ACOG Releases Revised Guidelines for Treatment of Opioid Use During Pregnancy
We have been writing over the last few years about the growing problem of opioid use and abuse in women of reproductive age. Responding to a dramatic increase in the number of women abusing opiates during pregnancy, the American College of Obstetricians and Gynecologists (ACOG) has released revised guidelines on the treatment of opioid use during pregnancy. ACOG recommends universal screening to be carried out at the first prenatal visit with [...]
In Brief: Hormone Replacement Has No Impact on Mortality in Women
While there have been concerns regarding the risks associated with prolonged use of hormone replacement, an increasing number of studies suggest that the risk may be relatively low in certain populations and that hormone replacement is appropriate in certain settings. A recent study published in JAMA has focused on mortality rates in women treated with hormone replacement. JoAnn Manson, MD, the lead author of study, notes that all-cause mortality is an [...]
Why Do Many Continue To Recommend Tapering SSRI Antidepressants During the Third Trimester?
In 2005, we saw the first reports describing an increased risk of “poor neonatal adaptation” in infants with prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants in late pregnancy. Since that time, studies have consistently indicate that about 25%-30% of infants exposed to SSRIs late in pregnancy manifest symptoms of poor neonatal adaptation. The most commonly observed symptoms include jitteriness, restlessness, irritability, increased muscle tone, sleep disturbance, feeding problems, [...]
The Etiology of Premenstrual Dysphoric Disorder: 5 Interwoven Pieces
The following post was first published in Current Psychiatry, published September 2017, Vol. 16, No. 9, p. 20-28. Check out the article on Current Psychiatry or listen to Dr. Raffi discuss treatment of menstrual–related mood and anxiety disorders. By Edwin R. Raffi, MD, MPH, & Marlene P. Freeman, MD In an age when psychiatry strives to identify the biologic causes of disease, studying endocrine-related mood disorders is particularly intriguing. DSM-5 defines premenstrual dysphoric [...]
Antenatal Exposure to Antidepressant and Risk of Psychiatric Illness in the Child
When we provide consultations regarding the use of antidepressants during pregnancy, one of the most difficult questions we have to answer is related to the long-term effects of prenatal antidepressant exposure. Specifically, do antidepressants used by the mother during pregnancy affect the long term development of the fetus? While many studies have attempted to look at the effects of prenatal antidepressant exposure on neurodevelopment and behavior, most of these studies [...]
Estrogen Receptor Modulator Raloxifene for Women with Schizophrenia
Several years ago, we reviewed a paper suggesting that estrogen may have beneficial effects for women with schizophrenia. In this study, women with schizophrenia were treated with estrogen in addition to their antipsychotic medications. Adjunctive treatment with estrogen was associated with significant improvement in their positive symptoms (hallucinations, delusions), but the women experienced no improvement in the severity of negative symptoms (reduction in range of emotional expression, poverty of speech, lack [...]