Clinically significant anxiety symptoms are common during the postpartum period and frequently complicate the treatment of postpartum depression. While SSRIs are indicted for the treatment anxiety symptoms, especially when they co-occur with depression, many women may need to use a benzodiazepine for managing more severe symptoms of anxiety or insomnia.
While a handful of studies have assessed the risk for congenital malformations in infants exposed to antipsychotic agents, there is even less information regarding neonatal outcome in this population. In 1992, it was first reported that infants exposed to first-generation antipsychotic medications exhibited increased muscle tone, tremulousness, and poor motor functioning when assessed within a few days of delivery.
The North American Menopause Society (NAMS) has updated its 2010 recommendations regarding the use of postmenopausal hormone therapy (HT) based on evidence accumulated subsequent to the previous report. In the decade since the first publication of the results from the Women's Health Initiative, we have accumulated evidence to indicate that multiple factors influence the effects of hormone therapy, including the type of estrogen used, the way the hormones are given, and the age and recency of menopause of the woman taking the medication. These factors also determine the risks associated with hormone therapy.
At MGH, we have Rounds weekly. For 2-3 hours per week, we discuss clinical cases, papers that come out in our field, and discuss our research. We have a relatively large group of perinatal psychiatrists, all of whom do clinical work, as well as social workers and a psychologist who regularly join us.
A few years ago on our blog, we reviewed a paper suggesting that estrogen may be a beneficial treatment for women with schizophrenia. In this study patients with schizophrenia receiving estrogen showed significant improvement in their positive symptoms (hallucinations, delusions), but no difference in negative symptoms (reduction in range of emotional expression, poverty of speech, lack of motivation).1, 2 Additional studies have also found estrogen to be effective in improving positive and general symptoms in patients with schizophrenia. 3, 4
We want to thank those of you who have continued to subscribe to our blog and who have visited our website. Some have written noting particular interest in the research conducted at the MGH Center for Women's Mental Health, including the National Pregnancy Registry for Atypical Antipsychotics.
Topiramate (marketed as a Topamax), in addition to its use for the treatment of epilepsy, is now being prescribed to reproductive aged women for a broad spectrum of indications, including migraine headaches, weight control, and mood stabilization. Limited information is available on its reproductive safety; however, the preliminary data we do have raises some concerns regarding the use of topiramate in pregnancy.
Sources of vitamin D include sunlight (ultraviolet B, or UVB, rays), dietary intake, and supplements. Sunlight is the main source of human vitamin D. Vitamin D refers to different forms of a steroid hormone. Vitamin D3 (also called 1, 25-dihydroxycholecalciferol or calcitriol) is produced by the body when ultraviolet light (in the form of UV B) interacts with 7-dehydrocholesterol . Vitamin D3 is thought to be more potent than vitamin D2, with D3 and D2 being the two forms of vitamin D contained in supplements.
In 2006, Chambers and colleagues published an article in the New England Journal of Medicine linking SSRI use during late pregnancy to an increased risk of persistent pulmonary hypertension in the newborn (PPHN). Based on these findings, the “Usage in Pregnancy” section on the labels for SRRI antidepressants was updated to include the following warning: “Infants exposed to SSRIs in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN).”
Understanding posttraumatic stress disorder (PTSD) during pregnancy is important given that PTSD is relatively common and persistent in nature. PTSD will occur in approximately 10% of women in their lifetime, with one-third of episodes lasting more than five years. Given the relatively high prevalence of PTSD in young women and the chronic nature of the illness, many women may experience PTSD symptoms during pregnancy.
