• Yearly Archives: 2012

    Dr. Lee Cohen: Using SSRIs in Pregnancy

    Over the last decade, attention in the medical literature has gathered logarithmically to focus on potentially efficacious treatments for perinatal depression. Studies of relevant databases, editorials, and various reviews have addressed the reproductive safety concerns of antidepressant treatments, particularly selective serotonin reuptake inhibitors (SSRIs) on one hand, and the impact of untreated maternal psychiatric illness on fetal and maternal well-being on the other.

    Brief Scales for Identifying Postpartum Depression and Anxiety

    While most agree that there is a need for improved detection of anxiety and mood disorders in pregnant and postpartum women, there remain questions regarding the best instruments to use for screening.  The Edinburgh Postnatal Depression Scale (a questionnaire consisting of 10 items) has long been used to screen women for postpartum depression (PPD); however, it is unclear how well these questions could be incorporated into larger surveillance programs, such as the CDC-sponsored Pregnancy Risk Assessment Monitoring System (PRAMS) which was designed to assess health behaviors and to screen for health problems, including depression and anxiety, in pregnant and postpartum women.

    Breastfeeding and Postpartum Depression: What’s the Connection?

    In our clinic, we often see women who come in for the treatment of depression and/or anxiety after the cessation of breastfeeding.  Many question if breastfeeding may protect against postpartum depression and if the cessation of breastfeeding is a trigger for postpartum depression and/or anxiety. However, the research examining the association between postpartum depression and breastfeeding has been somewhat difficult to interpret.

    SSRIs and Pregnancy: Putting the Risks and Benefits into Perspective

    Prozac hit the market in 1988, the first selective serotonin reuptake inhibitor (SSRI) antidepressant approved by the FDA for the treatment of depression.  Because it was safer and more tolerable than the antidepressants that preceded it, Prozac was soon the most commonly prescribed antidepressant in the United States.

    Duloxetine and Pregnancy: Preliminary Data

    Duloxetine (sold in the United Sates under the brand name of Cymbalta) is a serotonin-norepinephrine reuptake inhibitor (SNRI) effective for major depressive disorder and generalized anxiety disorder (GAD).  Although used fairly commonly in women of child-bearing age, information regarding its reproductive safety has been lacking.

    SSRIs and Cardiovascular Malformations: Another Look

    Over the last few years, we have reported on several studies which have suggested an increased risk of certain types of cardiovascular malformations among children exposed to selective serotonin reuptake inhibitors (SSRIs) during pregnancy.  The first reports suggested a link between cardiac septal defects and exposure to paroxetine; subsequent studies have also shown elevated risks with the other SSRIIs. 

    Exposure to Maternal Depression – Not Antidepressants – Predicts Worse Outcomes in Children

    While data accumulated over the last 30 years suggest that certain antidepressants may be used with relative safety during pregnancy, our knowledge regarding the risks of prenatal exposure to psychotropic medications is incomplete. Because neuronal migration and differentiation occur throughout pregnancy and into the early years of life, development of the central nervous system (CNS) remains particularly vulnerable throughout pregnancy.

    Is There a Link Between Vitamin D Deficiency and Antenatal Depression?

    Several studies have shown that vitamin D deficiency is associated with depression.  A recent study has assessed the relationship between vitamin D levels and risk for antenatal depression in a cohort of African-American women.  Vitamin D deficiency is more common among African-American women than in Caucasians.  The active form of vitamin D is produced as a byproduct of natural sun exposure.  Because women with darker skin have more melanin, which blocks the sun’s rays and affects the skin’s ability to produce the active form of vitamin D, they typically have lower vitamin D levels.  

    Hypnotherapy for Hot Flashes

    Peri- and post-menopausal women have various options for the management of hot flashes, including hormone replacement therapy, SSRIs, and gabapentin. It looks as if hypnosis may also be helpful.  In a recent study, researchers randomly assigned postmenopausal women to hypnotherapy or "structured attention," which was used as a control intervention.

    Facilitating Smoking Cessation in Pregnant Women: An Innovative Web-Based Training for Healthcare Professionals

    Women who smoke during pregnancy are at greater risk for certain complications, including placental previa, placental abruption, and premature rupture of the membranes, and premature delivery.  Furthermore, infants of mothers who smoke during pregnancy are more likely to be small for gestational age and are at greater risk of sudden infant death syndrome (SIDS).

    Go to Top