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Medications and Pregnancy: A Focus on the Pharmacokinetics

We have an abundance of articles which address the impact of psychotropic medications on pregnancy.  Much less research, however, has focused on how pregnancy may affect how these medications work.  Physiologic changes take place during pregnancy which may affect the absorption, distribution, metabolism, and elimination of medications.  These pharmacokinetic changes may result in lower psychotropic […]

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New Guidelines Limit Testosterone Supplements for Women

Both men and women produce testosterone. The big difference is that the levels are much lower in women, around 15 to 40 ng/dL.  In women, testosterone levels begin to decline gradually after the age of 20. In postmenopausal women, testosterone levels are between 0 and 20 ng/dL.  Various symptoms have been attributed to falling levels of testosterone in midlife women, including lower sex drive, decreased muscle mass and bone density, decline in cognitive functioning, and depression.  Some refer to this constellation of symptoms as “female androgen insufficiency syndrome”; others debate the clinical validity of this diagnosis in women.

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PTSD in Veterans Increases Risk of Preterm Birth

Posttraumatic stress disorder (PTSD) is relatively common among pregnant and postpartum women. The lifetime prevalence of PTSD for women is about 10%.  PTSD is most prevalent among women of childbearing age and PTSD symptoms are common during pregnancy.  Earlier this year, we reported on a study which observed that women with a diagnosis of PTSD had an increased risk of preterm birth.  The risk was particularly high in those women with diagnoses of both PTSD and a major depressive episode; these women had a 4-fold increased risk of preterm birth.

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Postpartum Depression and Positive Parenting Practices

How does postpartum depression affect a mother’s ability to care for and parent her child?  Various studies have demonstrated that depressed mothers may be less attuned to their children’s needs, either being less responsive to the baby or, in some cases, too intrusive.  Researchers have speculated that this mismatch between mother and baby may contribute to problems with infant bonding, delays in development and emotional dysregulation.

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SSRI exposure during pregnancy: What’s enough data?

The following post was first published in OB/GYN News. Numerous studies on the reproductive safety of selective serotonin reuptake inhibitors (SSRIs) have been published, particularly over the last decade. With the different methodologies used and often disparate results, the extensive data now available in the medical literature can be overwhelming for clinicians and researchers to […]

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Pilot Study: Aripiprazole Added to Antidepressants for Postpartum Depression

Augmentation strategies can be used to optimize response in patients with major depressive disorder (MDD) who have not responded adequately to antidepressant monotherapy; however, we have no data on the use of adjunctive treatments in women with postpartum depression (PPD).   A recent study tested the effectiveness of antidepressant augmentation with aripiprazole (Abilify) in a cohort of 10 women with onset of a depression within 3 months of the birth of a healthy, close-to-term baby.

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Older Moms at Higher Risk for Depression

A recent study from Canada has observed higher rates of depression in mothers who have children after the age of 40. The prevalence of depression after delivery was about threefold higher in women aged 40 to 44 years as compared to women aged 30 to 35 years. This relationship was even stronger after controlling for potential confounders, including education level, marital status, and chronic illness (adjusted OR 3.72; 95% CI 2.15 to 6.41).

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Anti-Epileptic Drugs and Risk of Miscarriage

Do anti-epileptic drugs increase the risk for miscarriage and/or stillbirth? Many reports have demonstrated an association between the use of antiepileptic drugs during pregnancy and increased risk of congenital malformations and pregnancy complications, including pre-eclampsia, preterm birth, and intrauterine growth retardation.  However, little is known about the impact of antiepileptic drugs (AEDs) on the risk […]

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Prenatal Valproate Exposure and Risk of Autism Spectrum Disorders

Autism spectrum disorders (ASDs), which include childhood autism, autistic disorder, Asperger syndrome, atypical autism, and other pervasive developmental disorders, are characterized by social and communication difficulties and by stereotyped or repetitive behaviors and interests. It is estimated that autism spectrum disorders affect about 1% of children. While genes play a significant role in the risk […]

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Pregnancy Outcomes in Women with Schizophrenia

With the advent of the newer, atypical antipsychotic medications, patients with psychotic disorders have been able to achieve greater symptom control with less disabling side effects. For women with schizophrenia, there has also been an increase in fertility rates over the last decade.  Previous studies have suggested that women with schizophrenia, as compared to women with no psychiatric illness, are at increased risk for pregnancy and delivery complications, including low birthweight, intrauterine growth restriction, and preterm birth.  However, most of these studies occurred at a time when the women were treated with older antipsychotic medications, and we cannot assume that these findings are relevant now, when women with schizophrenia are more commonly treated with the newer atypical antipsychotics and have much better control of their symptoms.

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