascular benefits. In addition, several studies have shown that supplementation with omega-3 fatty acids may improve outcomes in those receiving standard treatment for major depression and bipolar disorder. [...]
Discontinuation of Antidepressants: Slower is Better
September 13, 2010 – 10:46 am
About half of all pregnancies are unplanned. In this situation, many women who conceive while on psychotropic medications decide to abruptly stop their medications when they discover they are pregnant. While this may seem like the safest option, in terms of protecting the developing fetus, we have data demonstrating high rates of relapse in women [...]
Should SSRIs Be Tapered Prior To Delivery?
September 8, 2010 – 10:35 am
Increased muscle tone, jitteriness, sleep disturbance, irritability, feeding problems, mild respiratory distress and myoclonus have been reported as symptoms of a potential neonatal distress syndrome related to exposure to SSRIs in late pregnancy. The average duration of symptoms reported is 48 hours. It is estimated that between 25-30% of SSRI-exposed infants are at risk for [...]
The Importance of Proper Dosing of Antidepressants during Pregnancy
August 30, 2010 – 3:40 pm
Pregnancy and the postpartum period is a time of increased risk for depression. Therefore, women who are treated with antidepressant medications must consider whether or not to stay on medication during pregnancy. Despite reassuring data regarding the reproductive safety of various antidepressants, a woman may prefer not to continue medication during pregnancy due to concerns [...]
Massage Therapy for Depression
August 23, 2010 – 11:29 am
There are currently 100 clinical trials registered on clinicaltrials.gov using massage as a treatment. Six are listed for the indication of depression. A small minority are focused specifically on treating depression or anxiety, while in many the effects of massage for patients with serious medical conditions are being explored. Infant massage is also under study [...]
Non-Pharmacologic Options for the Treatment of Antenatal Depression: A Quick Review
July 27, 2010 – 10:37 am
About 15% of women suffer from depression during pregnancy, and the rate of depressive illness is greater in women with pre-existing histories of depression. While there are data to support the use of certain antidepressants during pregnancy, many women are reluctant to seek pharmacologic treatment during pregnancy and may benefit from efficacious non-pharmacologic options. In [...]
Anxiety During Pregnancy Predicts Worse Outcomes
July 14, 2010 – 9:43 am
In treating pregnant women with mood or anxiety disorders, we tend to focus primarily on the reproductive safety of psychotropic medications; however, it must be recognized that withholding or withdrawing pharmacologic treatment for depression or anxiety during pregnancy may carry some degree of risk. Untreated psychiatric illness in the mother cannot be considered a benign [...]
Depression and Anxiety: Do They Impact Infertility Treatment?
June 30, 2010 – 11:02 am
Infertility affects an estimated 10-15% of couples of reproductive age. Several studies have indicated that patients undergoing in vitro fertilization (IVF) experience high levels of stress, depression, and anxiety. Multiple risk factors for anxiety and depression during infertility treatment have been identified; these include being female, age over 30, lower level of education, lack of [...]
Antidepressants and Risk of Spontaneous Abortion
June 21, 2010 – 11:42 am
Although the last several decades of research have yielded important findings regarding the safety of antidepressants during pregnancy, some areas are still understudied. For example, there are no conclusive results concerning the risk of spontaneous abortions following antidepressant exposure during the first trimester. Several recent meta-analyses, including one from the Motherisk program (Hemels, 2005), have [...]
Valproic Acid and the Risk of Major Malformations
June 14, 2010 – 1:41 pm
Previous studies have indicated that infants exposed to valproic acid in pregnancy are at increased risk for a range of malformations, including neural tube defects. While these studies have shown an association between valproic acid and various malformations, they have been limited in their ability to quantify the risk of certain, less common malformations. To [...]
Men Get Postpartum Depression Too
June 7, 2010 – 4:23 pm
While postpartum depression (PPD) is typically considered to be a woman’s illness, a number of studies have suggested that, although men do not experience any of the dramatic physiologic or hormonal changes that go along with pregnancy, new fathers may also suffer from PPD. The most recent study was a meta-analysis published in the May [...]
Anticonvulsants and Bone Loss
May 18, 2010 – 4:37 pm
Anticonvulsants are not only used for the treatment of epilepsy but are now used with increasing frequency for the treatment of mood disorders, such as bipolar disorder. Recent studies have indicated that anticonvulsants may negatively affect bone mineral density, as well as increase fracture risk. This seems to be especially common with the older anticonvulsants [...]
Lithium and Breastfeeding
May 12, 2010 – 9:17 am
Bipolar disorder (types I and II) affect up to 5% of the population in the United States. As the onset of this condition typically occurs during or before the reproductive years, the management of bipolar disorder in women is often complicated by pregnancy. There are concerns regarding fetal exposure to medication, the impact of untreated [...]
New Oral Contraceptive Approved
May 12, 2010 – 9:13 am
The US Food and Drug Administration (FDA) has approved a combination oral contraceptive (OC) tablet called Natazia (Bayer HealthCare Pharmaceuticals). It is a bit different from other OC preparations in that it contains 4 progestin/estrogen dosing combinations during each 28-day cycle (instead of being monophasic or triphasic), and it contains estradiol valerate (instead of ethinyl [...]
What’s Safer for Breastfeeding: Lithium or Lamotrigine?
May 4, 2010 – 10:42 am
After last week’s post, we received several comments regarding the use of mood stabilizers in breastfeeding women, specifically asking which is safer: lithium or lamotrigine. Based on the available data, it is difficult to say with certainty which is “safer”. To date, there has been one report of an adverse event in a nursing infant [...]
Lamotrigine and Breastfeeding: An Update
April 27, 2010 – 10:44 am
Women with bipolar disorder are vulnerable to postpartum illness, and it is generally recommended that mothers continue treatment with a mood stabilizer throughout the postpartum period to reduce their risk of relapse; however, this recommendation is complicated by the all mood stabilizers are secreted into the breast milk, although their concentrations appear to vary considerably [...]
When Health Care Providers Say the Wrong Thing
April 14, 2010 – 4:02 pm
With increasing frequency, postpartum women who have taken antidepressants during pregnancy have shared – usually in tears – that while in the hospital for their labor and delivery hospitalization, a health care provider at the hospital said something judgmental about their being on an antidepressant. For example, one woman said that a nurse told her, [...]
MOTHERS Act Becomes Law
March 29, 2010 – 10:35 am
As part of the landmark health insurance reform bill that passed Congress on Monday, the Melanie Blocker Stokes MOTHERS Act – legislation sponsored by U.S. Senator Robert Menendez (D-NJ) – will become law. The legislation will establish a comprehensive federal commitment to combating postpartum depression through new research, education initiatives and voluntarily support service programs. [...]
Fenugreek and Breastfeeding
March 29, 2010 – 9:57 am
Breastfeeding has been associated with multiple medical and psychological benefits. Women with a strong desire to breastfeed, but with a limited milk supply, are often interested in potential ways to augment their milk production. Fenugreek is a plant whose leaves may be used as an herb and whose seeds may be ground into a spice; [...]
Diet and Nutrition May Influence Risk for Depression
March 18, 2010 – 4:35 pm
There has been a long held belief that diet may influence well-being. The phrase “you are what you eat” suggests that nutrition has an impact on physical as well as mental health. Until recently, however, there have been few studies that provide data to support this idea. In a study published by the American Journal [...]
Acupuncture for the Treatment of Depression During Pregnancy
February 23, 2010 – 5:44 pm
Depression during pregnancy is relatively common, affecting about 10 to 15% of women. While there is a growing body of literature supporting the reproductive safety of certain antidepressants, many women and their physicians would prefer to avoid the use of these medications during pregnancy; thus, there is a clear need for effective non-pharmacologic treatments for [...]
Omega-3 Fatty Acids May Prevent Onset of Psychotic Disorders in High Risk Populations
February 10, 2010 – 11:02 am
Psychotic disorders such as schizophrenia and schizoaffective disorder are devastating disorders that usually require chronic care and impact individuals and their family members greatly in terms of morbidity and mortality. Research has helped to identify those who may be at greatest risk for developing psychotic disorders. Strategies to prevent psychotic disorders would alleviate suffering and [...]
Call for Abstracts: Postpartum Support International and Marce Society Conference in October 2010
February 3, 2010 – 12:44 pm
Postpartum Support International will hold its annual conference jointly with the Marce Society in Pittsburgh, Pennsylvania from October 27-30, 2010. Marce Society president Katherine Wisner, M.D. has announced that the focus of the conference will be: Perinatal Mental Health Research: Harvesting the Potential. Abstracts are now being accepted (until April 1, 2010) for symposia, oral [...]
Anticonvulsant Use in Pregnancy and Nursing: Differences in Recommendations from Psychiatrists vs. Neurologists
February 3, 2010 – 11:39 am
There are strong parallels between the clinical management of bipolar disorder and epilepsy, and women with these disorders face significant challenges while pregnant or planning to conceive. In this setting, treatment decisions must balance the risks of recurrence of severe illness with the risks of potential harm to the fetus when certain medicines are taken [...]
Prenatal Use of Atypical Antipsychotics: Effect on Birth Weight
January 25, 2010 – 11:19 am
Atypical antipsychotic medications are commonly used for the treatment of schizophrenia and bipolar disorder. Despite the increasing use of these medications in women of child-bearing age, there is still relatively little data addressing the reproductive safety of these medications. Newham and colleagues studied a group of infants with in utero exposure to atypical antipsychotic medications [...]
Intrauterine Cannabis Exposure Affects Fetal Growth
January 21, 2010 – 12:46 pm
Although the risks of smoking tobacco while pregnant are well documented and well publicized to the general population, women continue to smoke cigarettes during pregnancy. Smoking cigarettes is known to increase a woman’s risk of having a low-birth weight baby and increases the risk of preterm delivery. While clinicians often ask about and discourage tobacco [...]
Premenstrual Syndromes: What is the Optimal Duration of Treatment?
December 21, 2009 – 11:23 am
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) affect a large number of women of childbearing age. 30-80% of reproductive age women experience premenstrual symptoms. PMS refers to a pattern of physical, emotional, and behavioral symptoms occurring 1-2 weeks before menses and remitting with the onset of menses. Common symptoms include fatigue, poor concentration, mild [...]
Use of the Emsam Patch (Selegiline) in Pregnancy
December 14, 2009 – 10:56 am
A clinician asks: “Is there any data on the use of the Emsam patch in pregnancy?” There is very little information on the reproductive safety of the MAOI-B inhibitor, selegiline, which is the active ingredient of the Emsam patch. While animal studies have failed to reveal any evidence of teratogenicity, the medical literature includes only [...]
Panic Disorder Increases the Risk of Adverse Birth Outcomes
December 8, 2009 – 10:11 am
Anxiety often results in the activation of the sympathetic nervous system. This activation is commonly known as the “fight or flight response”; symptoms may include increased heart rate, shortness of breath, perspiration, chest pain, and nausea or diarrhea. Activation of the fight or flight response is also associated with the activation of numerous other responses [...]
Clinical Question: Topamax and Seroquel in a Woman with Bipolar Disorder Planning to Breastfeed
December 1, 2009 – 5:40 pm
A clinician asks: “I am a psychiatrist treating a patient with Bipolar Disorder on Seroquel and Topamax. I would like to know what information is available regarding the safety of these medications to the infant if used during breastfeeding.” With regard to topiramate (Topamax), there is relatively little information on breastfeeding. One case series included [...]
The Truth About Bioidentical Hormones
November 23, 2009 – 12:50 pm
In increasing numbers, women who are candidates for hormonal replacement therapy are requesting “bioidentical” rather than synthetic hormones. Although there is a tendency to think of bioidentical hormones as “all-natural”, they, like synthetic hormones, are manufactured in the laboratory. In contrast to synthetic hormones, they are chemically identical to the hormones produced by the human [...]
SSRIs and PPHN: A Review of the Data
November 10, 2009 – 11:57 am
In 2006, Chambers and colleagues published an article linking SSRI use during late pregnancy to an increased risk of persistent pulmonary hypertension in the newborn (PPHN). Since that time, several other reports have been published which have examined the association between SSRI antidepressants and PPHN. Here is a summary of the findings to date: Chambers [...]
Paroxetine (Paxil) May Affect Sperm Quality
October 1, 2009 – 10:22 am
Within the field of psychiatry, there is a growing body of literature studying the use of antidepressants in women in the context of pregnancy and the postpartum period. However, much less attention has focused on the impact of these drugs on fertility, particularly in men. Because major depressive disorders affect about one in 10 American [...]
Pregabalin (Lyrica) for the Treatment of Hot Flashes
September 21, 2009 – 10:04 am
Although estrogen is highly effective for the treatment of hot flushes, many women are reluctant to use hormone therapy to manage these symptoms, given recent concerns that estrogen may carry certain risks. Several studies have demonstrated that gabapentin (Neurontin) and certain antidepressants, including paroxetine (Paxil) and venlafaxine (Effexor), may be useful non-hormonal treatments for the [...]
Hot Flashes or Depression: Which Comes First?
September 14, 2009 – 9:37 am
Hot flashes and depression are both common symptoms of the menopause transition. Several studies have found a relationship between depression and hot flashes: depressed women are more likely to experience hot flashes and women with hot flashes are more likely to have depression. Other studies have found no association between hot flashes and depression. The [...]
Examining Modifiable Risk Factors for Postpartum Depression
August 31, 2009 – 9:52 am
Approximately 10-15% of women will experience mood symptoms that meet criteria for a Major Depressive Episode during the postpartum period. However, as many as 50% of women may experience some level of depressive symptoms during the postpartum period. Recent evidence suggests that even depressive symptoms that do not qualify for a diagnosis of postpartum depression [...]
Lamotrigine and Pregnancy: An Update
August 25, 2009 – 1:30 pm
While anticonvulsants, such as lamotrigine (Lamictal), topiramate (Topamax), and gabapentin (Neurontin), are being used with increasing regularity for the treatment of women with bipolar disorder, we have limited information with respect to the reproductive safety of the newer anticonvulsant agents. In 2006, we reported on preliminary data indicating an increased risk of oral clefts among [...]
Depression and Menopausal Symptoms Go Together
August 17, 2009 – 10:52 am
It is well established that women are at increased risk for developing depression compared to men. It has been hypothesized that this vulnerability to depression may be hormonally mediated, and several longitudinal studies have documented an increased risk of depressive symptoms during perimenopause or the menopausal transition. Based on the results of two prospective cohort [...]
Generic Medications
August 10, 2009 – 10:41 am
Many patients ask questions about generic medications, wondering how they differ and if they’re as safe and as effective as the more expensive brand name versions. To better understand this concept, we’ll discuss an example. Many patients have heard of the medication, Prozac, a selective serotonin reuptake inhibitor antidepressant, generically known as fluoxetine. The company, [...]
Can We Identify Women at High Risk for Postpartum Psychosis?
August 3, 2009 – 9:29 am
Postpartum psychosis is rare, occurring in about 1 to 2 per 1000 women after delivery. While there appears to be a strong link between postpartum psychosis and bipolar disorder, it is estimated that about half of women who present with postpartum psychosis have no psychiatric history prior to delivery, making it difficult to identify those [...]
Prepregnancy Depressive Mood is a Risk Factor for Preterm Birth
July 28, 2009 – 9:34 am
There have been multiple studies suggesting that depression during pregnancy increases the risk for preterm labor. Most studies do not attribute this increase in risk to antidepressant exposure, but to the effects of the depression itself. The mechanism is believed to be related to increased levels of corticotropin releasing hormone (CRH) which is triggered by [...]
Mental Health Parity in Massachusetts
July 16, 2009 – 2:09 pm
Recent changes expanded the scope of mental health parity in the Commonwealth of Massachusetts, which requires insurance companies to cover specified diagnoses on a “nondiscriminatory basis”. This means that copayments, deductibles, coinsurance, unit of service limits- such as hospital days and outpatient visits, and/or annual or lifetime maximums are no greater for mental disorders when [...]
What Would You Do? A Pregnant Women on Duloxetine (Cymbalta)
June 29, 2009 – 1:25 pm
Ms. A is a 27-year-old woman who is seven weeks pregnant and is currently taking duloxetine (Cymbalta). She has a history of recurrent major depressive disorder (MDD) and has had a good response to duloxetine at 60 mg per day. She has had four previous episodes of major depressive disorder (most untreated) and has been [...]
Do SSRIs Increase the Risk of Preeclampsia?
June 22, 2009 – 12:03 pm
Hypertension in pregnancy is generally defined as a diastolic blood pressure of 90 mm Hg or greater or a systolic pressure at or above 140 mm Hg. Preeclampsia is defined as the development of hypertension with proteinuria or edema induced by pregnancy, generally in the second half of gestation. It is more common in women [...]
OCD in Pregnant and Postpartum Women
June 18, 2009 – 9:44 am
The lifetime prevalence rate of obsessive-compulsive disorder (OCD) has been consistently estimated to be 2%-3% in the general adult population throughout the world, making OCD one of more common psychiatric diagnoses; however research on OCD in pregnancy and peurperium has been limited. Although most studies have not been designed to estimate the prevalence of pregnancy-related [...]
Use of Complementary and Alternative Medicines for Menopausal Hot Flashes
May 29, 2009 – 10:49 am
Approximately seventy percent of all women experience hot flashes and/or night sweats (also called vasomotor symptoms) during the menopause transition (Stearns et al. 2002). Until recently, estrogen therapy was the treatment of choice for most women who sought treatment for hot flashes. Since the results of the Women’s Health Initiative in 2002 noted risks of [...]
Postpartum Depressive Symptoms Increase the Risk of Smoking Relapse
May 19, 2009 – 10:34 am
While many women who smoke successfully quit smoking during pregnancy, most of these women return to smoking within 12 months of delivery. Several studies have suggested that certain factors may increase the risk of postpartum relapse, including unwanted pregnancy, multiparity, and stressful life events. Two recent studies indicate that postpartum depressive symptoms may also increase [...]
Maternal Depression During Pregnancy May Lead to Infant Sleep Problems
May 12, 2009 – 9:42 am
About 15% of women suffer from depression during pregnancy, and many reports have suggested that depression during pregnancy may have negative effects on the fetus. A new study from researchers at the University of Michigan indicates a link between depression during pregnancy and infant sleep problems. This study examined sleep patterns in 18 healthy, full-term [...]
Pregnancy May Lower Lamotrigine (Lamictal) Blood Levels
May 5, 2009 – 9:40 am
Women with bipolar disorder are at increased risk for recurrence of illness during pregnancy. Therefore, many women with bipolar disorder elect to continue treatment with medications during pregnancy after weighing the risks and benefits of various treatment options with their physicians. Lamotrigine (Lamictal) is an anticonvulsant used to treat bipolar disorder. While the safety data [...]
Fetal Exposure to Valproate Associated with Lower IQ
April 24, 2009 – 10:06 am
There have long been concerns regarding the use of the anticonvulsant valproate (Depakote) during pregnancy. First trimester use of valproate has been associated with a 3-5% risk of neural tube defects, as well as an increased risk of other malformations affecting the heart, limbs, and genitals. A recent report published in the New England Journal [...]
Postpartum Depression Legislation Still Needs Your Support
April 14, 2009 – 11:11 am
Several weeks ago, the U.S. House of Representatives passed the Melanie Blocker Stokes MOTHERS Act by a significant bipartisan minority. The bill is now off to the Senate, where it sits in the Health, Education, Labor and Pension committee awaiting markup. While the bill was passed in the House and has gained the support of many [...]
Cognitive Behavioral Therapy for Premenstrual Syndromes: A Review of the Literature
April 6, 2009 – 9:23 am
Significant numbers of reproductive-aged women experience premenstrual syndromes characterized by depressed mood, irritability, mood swings, anxiety or tension, sleep disruption, and other physical symptoms, including bloating and breast tenderness. Typically these symptoms emerge during the week preceding menstruation, improve with the onset of menses, and are not present during the week after menstruation. When a [...]
Antenatal Use of Selective Serotonin Reuptake Inhibitors and QT Interval Prolongation in Newborns
March 24, 2009 – 10:08 am
Over the last several years, a number of studies have indicated that exposure to antidepressants near the time of delivery may be associated with poor neonatal outcomes. A recent prospective study from Dubnov-Raz and colleagues published in the journal Pediatrics found an association between QTc interval prolongation in neonates and antenatal exposure to selective serotonin [...]
We want to hear from you!
March 20, 2009 – 9:18 am
We invite your comments as we post more cases and clinical scenarios to our blog. Treatment decisions in the field of women’s mental health are often not straightforward, and we would like to encourage discussion among clinicians on these issues. You are welcome to leave your name, but comments may also be submitted anonymously. Please [...]
Using New Research to Inform Treatment Decisions during Pregnancy: A Case Report
March 17, 2009 – 11:34 am
As more research is conducted within the field of women’s mental health, there are times when recommendations may change depending on the available data. We will discuss a case here to illustrate this point. The patient is a 32 year old woman with a history of anxiety who was first evaluated by this clinician in [...]
A Mouse Model of Postpartum Depression
March 10, 2009 – 10:15 am
Maguire and Mody’s report, GABAA R Plasticity during Pregnancy: Relevance to Postpartum Depression, in the July 2008, Neuron, provides evidence that an abnormal Gamma-aminobutyric acid (GABAA) receptor subunit in pregnant mice may be a useful model for postpartum depression. The report describes how GABAA receptors, specifically, the delta-subunit-containing GABA receptor, are a preferred target for [...]
Case: Prevention of Mood Episodes When Planning for Pregnancy
March 2, 2009 – 10:07 am
Our Perinatal and Reproductive Psychiatry team often discusses clinical cases in Rounds, a confidential forum in which we can get advice and consultation from peers who also work in the area of Women’s Mental Health. We discussed a patient’s situation recently that highlighted the controversial area about how to prevent mood episodes in a woman [...]
Mood and well-being after removal of both ovaries
February 24, 2009 – 1:54 pm
The risk of depression after removal of both ovaries (also called bilateral oöphorectomy or surgical menopause) is a major factor for women to consider when they confront medical problems that require removal of the uterus (called a hysterectomy). Many women are advised to consider having their ovaries removed when they are having the uterus removed. [...]
SSRIs in Pregnancy and Neonatal Distress Syndrome
February 17, 2009 – 12:39 pm
Most obstetricians are now familiar with the potential for what has become known as neonatal distress syndrome (or “adaptation” syndrome) following third trimester exposure to SSRIs. Some patients still worry about the possibility of their baby developing neonatal distress syndrome, especially if anything unusual happened during the post-delivery experience of an earlier pregnancy. Women may [...]
Severe Pregnancy Stress May Increase Schizophrenia Risk in Offspring
February 10, 2009 – 10:13 am
A study published in the Archives of General Psychiatry shows that children of women who experience the death of a close relative may have an increased risk of developing schizophrenia later in life. This study was conducted with records of children born in Denmark between 1973 and 1995, which were then linked to the central [...]
Maternal depression, in-home violence, and use of physical punishment
January 26, 2009 – 12:48 pm
Parental use of physical punishment early in childhood may be associated with subsequent maladaptive behaviors such as child aggression and impaired social information processing. There are links between certain childhood behaviors and risk for parental use of physical punishment, although cause and effect are difficult to establish with these associations. Higher rates of physical punishment [...]
Phytoestrogens and Menopause
January 20, 2009 – 2:30 pm
For decades, estrogen was used as a component of hormone replacement therapy to treat menopausal symptoms and for anticipated preventative health benefits in women with prostesterone, or as a monotherapy hormone treatment in women after hysterectomy, but after studies reported that long-term estrogen increase the prevalence of cardiovascular events and breast cancer, many patients and [...]
Cognitive Behavioral Therapy used to treat Depression in Pakistani Women
January 13, 2009 – 10:47 am
Mood disorders and symptoms during pregnancy and the postpartum period are not uncommon and affect women across the world. In spite of relatively high rates of depression among childbearing women, there are often inadequate resources for treatment, particularly in poorer countries. In countries lacking resources, health care is often managed by community health workers or [...]
Sildenafil (Viagra) Treatment of Women with Antidepressant-Associated Sexual Dysfunction
January 6, 2009 – 10:05 am
While some side effects such as nausea, dizziness, and headaches associated with selective serotonin reuptake inhibitor (SSRI) antidepressants tend to decrease or resolve over time, other side effects such as sexual dysfunction rarely remit spontaneously. Treatment of sexual side effects in women is especially important when about 30-70% of patients taking antidepressants may experience sexual [...]
Top 10 Blog Posts from the MGH Center for Women’s Mental Health
December 23, 2008 – 10:23 am
Happy holidays from the Center for Women’s Mental Health! As we finish up 2008, we thank you for your support and interest in our program over the past year. The following are the ten most widely read posts from our blog over the past six months: 1. Use of Wellbutrin (Bupropion) During Pregnancy – February [...]
Bipolar Disorder and PMS
December 15, 2008 – 11:02 am
Premenstrual worsening of mood is common among women with depression, but little is known about how often women with bipolar disorder experience worsening of their mood premenstrually. In a study by Payne et al. (2007), premenstrual symptoms were reported by twice as many women diagnosed with mood disorders (mixture of Bipolar Disorder and Major Depressive [...]
Dr. Lee Cohen talks with Dr. Oz about Pregnancy and Mood Disorders on Oprah.com
December 8, 2008 – 10:54 am
Earlier this year, Dr. Lee S. Cohen, Director of the MGH Center for Women’s Mental Health, spoke with Dr. Mehmet Oz from Oprah.com and a woman with bipolar disorder about mood disorders during pregnancy and weighing the risks of treatment options. Click here to listen to the interview on Oprah.com.
Testosterone Patch Improves Sexual Functioning in Postmenopausal Women
December 1, 2008 – 2:37 pm
Sexual dysfunction is common among postmenopausal women and include a spectrum of problems, including low (or hypoactive) sexual desire, decreased satisfaction, and discomfort. Reports indicate that the prevalence of hypoactive sexual desire ranges from 9% in naturally postmenopausal women up to 26% in younger surgically postmenopausal women. A recent study published in the New England [...]
Exercise and Depression
November 24, 2008 – 10:13 am
Exercise plays a vital role in achieving and maintaining good health. Along with numerous other health benefits, recent studies have shown that exercise alleviates symptoms of depression and may be useful in treating mild to moderate major depressive disorder (MDD). A study by Dunn and colleagues (2005) examined the efficacy of exercise as a treatment [...]
Substance Abuse Treatment During Pregnancy Improves Outcomes
November 17, 2008 – 11:12 am
Despite efforts over the last decade to increase awareness regarding the negative effects of alcohol and other drug use during pregnancy, substance abuse among pregnant women continues to be a significant problem in the United States. The 2003 National Household Survey on Drug Use and Health indicated that 9.3% of pregnant women used alcohol and [...]
Folic Acid Supplementation is Recommended for All Women Taking Anticonvulsants and Planning Pregnancy
November 11, 2008 – 10:07 am
Given recent discussions within our group and with our colleague, Lewis Holmes, MD, chief of the Genetics and Teratology Unit at Massachusetts General Hospital for Children and director of the North American AED (Antiepileptic Drug) Pregnancy Registry, I wanted to expand upon a previous blog post. In the initial post, I wrote that women who [...]
University of North Carolina Center for Mood Disorders Expands Services to Postpartum Women
November 5, 2008 – 11:46 am
Last Wednesday, the UNC Medical Center opened an outpatient clinic for women with postpartum depression, and on November 3rd opened an inpatient unit for women with postpartum depression. The inpatient unit is called “the first of its kind” in the United States, and is a progressive example of specialized health care initiatives for improved screening, [...]
Depression during Pregnancy Increases the Risk of Preterm Delivery
November 3, 2008 – 10:07 am
A new study reported in Human Reproduction supports what many other studies have found, that untreated depression during pregnancy increases the likelihood of delivering before 37 weeks gestation. In this prospective cohort study from by De-Kun Li and colleagues at the Kaiser Foundation Research Institute, women were screened for depression during the first trimester, at [...]
Identifying Postpartum Depression: A Three Question Screening Tool
October 27, 2008 – 9:28 am
While postpartum depression is common among new mothers, our ability to reliably detect this illness remains poor. Recent studies have indicated that most obstetricians report that they screen for postpartum psychiatric problems at routine follow-up visits but typically do not use standardized instruments to assess for postpartum depression. Unfortunately, studies which have measured the success [...]
Oral Contraceptives Reduce Lamotrigine (Lamictal) Blood Levels
October 20, 2008 – 9:12 am
Lamotrigine (Lamictal) has been effectively used for the maintenance treatment of bipolar disorder. Many women suffering from bipolar disorder are of childbearing age; therefore an adequate contraception is a major concern that needs to be addressed in this population. Special consideration should be taken when patients taking lamotrigine plan to use oral contraceptives (OCs). Studies [...]
National Depression Screening Day – October 10, 2008
October 9, 2008 – 2:38 pm
This Friday, October 10, is Screening for Mental Health’s National Depression Screening Day, an effort to raise awareness for depression and its treatment. The risk for depression is nearly twice as high in women as in men, and reproductive-aged women are at highest risk for developing depression. Numerous research studies suggest that untreated depression can [...]
Post-Traumatic Stress Disorder (PTSD) Following Childbirth
October 8, 2008 – 9:17 am
Post-Traumatic Stress Disorder (PTSD) after childbirth is an understudied condition. Traditionally, much of the data have been based on case reports, indicating that PTSD can occur following a range of childbirth and child loss situations, including long or complicated labor, severe pain with labor or delivery, cesarean section, and unanticipated pregnancy outcome, such as child [...]
Last week to vote for our blog in the Blogger’s Choice Awards!
October 6, 2008 – 9:30 am
Our blog has been nominated for Best Health Blog in the 2008 Blogger’s Choice Awards. Please vote and show your support - our hope is that being voted one of the top blogs in the health field will introduce more people to the important issues in perinatal and reproductive psychiatry. We are currently one of [...]
Acupuncture for Hot Flushes in Women with Breast Cancer
September 30, 2008 – 9:28 am
Many women report vasomotor symptoms, including hot flushes and night sweats, during the menopausal transition. While estrogen is clearly one of the most effective treatments for vasomotor symptoms, recent concerns regarding the use of hormone replacement therapy (HRT) have made treaters much more reluctant to recommend HRT, even for short-term management of vasomotor symptoms. Data [...]
Cognitive-Behavioral Therapy for the Treatment of Menopausal Hot Flashes: A Pilot Study
September 29, 2008 – 12:27 pm
Hot flashes are a common and distressing symptom of menopause, affecting approximately 60-70 % of women undergoing the menopausal transition. Several pharmacologic treatments for hot flashes, including hormone replacement therapy (HRT) and some antidepressants, have been shown to reduce the frequency and intensity of hot flashes. However, some women prefer not to use HRT or [...]
Estrogen for the Treatment of Women with Schizophrenia
September 22, 2008 – 12:03 pm
There is cumulative evidence suggesting that estrogen might play a role in the development of schizophrenia and therefore may be useful in the treatment of this illness. On average, the first signs of schizophrenia appear 3 to 4 years later in women than in men, with a second peak in women around menopause. Interestingly, men [...]
PPHN and SSRIs: Another Study Evaluating the Risk
September 16, 2008 – 9:57 am
In 2006, Chambers and colleagues published an article linking SSRI use during late pregnancy to an increased risk of persistent pulmonary hypertension in the newborn (PPHN). Based on the results of this analysis, the authors estimated the risk of PPHN to be about 1% in infants exposed to SSRIs late in pregnancy (after 20 weeks). [...]
Citalopram (Celexa) Effective for Treating Hot Flashes
September 8, 2008 – 10:38 am
For decades, estrogen has been used to treat menopausal symptoms, including night sweats and hot flushes. However, after studies reported that estrogen may have an adverse effect on risk for cardiovascular disease and breast cancer, many patients and clinicians have looked into alternative treatments for hot flashes, including selective serotonin reuptake inhibitors (SSRIs). The North [...]
Impact of Infertility Treatment on Risk for Depression and Anxiety
August 28, 2008 – 9:29 am
Infertility and its treatment have been shown to be a trigger for both depression and anxiety. Women with pre-existing histories of depression and anxiety who have been stable on medication may find themselves with worsening symptoms brought on by the stress involved in the process of infertility treatment. Many women find the process an emotional [...]
Pre-Existing Psychiatric Illness is a Risk Factor for Postpartum Suicide Attempt
August 21, 2008 – 10:33 am
A recent population-based case-control study published in the American Journal of Obstetrics & Gynecology used Washington State birth certificates linked to hospital discharge data to evaluate the association between hospitalization for a psychiatric illness before delivery and risk of postpartum suicide attempt. The study compared women hospitalized for a postpartum suicide attempt (n = 355) [...]
Antidepressants and Risk for Osteoporosis
August 15, 2008 – 11:11 am
Selective serotonin reuptake inhibitors (SSRIs) account for approximately 62% of all antidepressants prescribed in the United States. There have been several recent studies suggesting that SSRIs may lower bone mineral density in individuals over the age of 65. However, depression itself has been shown to decrease bone mineral density and has also been associated with [...]
New England Journal of Medicine Case Report: Postpartum Psychosis in a Woman with Bipolar Disorder
August 11, 2008 – 9:51 am
The most recent issue of the New England Journal of Medicine includes the presentation of a case from the Center for Women’s Mental Health of a woman with bipolar disorder who developed postpartum psychosis after the birth of her child. The case highlights some of the clinical challenges in treating patients with bipolar disorder during [...]
St. John’s Wort: Is it Safe for Pregnancy?
August 5, 2008 – 8:40 am
St. John’s wort (Hypericum perforatum) is an herbal preparation which has been shown, in some studies, to be effective for the treatment of mild to moderate depressive symptoms. St. John’s wort is now one of the most commonly used herbal products in the United States and is widely used in Europe. Despite the prevalence of [...]
Does Depo-Provera Cause Mood Changes?
July 29, 2008 – 1:52 pm
Depo-Provera (DMPA), also known as the birth control shot, is a highly effective form of contraception that lasts for 3 months, and thus requires only 4 injections per year. DMPA contains a long-lasting form of depot medroxyprogesterone acetate that works as a contraceptive agent by preventing the ovaries from releasing an egg each month. Potential [...]
Maternal Stress During Pregnancy Linked to Infant Sleep Problems
July 26, 2008 – 10:36 am
The link between maternal depression and anxiety during pregnancy and adverse neonatal outcome has been well-documented in the medical literature and reviewed on our website. A recent study published in the journal Early Human Development suggests that a mother’s stress during pregnancy may also negatively affect her baby’s sleep patterns. In this longitudinal, prospective study, [...]
Psychological Stress During Pregnancy and Risk for Stillbirth
July 21, 2008 – 9:46 am
Previous studies have suggested that prenatal stress may be associated with a spectrum of adverse pregnancy outcomes, including preterm birth and low birth weight (reviewed in Hobel et al, 2008). A recent study from Danish researchers has investigated the impact of psychological stress on risk for stillbirth. In this prospective cohort study, data from a [...]
Use of Hormonal Contraception in Women with Coexisting Medical Conditions
July 14, 2008 – 1:29 pm
Is the use of hormonal contraception safe for women older than 35 years? Yes, in non-smoking, healthy women over 35, there appears to be no increased risk of heart attack or stroke. Perimenopausal women may benefit from the positive effects of estrogen on bone mineral density and vasomotor symptoms. In addition, women on oral contraceptives [...]
Mental Health Parity Legislation
July 9, 2008 – 1:51 pm
Recently, the Massachusetts House of Representatives passed the Mental Health Parity House Bill 4423, which mandates that insurers and government programs cover mental health in the same capacity that they cover physical health. The Bill was introduced by Representative Ruth Balser (D-Newton). This bill builds on the first Mental Health Parity House Bill (2000) which [...]
Oral Contraceptives and the Risk of Blood Clots in Postpartum Women
July 2, 2008 – 2:12 pm
If a woman does not breastfeed following delivery, prolactin levels decrease and fertility returns to normal, and pregnancy is possible. Even if a woman decides to breastfeed, she should still use some form of contraception, as prolactin levels vary depending on individual breastfeeding styles. Women may be fertile and become pregnant even before the resumption [...]
Using Omega-3 Fatty Acids to Treat Depression During Pregnancy
June 25, 2008 – 9:10 am
We commonly see women in our consultation service who have histories of depression and are planning pregnancy. They frequently have questions about alternative treatments for depression while pregnant. Given that many women are taking omega-3 fatty acids prior to pregnancy, the question arises whether they should discontinue them during pregnancy. An additional question is whether [...]
Interactions Between Antidepressants and Tamoxifen
June 18, 2008 – 9:46 am
Women receiving tamoxifen for the treatment or prevention of breast cancer should be aware of possible drug-drug interactions with specific antidepressant medications (e.g., SSRI). These antidepressants are used widely to treat depression and anxiety disorders. In addition, multiple studies have shown that these antidepressants are an effective non-hormonal treatment for hot flashes; over 25% of [...]
FDA Proposes Major Revision of Prescription Drug Labeling
June 10, 2008 – 9:52 am
The U.S. Food and Drug Administration (FDA) has proposed major revisions to prescription drug labeling in order to provide more accurate and helpful information on the effects of medications used during pregnancy and breastfeeding. As it stands, the current system used by the FDA classifies the reproductive safety of medications using five risk categories (A, [...]
MOTHERS Act Legislation Faces Opposition
June 4, 2008 – 11:13 am
The Melanie Blocker Stokes MOTHERS Act — named for an Illinois woman who committed suicide three months after giving birth — was approved by the House of Representatives in October. This article from the North Jersey Record reports that the legislation has been held up in the Senate Health, Education, Labor and Pensions committee. Opposition [...]
Melatonin in Pregnancy: Is it Safe?
May 30, 2008 – 1:51 pm
Many women experience some degree of sleep disturbance during pregnancy. For a significant number of women, the sleep disruption may be so severe as to require some type of intervention. In a previous post, we discussed the use of different types of medications to treat insomnia during pregnancy. While these drugs are highly effective, many [...]
Postnatal depression in men links to psychiatric illness in their children
May 26, 2008 – 10:53 am
While many studies have looked at the impact of postpartum depression in mothers on their children, there is very limited data on postnatal depression in the fathers and the potential impact it may have on their children. Researchers at the University of Oxford recently examined predictors of postnatal depression in the fathers and studied the [...]
Maternal Stress and Low Birth Weight Predict Later Risk for Mood and Anxiety Disorders
May 22, 2008 – 9:49 am
It has been postulated that psychological stress in the mother, if present at a critical time of brain development, can permanently alter a child’s response to stress and may have long-term negative consequences. In response to stress, blood flow to the uterus is restricted and the fetus receives fewer nutrients, which may result in lower [...]
Depression is Common Following Successful IVF
May 18, 2008 – 9:29 am
Psychological symptoms play a significant role in infertility. Some studies have examined the impact of psychological symptoms (e.g., anxiety, depression) on fertility status. Most of this research has focused on women with unsuccessful IVF treatment. Some have investigated the extent to which a woman’s psychological state during assisted reproductive therapy (ART, which includes in vitro [...]
Stress During Pregnancy Increases ADHD Risk
May 10, 2008 – 5:02 am
While genetic factors are clearly important in determining a child’s risk for attention deficit hyperactivity disorder (ADHD), recent studies have investigated the link between exposure to certain maternal behaviors during pregnancy, such as smoking and alcohol use, and the risk of developing behavioral problems related to attention deficit hyperactivity disorder in childhood. While multiple studies [...]
Eating Disorders in Pregnancy and Postpartum
May 8, 2008 – 11:59 am
The British Medical Journal recently published a brief, but comprehensive review of eating disorders in pregnancy by Veronica Bridget Ward. Eating disorders (anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified) most commonly occur in women of reproductive age and may be influenced by pregnancy and its associated weight gain and change in body [...]
Show Your Support for Postpartum Depression Legislation
May 2, 2008 – 12:04 pm
Please sign this online petition to support passage of The Melanie Blocker Stokes MOTHERS Act. A companion bill passed in the House of Representatives last fall to a nearly unanimous bipartisan vote. Democratic Senators Obama and Clinton both support this legislation along with Republican Senators including Olympia Snowe of Maine. Please help us gain our [...]
Do Oral Contraceptives Cause Mood Changes?
May 1, 2008 – 10:59 am
Many women have concerns about the side effects of oral contraceptives (birth control pills). Potential side effects include bloating, breast tenderness, and weight gain. In addition, some women may experience depression or mood swings, side effects that may influence a woman’s decision to start taking a birth control pill, particularly if she has a history [...]
New Study Does Not Find Link Between Paroxetine and Cardiovascular Defects
April 23, 2008 – 8:46 am
In 2006, GlaxoSmithKline (GSK) elected to change product label warnings for the antidepressant paroxetine (Paxil), advising against the use of this drug by women who are pregnant. This decision was based on preliminary studies which suggested an increase in the risk of cardiovascular malformations among infants exposed to paroxetine in utero. A recent study from [...]
22nd Annual Postpartum Support International Conference
April 17, 2008 – 4:33 pm
The 22nd Annual Postpartum Support International (PSI) Conference will be held in Houston, TX from June 4 through June 7, 2008. The theme of this year’s conference is “Maternal Health, a Multisystemic View.” One of the featured speakers is Valerie Plame, former CIA agent and author of “Fair Game: My Life as a Spy, My [...]
Migraine Headaches Associated with the Menstrual Cycle
April 10, 2008 – 9:36 am
Up to 25% of women experience migraine headaches during their reproductive years; often migraine headaches may be triggered or exacerbated by hormonal changes. It has been estimated that 7-14% of women experience migraines only during the premenstrual or menstrual phase of their cycles. Another 52-70% experience headaches throughout the month but note increased headache activity [...]
Obesity Linked to Postpartum Depression Risk
April 3, 2008 – 10:52 am
Previous studies have linked postpartum depression (PPD) to numerous risk factors, including depression during pregnancy, a history of depression prior to pregnancy, as well as marital problems, recent stressful events, and inadequate social supports. Research conducted at the University of Utah in Salt Lake City now suggests that obesity may place women at increased risk [...]
Acupuncture for the Treatment of Menopausal Hot Flushes
March 31, 2008 – 3:08 pm
Many women report vasomotor symptoms, including hot flushes and night sweats, during the menopausal transition. While estrogen is clearly one of the most effective treatments for vasomotor symptoms, recent concerns regarding the use of hormone replacement therapy (HRT) have made treaters much more reluctant to recommend HRT, even for short-term management of vasomotor symptoms. A [...]
Switching Antidepressants After the First Trimester
March 31, 2008 – 9:44 am
Q. I am currently talking Remeron for depression. I am about 16 weeks pregnant and doing well. I recently started working with a new psychiatrist, and my new doctor suggested that I switch to Prozac because he thought it would be safer for the baby. I am a little worried about making a change; I [...]
PPHN and SSRIs: New Findings
March 31, 2008 – 9:35 am
Over the past few years, multiple reports have raised questions regarding the safety of selective serotonin reuptake inhibitor (SSRI) antidepressants during pregnancy. Chambers and colleagues reported that exposure to SSRIs late in pregnancy may be associated with an increased risk of persistent pulmonary hypertension of the newborn (PPHN). In the general population, PPHN affects about [...]
SSRIs and Pregnancy: Evaluating New Reproductive Safety Data
March 31, 2008 – 9:33 am
Over the past 15 years, multiple studies have addressed the reproductive safety of various antidepressants. Data on the overall teratogenicity of SSRIs has come from relatively small prospective observational studies, larger international birth registries, managed health care databases, and case series; these data have cumulatively supported the reproductive safety of fluoxetine and certain other SSRIs. [...]
Untreated Maternal Depression: What is the Impact on the Unborn Child?
March 27, 2008 – 2:47 pm
Depression during pregnancy is common. While concerns have been raised regarding the potential teratogenic and long-term neurobehavioral effects of psychotropic drug use during pregnancy, what is often overlooked is the fact that untreated maternal depression may also put the unborn baby at risk. Maternal depressive symptoms during pregnancy have been shown to be associated with [...]
Top Ten Blog Posts on the Women’s Mental Health Blog
March 21, 2008 – 10:59 am
Since the launch of our blog we’ve addressed many issues and questions in the field of Women’s Mental Health. Compiled below is a list of our most popular blog posts, on topics ranging from the safety of psychotropic drug use during pregnancy to postpartum depression. 1. Can Women Suffer from Postpartum Depression after Miscarriage? – [...]
Hormone Replacement Therapy Revisited
March 13, 2008 – 10:58 am
As a result of dramatically increased life expectancies in industrialized countries, healthy women today expect to spend nearly 40% of their lives after menopause. For these postmenopausal women, lack of estrogen may contribute to long-term adverse effects, including cardiovascular disease and osteoporosis. Many postmenopausal women might benefit from hormone replacement therapy (HRT) with estrogens and [...]
Bipolar Disorder and Pregnancy: Should Medications Be Discontinued?
March 7, 2008 – 2:44 pm
As many of the traditional mood stabilizers used to treat bipolar disorder, including lithium and valproic acid, carry some teratogenic risk and the reproductive safety of other medications, including the atypical antipsychotic agents, has not been well-characterized, many women with bipolar disorder decide to discontinue their treatment during pregnancy. A new study from Dr. Adele [...]
Desvenlafaxine for the Treatment of Menopausal Hot Flushes
March 7, 2008 – 10:56 am
Last Friday, Wyeth received FDA approval for the antidepressant desvenlafaxine succinate (marketed under the name Pristiq), a metabolite of venlafaxine or Effexor. Although this drug was approved for the treatment of major depression, a recent study has demonstrated that desvenlafaxine could be an effective treatment for vasomotor symptoms in postmenopausal women. Many women report vasomotor [...]
Depression is More Common in Women with High Risk Pregnancies
March 6, 2008 – 10:52 am
Epidemiologic studies suggest that about 10% to 15% of women suffer from clinically significant depressive symptoms during pregnancy. Little is known, however, about the prevalence of depression among women with high risk pregnancies. A recent study published online in the Journal of Clinical Psychiatry suggests that this population may be at significant risk for antenatal [...]
Vote for The Center for Women’s Mental Health in the Blogger’s Choice Awards
March 3, 2008 – 10:49 am
Our blog has been nominated for Best Health Blog for the 2008 Blogger’s Choice Awards. We are very excited about this nomination and hope that being voted one of the top blogs in the health field will introduce more people to the important issues in perinatal and reproductive psychiatry. Please take a few minutes and [...]
Medication Changes During Pregnancy
February 28, 2008 – 10:44 am
At our clinic we have the opportunity to see patients at various stages of pregnancy. When we evaluate a patient while she is still in the planning stages, we may recommend changing medications to those that have a better studied safety profile during pregnancy and see how she does on those medications prior to conception. [...]
A Message from Lee S. Cohen MD, Director
February 26, 2008 – 10:43 am
To all our readers: We are so happy with the blog’s activity and the comments we have received since the blog launched last year. Please keep in mind that the purpose of our blog is not to provide individual consultation. Responding to individual requests for consultation on specific patients exceeds the capacity and goal of [...]
Fish Oil and Postpartum Depression
February 20, 2008 – 10:41 am
One treatment that has recently received a great deal of interest lately is fish oil. There is some preliminary evidence to suggest that the omega-3 fatty acids contained in fish and fish oil, including eicosapentanoic acid (EPA) and docosahexanoic acid (DHA), have an antidepressant effect. It has been discovered that mothers selectively transfer DHA to [...]
New Research Study at CWMH: Treatment of Premenstrual Worsening of Depression
February 15, 2008 – 10:38 am
Seeking women between 18-45 with PMS who have been diagnosed with depression. If you are between 18 and 45 and: Suffer with PMS Currently being treated with an antidepressant You may be eligible for a research study at Massachusetts General Hospital evaluating how a birth control pill helps with premenstrual mood symptoms. Women who participate [...]
Fertility and Antipsychotic Medications
February 14, 2008 – 10:37 am
Infertility is a problem which has gained increased attention over the past several decades. While many factors may contribute to infertility, some medications may also affect reproductive functioning and thus may have an impact on fertility. This post will focus on the antipsychotic drugs, which are now used to treat many psychiatric disorders other than [...]
Reproductive Age Women Need Folic Acid
February 7, 2008 – 10:26 am
A few weeks ago, January 7-13, 2008, was National Folic Acid Awareness Week at the Centers for Disease Control (CDC), therefore we wanted to take the opportunity to remind women of the importance of folic acid in the prevention of birth defects. Folic acid can prevent from 50-70% of neural tube defects, which are defects [...]
ECT and Pregnancy
January 30, 2008 – 3:49 pm
Electroconvulsive therapy (ECT) is one of the most effective treatments for depression, with response rates that are consistently higher than those observed in clinical trials of antidepressants. Furthermore, ECT may be more effective than medications for treatment-refractory depression. The American Psychiatric Association (APA) recommends ECT for patients who have had previous positive response to ECT [...]
Nutritional Supplements for Premenstrual Syndrome: Do They Work?
January 24, 2008 – 3:48 pm
Many promote the use of certain vitamins and minerals for the treatment of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), but controlled studies supporting the use of nutritional supplements are sparse. There is some literature suggesting that the recommended dose of calcium (600 milligrams twice a day) can help to relieve mild to moderate [...]
Smoking While Breastfeeding: What Are the Risks?
January 22, 2008 – 10:09 am
Approximately 25% of American women of reproductive age smoke tobacco, and many continue to smoke during and after pregnancy despite the known potential harm to their own health and to their child’s health. These health threats remain after the child’s birth as the baby is exposed to nicotine and other toxins in both ambient air [...]
Research Study at CWMH: Bipolar Disorder in Pregnancy
January 7, 2008 – 10:06 am
Are you an expectant mother? Do you have questions about bipolar disorder and antidepressants or mood-stabilizers during pregnancy? If you are pregnant and diagnosed with bipolar disorder (or manic depression), you may be eligible for this research study. Participants meet with research coordinators and psychiatrists who specialize in bipolar illness during pregnancy. For more information [...]
Depression Related to Childbirth Affects One in Seven Women
December 24, 2007 – 1:39 pm
Although pregnancy has often been concerned a time of emotional well-being, several recent studies have indicated that women are vulnerable to depression during pregnancy. Analyzing data from the Kaiser Permanente Northwest HMO, researchers assessed the prevalence of depression before, during, and after pregnancy in a group of 4,398 women with pregnancies ending in a live [...]
What About Vagus Nerve Stimulation?
December 14, 2007 – 12:08 am
Vagus Nerve Stimulation, or VNS, has been available for the treatment of epilepsy since 1997 and was approved by the FDA for the adjunctive treatment of refractory depression in 2005. VNS relies upon the use of a surgically implanted device which delivers periodic stimulation to the vagus nerve. How VNS therapy works is not completely [...]
How to Treat Anxiety Symptoms During Pregnancy
December 11, 2007 – 7:57 pm
Given the limited information on the reproductive safety of certain medications, it is common for women to discontinue anti-anxiety medications during pregnancy. However, many women experience worsening of their anxiety symptoms during pregnancy, and it seems that the first trimester may be particularly difficult. Cognitive-behavioral therapy and relaxation techniques may be very useful for treating [...]
Interaction Between Birth Control Preparations and Anti-Epileptic Medications
December 6, 2007 – 10:41 am
The interaction between specific birth control preparations and anti-epileptic medications should always be taken into consideration when developing a treatment approach, as taking the two simultaneously may decrease the birth control pill’s effectiveness. An oral contraceptive (OC) is effective because it delivers high doses of estrogen to prevent ovulation. Unfortunately, some anti-epileptic medications alter the [...]
Can Paxil (Paroxetine) Be Used While Breastfeeding?
December 4, 2007 – 10:47 pm
All medications are secreted into the breast milk, although concentrations appear to vary. There is a fair amount of information on the use of Paxil (paroxetine) in nursing women. While Paxil may be detected in the breast milk, there have been no reports of adverse events in the nursing infant. The only situation where one [...]
Cognitive Therapy versus Medication in the Treatment of Depression
November 26, 2007 – 12:53 pm
Both antidepressant medications and cognitive therapy have been shown to be effective for the treatment of depression; however, the question remains as to whether one treatment is preferred over the other. Subjects enrolled in The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (men and women with major depression, ages 18-75) were initially treated with [...]
Treatment of Insomnia During Pregnancy
November 19, 2007 – 11:48 pm
Most women experience some degree of sleep disturbance during pregnancy, and for a significant number of women sleep disruption may be quite severe. There are many different causes for sleep disturbance during pregnancy, and choosing the appropriate intervention relies on an accurate diagnosis of the problem. Certain sleep disorders, such as restless leg syndrome and [...]
Lee S. Cohen, MD
November 15, 2007 – 10:48 am
Dr. Cohen is Director of the Perinatal and Reproductive Psychiatry Clinical Research Program within the Clinical Psychopharmacology Unit of the Massachusetts General Hospital, as well as Associate Professor of Psychiatry at Harvard Medical School. He completed his residency training and fellowship at the Masschusetts General Hospital. The Perinatal Psychiatry Program was founded in 1987 and [...]
Oral Contraceptives for the Treatment of Premenstrual Mood Symptoms
November 13, 2007 – 6:44 pm
Oral contraceptives are commonly prescribed for the treatment of premenstrual symptoms and premenstrual dysphoric disorder (PMDD); however, the evidence supporting the use of oral contraceptives in this setting is limited. While most studies have shown that oral contraceptives are not effective for the treatment of premenstrual symptoms, there is preliminary evidence that a new oral [...]
Paroxetine CR May Be Helpful for Menopausal Women Discontinuing Hormone Therapy
November 12, 2007 – 6:40 pm
Estrogen was first approved by the FDA for the treatment of menopausal symptoms in 1942, and for many decades estrogen replacement therapy had been widely prescribed for peri- and post-menopausal women. In 2002, however, data from the Women’s Health Initiative (WHI) suggested that hormonal therapy may be associated with an increased risk of breast cancer [...]
ACOG Opinion on SSRI Use During Pregnancy
November 12, 2007 – 2:49 pm
Recent reports have raised questions regarding the use of selective serotonin reuptake inhibitors (SSRI) during pregnancy. To date, no professional medical association has issued formal guidelines regarding the use of SSRIs during pregnancy. However, in December the American College of Obstetricians and Gynecologists ACOG published an opinion paper on this topic that is noteworthy for [...]
Polycystic Ovarian Syndrome in Women Taking Valproate
November 8, 2007 – 7:44 pm
Polycystic ovarian syndrome (PCOS) occurs in 4-7% of women and is characterized by irregular menstrual cycles and hyperandrogenism (facial hair, acne, male-pattern hair loss, acne, or elevated male hormone levels). The majority of women with PCOS also suffer from obesity and insulin resistance. PCOS has been associated with a spectrum of health problems including infertility, [...]