About 15% of women suffer from depression during pregnancy, and many reports have suggested that depression during pregnancy may have negative effects on the fetus.  A new study from researchers at the University of Michigan indicates a link between depression during pregnancy and infant sleep problems.
Significant numbers of reproductive-aged women experience premenstrual syndromes characterized by depressed mood, irritability, mood swings, anxiety or tension, sleep disruption, and other physical symptoms, including bloating and breast tenderness. Typically these symptoms emerge during the week preceding menstruation, improve with the onset of menses, and are not present during the week after menstruation.
Atypical antipsychotics are increasingly used to treat psychiatric disorders such as bipolar disorder or schizophrenia. In spite of the important role they play for many patients in treating serious psychiatric disorders, atypicals have been associated with negative side effects that may worsen a patient's cardiovascular health profile.  This includes a greater risk for weight gain, glucose dysregulation/diabetes, and dyslipidemia (elevated triglycerides/cholesterol).
Over the last several years, a number of studies have indicated that exposure to antidepressants near the time of delivery may be associated with poor neonatal outcomes. A recent prospective study from Dubnov-Raz and colleagues published in the journal Pediatrics found an association between QTc interval prolongation in neonates and antenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants. The QT interval is a measurement of the heart's electrical cycle from ventricular depolarization to the end of ventricular polarization. It is determined from an electrocardiogram (ECG) and is corrected for heart rate.Â
We invite your comments as we post more cases and clinical scenarios to our blog. Treatment decisions in the field of women's mental health are often not straightforward, and we would like to encourage discussion among clinicians on these issues. You are welcome to leave your name, but comments may also be submitted anonymously. Please keep in mind that all comments are reviewed by our staff prior to being posted on the blog; unfortunately we can not respond to any individual health inquiries on the blog or through our website.
As more research is conducted within the field of women's mental health, there are times when recommendations may change depending on the available data.  We will discuss a case here to illustrate this point.
Maguire and Mody's report, GABAA R Plasticity during Pregnancy: Relevance to Postpartum Depression, in the July 2008, Neuron, provides evidence that an abnormal Gamma-aminobutyric acid (GABAA) receptor subunit in pregnant mice may be a useful model for postpartum depression. The report describes how GABAA receptors, specifically, the delta-subunit-containing GABA receptor, are a preferred target for neurosteroids. They designed a study to identify functional changes in these receptors during pregnancy and postpartum and then looked at possible behavioral correlates in the mice.Â
Our Perinatal and Reproductive Psychiatry team often discusses clinical cases in Rounds, a confidential forum in which we can get advice and consultation from peers who also work in the area of Women's Mental Health. We discussed a patient's situation recently that highlighted the controversial area about how to prevent mood episodes in a woman planning for pregnancy.
The risk of depression after removal of both ovaries (also called bilateral oöphorectomy or surgical menopause) is a major factor for women to consider when they confront medical problems that require removal of the uterus (called a hysterectomy). Many women are advised to consider having their ovaries removed when they are having the uterus removed. Sometimes removal of the ovaries is required to fully treat the condition leading to surgery, but other times it is suggested as a precaution to reduce the risk of ovarian cancer. Removal of both ovaries in a premenopausal woman results in an abrupt withdrawal of estrogen, progesterone, and testosterone. Therefore removing both ovaries (rather than just one or neither ovary) may have significant effects on mood and well-being in women.
Most obstetricians are now familiar with the potential for what has become known as neonatal distress syndrome (or "adaptation" syndrome) following third trimester exposure to SSRIs. Some patients still worry about the possibility of their baby developing neonatal distress syndrome, especially if anything unusual happened during the post-delivery experience of an earlier pregnancy. Women may be concerned about whether and to what degree the medication they were on played a role in their infant's distress and whether to continue that medication during a subsequent pregnancy. The following case may help illustrate the decision-making dilemmas.
