What is the Risk for Relapse After Stopping Antidepressants During Pregnancy?
For women taking antidepressants, how do we decide whether or not they should maintain their medication during pregnancy? Based on our previous research and clinical experiences, we know that many women who discontinue antidepressant therapy will relapse during pregnancy. Our decision is typically guided by the severity of the woman's illness. If she has had recurrent or severe depression, we are more likely to recommend continuing treatment during pregnancy. On the [...]
Finding Information on the Reproductive Safety of Medications
Last week, I met with a woman who was planning pregnancy. She had a long history of generalized anxiety disorder and panic disorder and had done very well over the past 10 years on a regimen of citalopram (Celexa) and lorazepam (Ativan) as needed for sleep. She wanted to discuss alternative sleep medications because “my OB told me I couldn’t take Ativan because it’s a Category D medication”. The Pregnancy [...]
Weekly Roundup for June 26, 2020: Recent Publications in Women’s Mental Health
Every week we review the most recent publications in women’s mental health, covering topics related to premenstrual symptoms, perinatal mood and anxiety disorders, use of medications in pregnant and breastfeeding women, perinatal substance use, and menopausal mental health. While we now have many studies assessing the safety of antidepressants during pregnancy, we have only a handful of studies looking at the natural course of illness in women with histories of depressive [...]
Risk of Preterm Birth and Respiratory Distress in Pregnancies with Prenatal Exposure to Antidepressants
From the OptumLabs Data Warehouse, researchers identified 226,932 singleton deliveries. Cases of antidepressant exposure were defined as pregnancies with prescription claims for antidepressants submitted between the last menstrual period and 35 weeks’ gestation. To standardize dosing, prescriptions were converted to fluoxetine equivalents, and a longitudinal cluster analysis was performed. The outcomes observed in this study included major cardiac malformations (11.7 of 1000 births), preterm birth (75.7 of 1000 births), and [...]
New Research from the CWMH: Impact of Obesity on Pregnancy Outcomes in Women with Psychiatric Illness
Individuals with psychiatric disorders are at higher risk for obesity than the general population, as well as for medical comorbidity, such as diabetes, hypertension, hyperlipidemia, and cardiovascular disease. Because obesity is associated with an increased risk of adverse pregnancy outcomes, we examined the effect of obesity on neonatal and maternal outcomes in a group of women with psychiatric illness. Pregnant women with psychiatric disorders were enrolled in the Massachusetts General [...]
Improved Screening for Perinatal Depression and Anxiety, But What Now?
The American College of Obstetricians and Gynecologists (ACOG) now recommends screening for perinatal depression and anxiety, stating that “clinicians screen patients at least once during the perinatal period for depression and anxiety symptoms using a standard, validated tool.” Approximately 40 states have instituted guidelines and recommendations regarding screening for perinatal depression; however, we are still gathering information on how successful these recommendations have been in terms identifying and treating [...]