• Yearly Archives: 2006

    Can Women Suffer from Postpartum Depression After Miscarriage?

    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 hormonal changes that take place after delivery and that these hormonal changes may contribute to emergence of depressive symptoms during the postpartum period.

    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)

    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.

    Use of SSRIs During Pregnancy

    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 pregnancy because they may cause problems for the baby at the time of delivery. I am concerned about having to come off my medication for such a long time. In the past, every time I have tried to stop the medication, my depression has come back within a month or so.

    Duloxetine for the Treatment of Menopausal Symptoms and Mood in Postmenopausal Women

    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 of menopausal symptoms, and recent data suggest that selective serotonin reuptake inhibitor antidepressants (SSRIs) and the serotonin norepinephrine reuptake inhibitor (SNRI), venlafaxine, may be effective for the treatment of depression and vasomotor symptoms in peri- and postmenopausal women. In a study presented at the annual meeting of the American Psychiatric Association, Dr. Hadine Joffe and her colleagues at the Center of Women’s Mental Health presented data on the use of duloxetine (Cymbalta), a new SNRI, for the treatment of mood, vasomotor symptoms, and insomnia in postmenopausal women.

    Neurobehavioral Outcomes in Children Exposed to Lithium in Utero

    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 with bipolar disorder, relapse rates were very high (58%) in women who discontinued maintenance treatment with lithium during pregnancy (Viguera et al 2000). Given this risk of recurrent illness, many women may consider continuing lithium treatment during pregnancy. While the teratogenic effects of first trimester exposure to lithium have been well studied, data on the long-term outcome of children exposed to lithium during pregnancy are sparse. At the 61st Annual Meeting of the Society of Biological Psychiatry in Toronto, Dr. Viguera presented preliminary data on the neurobehavioral outcomes of children exposed to lithium in utero.

    Evaluating the Safety of First-Trimester Exposure to Lamotrigine (Lamictal)

    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 with bipolar disorder. Dr. Adele Viguera and her colleagues at the Center for Women's Mental Health reported that among pregnant bipolar women, relapse rates were very high (58%) in those women who discontinued maintenance treatment with lithium during pregnancy (Viguera et al 2000).

    Menstrual Cycle Irregularity in Women with Bipolar Disorder

    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 treat these psychiatric disorders.In a recent study, Dr. Hadine Joffe of the Center for Women’s Mental Health and her colleagues assessed the prevalence of menstrual cycle dysfunction in 3 groups of women: (1) with bipolar disorder, (2) with unipolar depression, or (3) with no psychiatric illness (Joffe 2006).

    By |2015-07-28T09:54:19-04:00April 24th, 2006|PMS and PMDD|0 Comments

    Use of Paxil during Pregnancy

    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 during pregnancy. Are there any other options?

    Withdrawal Symptoms in Newborns Exposed to SSRIs

    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.

    SSRIs and Persistent Pulmonary Hypertension of the Newborn

    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 antidepressants around the time of labor and delivery (see Fall 2004 and Spring 2005 Newsletters). In addition, a recent study published in the New England Journal of Medicine has linked SSRI use during late pregnancy to an increased risk of persistent pulmonary hypertension in the newborn (Chambers 2006).

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