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 [...]
Tag Archives: Depression
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
Use of Wellbutrin (Bupropion) During Pregnancy
February 20, 2007 – 12:38 pm
There are data to support the use of certain antidepressants during pregnancy. Most of the research over the last decade has focused on the selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and the older tricyclic antidepressants, but there is some new data supporting the use of bupropion during pregnancy. The most recent information from [...]
Perimenopause May Be a Time of Risk for New Onset Depression
February 10, 2007 – 12:35 pm
The transition to menopause has typically been considered a time when women may be more vulnerable to mood changes. There have been inconclusive data, however, as to whether women with no lifetime history of depression transitioning to menopause are at increased risk for developing an episode of major depression. In a recent study, Drs. Lee [...]
Depression During Pregnancy is Often Not Treated
February 10, 2007 – 2:11 am
While pregnancy has traditionally been considered a time of emotional well-being, recent data indicate that about 10% to 15% of women experience clinically significant depressive symptoms during pregnancy. Furthermore, women with a history of major depression appear to be at high risk for recurrent illness during pregnancy particularly in the setting of antidepressant discontinuation. In [...]
Relapse of Major Depression during Pregnancy
April 22, 2006 – 9:22 am
Over the last decade, the number of reproductive-age women treated for depression has increased significantly. Given the incomplete information available regarding the reproductive safety of many antidepressant medications, many women choose to discontinue pharmacologic treatment during pregnancy. However, several studies estimate that about 10 to 15% of women suffer from depression during pregnancy (O’Hara et [...]
Perimenopause: A Time of Risk for Depression
October 22, 2005 – 7:41 pm
More than 50 percent of women experience some perimenopausal symptoms, including hot flushes, night sweats, and sleep disturbance, before reaching the menopause. A recent article from Aetna Intelihealth notes that many women may also experience depression. In a study form Dr. Claudio Soares, women with clinically confirmed perimenopause were interviewed: Of the 101 women studied, [...]
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 [...]
Oral Contraceptives for the Treatment of Premenstrual Mood Symptoms in Women with Depression
June 14, 2005 – 12:20 pm
About 3-5% of women of reproductive age suffer from premenstrual dysphoric disorder (PMDD), where they experience depressive symptoms, anxiety or irritability during the last one to two weeks (the premenstrual phase) of their menstrual cycle. In addition, many women who suffer from depression, including those who have been effectively treated with an antidepressant, report worsening [...]
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 [...]
Acupuncture for Depression During Pregnancy
February 14, 2005 – 7:03 am
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, our understanding of how these psychotropic medications affect the developing fetus remains incomplete. For this reason, many women and their physicians would prefer to avoid the use [...]
Infertility Treatment: A Trigger for Depression and Anxiety
August 18, 2004 – 4:05 pm
While several studies have demonstrated high levels of psychological distress among women pursuing infertility treatment, few studies have assessed the prevalence of psychiatric illness in populations undergoing infertility treatment using standardized diagnostic instruments. In a recent study from Taipei Veterans General Hospital, a university-affiliated medical center in Taiwan, women attending an assisted reproduction clinic were [...]
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 [...]
Depression and Preterm Labor
April 30, 2002 – 12:34 pm
Although most people tend to think of pregnancy as a time of emotional well-being, depression is relatively common, affecting about 1 in 10 women. While there are obvious concerns related to the use of antidepressants during pregnancy and the effects of these medications on the developing fetus, less attention has focused on the impact of [...]
Preventing Depression During Pregnancy
May 6, 2000 – 4:13 pm
Women who take antidepressants for their depression must make a difficult decision when they plan to become pregnant. Should they continue their medication during pregnancy? Or should they stop? Although there is information to support the reproductive safety of at least some antidepressants, most women, understandably concerned about exposing their babies to medication, choose to [...]
