Antidepressant Treatment During Pregnancy: One Woman’s Experience (Part 1)
Part 1:Â Pre-Pregnancy Planning
Sleep Medications: What Information Do We Have on Reproductive Safety?
It is estimated that up to 95% of women experience some type of sleep disturbance during pregnancy. While for many women the insomnia is relatively benign and may respond to simple interventions, other women experience more severe insomnia which has a significant impact on their quality of life and ability to function. Various non-benzodiazepine hypnotic agents, specifically zalepion (Sonata), eszopiclone (Lunesta), and zolpidem (Ambien), are commonly used for the short-term treatment of insomnia; however, information regarding the reproductive safety of these sleep aids has been sparse.
Autism Spectrum Disorders and SSRIs
It is now estimated that autism spectrum disorders (ASD) affect about 1% to 2% of the population. Data derived from twin and sibling studies indicate that ASD is highly heritable. While genetic factors clearly play an important role, other studies point to an interplay between environmental and genetic factors in the etiology of this disorder. Over the years, various environmental exposures have been implicated, including vaccinations, mercury, and insecticides; however, it has been difficult to generate solid evidence linking specific environmental factors with increased risk for autism.
What is the Impact of Depression During Pregnancy?
In a recent study by Gerardin and colleagues, the authors note that more research has been done to demonstrate the consequences of postpartum depression than depression during pregnancy (also called antenatal or prenatal depression). Infants born to mothers with depression during pregnancy have been demonstrated to have lower scores on motor behavior and more crying and irritability. Few studies, however, have assessed the longer-term effects of antenatal depression.
![By Vera Kratochvil [Public domain], via Wikimedia Commons](https://womensmentalhealth.org/wp-content/uploads/2015/06/Mother_Kissing_Baby-320x202.jpg)
Serotonin Reuptake Inhibitors and Fertility (Part 2): What Can Basic Science Tell Us?
Serotonin (5-HT) is one of the neurotransmitters involved in mood regulation and has been implicated in the development of mood and anxiety disorders. Serotonin transporters (SERT) facilitate the transfer of serotonin into neurons; serotonin reuptake inhibitor (SSRI) antidepressants bind to these transporters and appear to exert their effect on mood by inhibiting the reuptake of serotonin and thus increasing the levels of this neurotransmitter at the synapse.
Serotonin Reuptake Inhibitors and Fertility (Part 1): A Clinical Perspective
We previously reported that paroxetine, a selective serotonin reuptake inhibitor (SSRI), may affect sperm motility and may thus have a negative impact on male fertility. Many women who are planning a pregnancy question whether SSRIs and other antidepressants may affect fertility; this is obviously a particularly important issue for those who are having difficulty conceiving.
Generalized Anxiety in Pregnancy
Few studies have focused on anxiety disorders in the perinatal period. While various studies have measured levels of anxiety or distress during pregnancy, most studies have relied upon self-report questionnaires to assess for anxiety. In contrast, few studies have used standardized diagnostic criteria to determine the prevalence of anxiety disorders in pregnant populations.  In a recent study, Buist and colleagues studied the prevalence and course of generalized anxiety disorder (GAD) in a prospectively ascertained population of pregnant women.
Clinical Case: Should SSRIs Be Tapered Prior To Delivery?
Ms. T is a 33 year old woman with a history of recurrent depression who is 32 weeks   pregnant with her first pregnancy. She has remained on her citalopram (Celexa) throughout pregnancy and has been well. Her gynecologist has encouraged her to enquire about coming off the Celexa prior to delivery in order to avoid symptoms of neonatal distress. What should she do?
Postpartum Depression and Poor Sleep Quality Occur Together
In a new mother, sleep is disrupted by repeated awakenings of the infant, but hormonal factors also seem to play a role. Immediately after childbirth, levels of the reproductive hormones, estrogen and progesterone, drop precipitously. It is believed that, because these hormones modulate neurotransmitter systems in the brain responsible for sleep quality, this dramatic hormonal shift may cause significant disruptions in sleep.
In Utero Exposure to Antipsychotics
May 2011, ObGyn News, Lee S. Cohen, MD