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 [...]
Author Archives: mghcwmh
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 [...]
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 [...]
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 link [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 of [...]
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. [...]
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 a [...]
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? - Oct. [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 will receive study [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 metabolism [...]
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 [...]
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 [...]
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 [...]
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, [...]