Omega-3 Fatty Acids: The Basics for Clinicians and Patients
Omega-3 Fatty Acids: The Basics for Clinicians and Patients
Discontinuation of Antidepressants: Slower is Better
About half of all pregnancies are unplanned. In this situation, many women who conceive while on psychotropic medications decide to abruptly stop their medications when they discover they are pregnant. While this may seem like the safest option, in terms of protecting the developing fetus, we have data demonstrating high rates of relapse in women who discontinue antidepressant medications or mood stabilizers proximate to conception. We now have data (from several studies in non-pregnant populations) to indicate that the rate of medication discontinuation (abrupt vs. gradual) may also affect risk of relapse.
Should SSRIs Be Tapered Prior To Delivery?
Increased muscle tone, jitteriness, sleep disturbance, irritability, feeding problems, mild respiratory distress and myoclonus have been reported as symptoms of a potential neonatal distress syndrome related to exposure to SSRIs in late pregnancy. The average duration of symptoms reported is 48 hours. It is estimated that between 25-30% of SSRI-exposed infants are at risk for this syndrome. No treatment intervention is required. Reassuringly, follow-up studies have shown that at 2, 4, 6, and 8 months SSRI-exposed infants are indistinguishable from control infants without known exposure.
The Importance of Proper Dosing of Antidepressants during Pregnancy
Pregnancy and the postpartum period is a time of increased risk for depression. Therefore, women who are treated with antidepressant medications must consider whether or not to stay on medication during pregnancy. Despite reassuring data regarding the reproductive safety of various antidepressants, a woman may prefer not to continue medication during pregnancy due to concerns about long term effects of medication on the baby. However, by discontinuing antidepressant medication, a woman increases her risk of depression during pregnancy. This is a highly personal decision for women as the potential risks of continuing medication must be weighed against the possibility of relapse and the potential effects of untreated depression on the pregnancy and baby.
Massage Therapy for Depression
There are currently 100 clinical trials registered on clinicaltrials.gov using massage as a treatment. Six are listed for the indication of depression. A small minority are focused specifically on treating depression or anxiety, while in many the effects of massage for patients with serious medical conditions are being explored. Infant massage is also under study for developmental benefits. The number of randomized trials for verified psychiatric disorders using massage as an intervention are limited to date.
Non-Pharmacologic Options for the Treatment of Antenatal Depression: A Quick Review
About 15% of women suffer from depression during pregnancy, and the rate of depressive illness is greater in women with pre-existing histories of depression. While there are data to support the use of certain antidepressants during pregnancy, many women are reluctant to seek pharmacologic treatment during pregnancy and may benefit from efficacious non-pharmacologic options. In a recent review article from Medscape, Christopher Tjoa and colleagues from the University of Pennsylvania summarize the literature assessing the efficacy of non-pharmacologic options for the treatment of antenatal depression.
Anxiety During Pregnancy Predicts Worse Outcomes
In treating pregnant women with mood or anxiety disorders, we tend to focus primarily on the reproductive safety of psychotropic medications; however, it must be recognized that withholding or withdrawing pharmacologic treatment for depression or anxiety during pregnancy may carry some degree of risk. Untreated psychiatric illness in the mother cannot be considered a benign event, and a number of studies have indicated that depression during pregnancy may negatively affect pregnancy outcomes (reviewed in Bonari 2004).
Depression and Anxiety: Do They Impact Infertility Treatment?
Infertility affects an estimated 10-15% of couples of reproductive age. Several studies have indicated that patients undergoing in vitro fertilization (IVF) experience high levels of stress, depression, and anxiety. Multiple risk factors for anxiety and depression during infertility treatment have been identified; these include being female, age over 30, lower level of education, lack of occupational activity, a male cause for infertility, and infertility for 3-6 years.
Antidepressants and Risk of Spontaneous Abortion
Although the last several decades of research have yielded important findings regarding the safety of antidepressants during pregnancy, some areas are still understudied. For example, there are no conclusive results concerning the risk of spontaneous abortions following antidepressant exposure during the first trimester. Several recent meta-analyses, including one from the Motherisk program (Hemels, 2005), have observed an increased risk of spontaneous abortion among women taking antidepressants.
Valproic Acid and the Risk of Major Malformations
Previous studies have indicated that infants exposed to valproic acid in pregnancy are at increased risk for a range of malformations, including neural tube defects. While these studies have shown an association between valproic acid and various malformations, they have been limited in their ability to quantify the risk of certain, less common malformations. To do this, large population-based case–control studies are more appropriate.