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 [...]
Tag Archives: Antidepressants
Antidepressant Treatment During Pregnancy: One Woman’s Experience (Part III)
September 19, 2011 – 10:17 am
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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. [...]
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 [...]
SSRIs and Pregnancy: Putting the Risks into Perspective
October 7, 2007 – 5:49 pm
Depression is common during pregnancy, affecting 10% to 15% of women. While psychotherapy is an attractive option for the treatment of depression during pregnancy, all women do not respond to this intervention and many require pharmacotherapy. Thus far, no antidepressants have yet been approved by the FDA for use during pregnancy. Although data accumulated over [...]
Antidepressant-Induced Sexual Side Effects
October 1, 2007 – 1:06 am
A recent article published in Psychiatric Times reviews options for the management of antidepressant-induced sexual dysfunction. According to this review, sexual side effects may occur in 40% to 70% of patients treated with serotonin reuptake inhibitors (SRIs) and is a common reason for poor compliance with treatment and eventual discontinuation. When sexual side effects occur, [...]
Expert Guidelines for the Treatment of PMDD
August 31, 2007 – 5:45 pm
In this review, guidelines for the treatment of PMDD are provided. Selective serotonin reuptake inhibitors (SSRIs) are the most widely used pharmacologic agents for treating depression and anxiety disorders, and several have also emerged as first-line treatment for premenstrual dysphoric disorder (PMDD). In numerous clinical trials, SSRIs have demonstrated efficacy in reducing the physical and [...]
Withdrawal Symptoms in Newborns Exposed to SSRIs
April 24, 2006 – 6:28 am
A recent report suggests that newborns exposed to selective serotonin reuptake inhibitors (SSRI) antidepressants such as Prozac, Zoloft, Celexa and Paxil may be at risk for developing withdrawal symptoms after delivery (Levinson-Castiel 2005). However, the investigators also noted that the symptoms usually disappeared within 48 hours and did not require medical intervention. In this study, [...]
SSRIs and Neonatal Outcomes: A Population-Based Study from Finland
January 24, 2006 – 6:53 am
Literature accumulated over the last decade supports the use of certain selective serotonin reuptake inhibitors (SSRIs) and the older tricyclic antidepressants during pregnancy, indicating no increased risk of congenital malformation in children exposed to these medications during the first trimester of pregnancy. Still, questions remain regarding the purported risk for “toxicity” in newborns exposed to [...]
Neonatal Symptoms After In Utero Exposure to SSRIs
July 27, 2005 – 7:21 am
The increasing number of reproductive-age women taking antidepressants has raised concerns about the potential risks of using these medications during pregnancy. Literature accumulated over the last decade supports the use of certain selective serotonin reuptake inhibitors (SSRIs) and the older tricyclic antidepressants during pregnancy, indicating no increased risk of congenital malformation in children exposed to [...]
Should SSRIs Be Discontinued Prior to Delivery?
June 13, 2005 – 6:54 pm
About 10-15% of women suffer from depression during pregnancy. The rates are probably even higher among those women who have histories of depression prior to pregnancy. Thus, many women with recurrent illness make the decision to remain on antidepressant during pregnancy. While there have been many studies supporting the reproductive safety of certain antidepressants, including [...]
Prevention of Postpartum Depression
July 20, 2004 – 3:23 pm
Postpartum depression (PPD) is a relatively common problem, affecting between 10% and 15% of women after delivery. Although it is difficult to reliably predict which women in the general population will experience postpartum mood disturbance, it is possible to identify certain subgroups of women who are more vulnerable to postpartum affective illness. Women who have [...]
Long-term Effects of Fetal Exposure to Antidepressants
March 31, 2003 – 12:25 pm
Although data accumulated over the last 30 years suggest that some medications may be used safely during pregnancy, our knowledge regarding the risks of prenatal exposure to psychotropic medications is incomplete. Because neuronal migration and differentiation occur throughout pregnancy and into the early years of life, the central nervous system (CNS) remains particularly vulnerable to [...]
Light Therapy for Depression During Pregnancy
June 23, 2002 – 12:31 pm
Depression during pregnancy (antenatal depression) is relatively common, affecting about 10% of women. While there is a growing body of literature supporting the reproductive safety of certain antidepressants, our understanding of how these psychotropic medications affect the developing fetus remains incomplete. For this reason, antidepressants are typically avoided during pregnancy; thus, there is a clear [...]
Breastfeeding and antidepressants
January 6, 2002 – 10:35 am
When discussing the use of antidepressant medications by breastfeeding women, It is somewhat misleading to say that certain medications are “safer” than others. All medications taken by the mother are secreted into the breast milk. The amount of drug to which the infant is exposed depends on many factors, including the medication dosage, as well [...]
Intermittent Dosing of SSRIs for PMS
April 6, 2000 – 11:32 am
Selective Serotonin Reuptake Inhibitors or SSRIs have been shown to be effective for the treatment of premenstrual symptoms. These medications are not only useful for treating the irritability, depression and anxiety that occur during the 1-2 weeks before the menstrual period but may also help alleviate some of the physical symptoms of PMS. Initially, SSRIs [...]
