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 [...]
Tag Archives: women’s health
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. [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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. [...]
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 [...]
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 [...]
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, [...]
Can Estrogen Be Used to Treat Posptartum Depression?
November 6, 2007 – 4:41 am
After delivery, women experience a dramatic drop in estrogen hormone levels. Many have hypothesized that this decline in estrogen levels may precipitate postpartum depression (PPD) in susceptible individuals, and several studies have explored the use of estrogen for the treatment of depression after delivery.
In a double blind, placebo-controlled study including 61 women with PPD, [...]
Sleep Problems in Menopausal Women
November 3, 2007 – 5:22 am
Peri- and post-menopausal women frequently complain of insomnia or poor sleep quality. Sleep disturbance is often attributed to nocturnal hot flashes; however, a recent study from researchers at Wayne State University School of Medicine suggests that about half of these women may have a primary sleep disorder.
In this study, 102 women (ages 44 to [...]
Does Estrogen Improve Cognition?
October 30, 2007 – 5:38 pm
While earlier observational studies suggested that postmenopausal hormone treatment may improve cognitive functioning in women, studies from the Women’s Health Initiative have shown that estrogen replacement therapy started in postmenopausal women (65 years or older) did not enhance cognitive functioning nor did it decrease the risk of dementia.
In order to assess the effect of [...]
Binge Eating Disorder is More Common during Pregnancy
October 27, 2007 – 11:54 pm
While it appears that many women with eating disorders may experience a remission of their symptoms during pregnancy, a new study from researchers at the University of North Carolina, Chapel Hill and the University of Oslo, Norway suggests that binge eating disorder may be triggered during pregnancy.
The study included 41,157 women who self-reported eating disorder [...]
Link Found Between Anxiety and Preterm Birth
October 22, 2007 – 9:32 am
While there have been concerns regarding the reproductive safety of psychotropic medications, it must be recognized that withholding or withdrawing pharmacologic treatment for depression or anxiety during pregnancy may not always be the safest option. Untreated psychiatric illness in the mother cannot be considered a benign event, and a number of studies have indicated that [...]
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 [...]
Panic Attacks in Older Women Linked to Heart Disease
October 2, 2007 – 11:44 pm
An article published in the October 2007 issue of Archives of General Psychiatry suggests that older women who experience panic attacks may be at increased risk of having a heart attack or stroke and at increased risk of death over the next five years. MGH researcher Jordan W. Smoller, M.D. and colleagues followed 3,369 healthy [...]
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, [...]
Two MGH Center for Women’s Mental Health Physicians Featured in Elle Magazine
September 28, 2007 – 12:13 pm
Lee S. Cohen, MD, and Hadine Joffe, MD, MSc, shared their expertise in reproductive health and oral contraceptives (OC) for Elle magazine’s recent article, “Against the Flow.” The article discusses Lybrel, the first continuous OC approved by the Food and Drug Administration (FDA). This new birth control pill has received attention because its continual low [...]
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 behavioral [...]
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 the [...]
Evaluating the Long-Term Effects of Prenatal Antidepressant Exposure
February 20, 2007 – 8:32 am
Over the last decade information has accumulated regarding the safety of antidepressants taken during pregnancy. While much research has addressed the effect of antidepressant drugs on risk for congenital malformation, less research has focused on the long-term effects of prenatal antidepressant exposure.
In a landmark study from Irena Nulman and her colleagues at the Mortherisk program [...]
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 Cohen [...]
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 [...]
Can Women Suffer from Postpartum Depression After Miscarriage?
October 19, 2006 – 8:18 pm
After the birth of a child, it is common for women to experience some type of mood disturbance. Typically, it is relatively mild (postpartum blues). However, about 10-15% of women experience a more severe and disabling illness, postpartum depression. It has been suggested that women who develop postpartum depression may be more sensitive to the [...]
New Book: A Deeper Shade of Blue: A Women’s Guide to Recognizing and Treating Depression in Her Childbearing Years, by Ruta Nonacs, MD. (Simon and Schuster, 2006)
July 30, 2006 – 3:36 pm
Depression affects women almost twice as often as men, with about one in four women suffering from it in her lifetime. While depression may strike at any time, studies show that women are particularly vulnerable during their childbearing years.
Despite the increasing awareness of this deeply concerning issue, many studies and health professionals still continue to [...]
Use of SSRIs During Pregnancy
July 30, 2006 – 1:40 pm
Q. I have been taking antidepressants on and off for the last ten years, and I am now planning a pregnancy. I am now on Effexor, and my psychiatrist recommended switching to Prozac and staying on it up until the end of the second trimester. He said that antidepressants should be avoided later on in [...]
Duloxetine for the Treatment of Menopausal Symptoms and Mood in Postmenopausal Women
July 30, 2006 – 1:23 pm
Depression is common in postmenopausal women suffering from menopausal vasomotor symptoms (hot flushes, night sweats) and insomnia. While estrogen replacement therapy may alleviate these symptoms and may also have a positive impact on mood, the use of estrogen has declined over recent years. There has been great interest in finding alternative strategies for the management [...]
Neurobehavioral Outcomes in Children Exposed to Lithium in Utero
July 30, 2006 – 1:17 pm
Driven by concerns regarding fetal exposure to psychotropic medications, many women with psychiatric illness attempt to discontinue their pharmacologic treatment during pregnancy; however, recent studies indicate that this approach may not be appropriate for all women. Dr. Adele Viguera and her colleagues at the Center for Women’s Mental Health have reported that among pregnant women [...]
Evaluating the Safety of First-Trimester Exposure to Lamotrigine (Lamictal)
July 11, 2006 – 1:30 pm
Early reports suggested that women with bipolar disorder may be at lower risk for onset or relapse of this disorder during pregnancy and that some women may be able to remain well during pregnancy despite medication discontinuation. However, more recent studies have suggested that recurrence of affective illness during pregnancy is relatively common among women [...]
Menstrual Cycle Irregularity in Women with Bipolar Disorder
April 24, 2006 – 3:09 pm
Preliminary reports have suggested that menstrual irregularity may occur more commonly in women with mood disorders than in the general population. What has been unclear, however, is whether these menstrual cycle irregularities reflect an underlying disruption of the hypothalamic-pituitary-gonadal (HPG) axis in women with mood disorders or are caused by the psychotropic medications used to [...]
Use of Paxil during Pregnancy
April 24, 2006 – 2:51 pm
Q. I have taken Paxil for about six years for depression and obsessive-compulsive disorder. I have tried several times to stop the medication but the symptoms come back within a few weeks of stopping the medication. My husband and I are now planning a pregnancy, and my obstetrician tells me that I cannot take Paxil [...]
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, published [...]
SSRIs and Persistent Pulmonary Hypertension of the Newborn
April 24, 2006 – 6:15 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 [...]
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 [...]
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 [...]
Reviewing the Safety of SSRI’s in Pregnancy
December 31, 2005 – 2:24 pm
Over the past 15 years, multiple studies have addressed the reproductive safety of the selective serotonin reuptake inhibitors (SSRIs). Data on the overall teratogenicity of SSRIs come from relatively small cohort studies and larger international programs, and they have cumulatively supported the reproductive safety of fluoxetine (Prozac) and certain other SSRIs. However, several recent studies [...]
Escitalopram for Menopause-Related Depression and Vasomotor Symptoms
December 30, 2005 – 2:45 pm
Every year more than 1.7 million women in the United States enter into menopause. During this time of hormonal fluctuations it is typical for women to experience hot flashes, night sweats and sleep disturbance. More recently, studies have identified an association between menopausal transition and an increased risk for developing depressive symptoms (Harlow et al., [...]
Lamotrigine and Breastfeeding
November 18, 2005 – 6:29 pm
Because rates of postpartum illness are very high in women with bipolar disorder, it is generally recommended that mothers continue treatment with a mood stabilizer throughout the postpartum period to reduce their risk of relapse; however, the use of medications during the postpartum period is complicated by the issue of breastfeeding. All medications are secreted [...]
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, nearly [...]
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 [...]
Postpartum Depression: Who is at Risk?
June 20, 2005 – 3:39 pm
Many women imagine new motherhood as a time of total fulfillment, days filled with mother-infant bonding and boundless joy. In reality, however, many women experience significant mood changes following childbirth. Between 50 and 85% of new mothers experience a brief postpartum period of tearfulness and anxiety, termed the “maternity blues.” But some 10 to 15% [...]
Can Women Taking Lithium Breastfeed Their Infants?
June 14, 2005 – 6:46 pm
It is clear that women with bipolar disorder are at high risk for relapse during the immediate postpartum period (Viguera 2000). There is evidence that the resumption of lithium prior to or within 24-48 hours of delivery can significantly reduce the risk of postpartum illness (Cohen 1995). While this intervention is the current standard of [...]
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 [...]
Is Wellbutrin Safe During Pregnancy?
April 15, 2005 – 12:03 pm
Q. I have a long history of depression and have been taking Wellbutrin (bupropion SR) for several years now. Every time I try to come off the medication, the depression comes back. I am planning to get pregnant within the next year and was wondering if it is safe to use Wellbutrin.
A. While there is [...]
Recent Antidepressant Label Changes
April 15, 2005 – 11:44 am
In October, the Food and Drug Administration (FDA) ordered drug manufacturers to include warnings in the packaging inserts regarding the use of certain antidepressants, including the selective serotonin reuptake inhibitors (SSRIs) and venlafaxine (Effexor), during pregnancy. The labels now describe a spectrum of adverse events in newborns exposed to these drugs late in the third [...]
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 [...]
Venlafaxine (Effexor) for Postmenopausal Hot Flushes
January 18, 2005 – 4:00 pm
During the menopausal transition, up to 85% of women experience vasomotor symptoms of hot flushes and night sweats. For many women, hot flushes may be severe; they can interfere with work and other daily activities and affect sleep quality. Hot flushes may be associated with fatigue, poor concentration, and depression. Given the recent data from [...]
Paroxetine and Cognitive-Behavioral Therapy (CBT) for the Treatment of Postpartum Depression
September 20, 2004 – 3:27 pm
Postpartum depression (PPD) is relatively common, occurring in about 10 to 15% of women after delivery. Non-pharmacologic interventions, including interpersonal psychotherapy, have been shown to be effective for the treatment of PPD. In addition, several reports have documented the efficacy of selective serotonin reuptake inhibitors (SSRIs) and the serotonin norepinephrine reuptake inhibitor venlafaxine (Effexor). In [...]
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 [...]
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 [...]
Is St. John’s Wort Safe in Breastfeeding Women?
January 18, 2004 – 5:44 pm
Postpartum depression is a relatively common event, affecting 10 to 15% of women after the birth of a child. Many women, however, do not receive treatment, and one of the most common reasons for avoiding or deferring treatment is concern regarding the use of medications while breastfeeding. A preliminary study from Lee and colleagues at [...]
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 [...]
Bupropion and Breastfeeding
November 6, 2002 – 4:46 pm
Data have accumulated over the last few years on the use of antidepressants in nursing mothers. It appears that all antidepressants are secreted into the breast milk; however, the amount of medication [...]
Anticonvulsants During Pregnancy in Women with Bipolar Disorder
October 6, 2002 – 4:00 pm
Unfortunately the mood stabilizers most commonly used to treat bipolar disorder (including lithium and valproic acid) can increase the risk of certain types of congenital malformations in children exposed [...]
Reevaluating the Pros and Cons of Hormone Replacement Therapy
September 18, 2002 – 2:07 pm
Each year, more than 1.3 million American women become menopausal in the U.S. The menopausal transition is marked by intense hormonal variability, and frequently accompanied by vasomotor symptoms (e.g., hot flashes, night sweats), sleep disturbance, and altered libido. In addition, as women become estrogen-deprived, they may also experience an increased risk for osteoporosis, cardiovascular disease, [...]
Breastfeeding Boosts Intelligence
July 18, 2002 – 5:28 pm
Over the years, various studies have demonstrated the many advantages of breastfeeding, findings that have led the American Academy of Pediatrics to recommend that all mothers breastfeed their children for the first year of the child’s life. Several studies have also examined the relationship between breastfeeding and intellectual development in younger children and have demonstrated [...]
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 [...]
Agnus Castus Fruit Extract as a Treatment for Premenstrual Syndrome
May 20, 2002 – 11:58 am
During the period before menstruation, many women report experiencing psychological and physical symptoms collectively referred to as premenstrual syndrome (PMS). The fruits, leaves and flowers of Vitex agnus castus (the Chaste Tree) have traditionally been used to relieve these symptoms. While the mode of action is not clear, the effects of the plant seem to [...]
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 [...]
Lithium Discontinuation While Attempting to Conceive
February 6, 2002 – 11:21 am
For women with bipolar disorder who are planning a pregnancy, it is common practice to discontinue mood stabilizers prior to attempts to conceive, since the mood stabilizers most commonly used to treat [...]
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 [...]
Benzodiazepines and Pregnancy
May 6, 2001 – 4:08 pm
The data regarding the use of the benzodiazepines (including Klonopin, Xanax, Ativan, and Valium) during pregnancy are somewhat controversial. Studies suggest there may be an increased risk of cleft lip and palate [...]
Selecting an Antidepressant During Pregnancy
May 6, 2001 – 3:42 pm
Most women and their doctors try to avoid using medications during pregnancy. Of greatest concern is that a medication used during pregnancy may in some way harm the developing fetus or, at the [...]
Alternative Treatments for PMS
May 6, 2001 – 1:58 pm
During the two weeks prior to the onset of a menstrual period, many women experience physical symptoms, such as bloating, breast tenderness, headache, and muscle aches. A small proportion of women also note [...]
Bipolar Disorder and Pregnancy
January 6, 2001 – 10:53 am
Unfortunately the mood stabilizers most commonly used to treat bipolar disorder (including lithium and valproic acid) can increase the risk of certain types of birth defects or congenital malformations [...]
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 [...]
Serzone for Panic Disorder During Pregnancy
May 6, 2000 – 11:44 am
It is relatively common for women with panic disorder to experience recurrent anxiety and panic symptoms during pregnancy. This is especially true for women who have been stabilized on an anti-panic medication prior to conception and abruptly discontinue the medication after becoming pregnant. [...]
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 [...]
