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?
Women face difficult choices when deciding whether or not to continue psychiatric medications during pregnancy. This choice can be especially difficult for women taking newer medications which lack adequate reproductive safety data.
Postpartum depression is experienced by 10-15% of women and carries risks to both mother and baby. Untreated maternal depression is associated with negative outcomes for children including behavioral problems, cognitive or developmental delays and impaired attachment. Treatment of a mother’s depression can improve not only her own functioning and quality of life, but can improve her children’s symptoms as well (Pilowsky 2008). Given the importance of a mother’s mental health on her baby’s well-being, the American Academy of Pediatrics (AAP) released a recent report which recommends that pediatricians screen mothers for postpartum depression at baby’s one-, two-, and four-month visits (Earls 2010).
Many individuals have the experience of weight gain while receiving treatment with an antidepressant, and often wonder if selective serotonin reuptake inhibitors (SSRIs) are associated with weight gain. This is an excellent, complex, and clinically important question.
Given the potential health benefits of breastfeeding on both mother and baby, the U.S. Public Health Service for Healthy People 2010 set a goal to have 75% of mothers breastfeed in the early postpartum period and 50% of mothers to continue breastfeeding to 6 months by the year 2010 (US Dept of Health and Human Services 2000). Groups of women who are less likely to breastfeed have been targeted in this effort.
The New York Times published an interesting article on the high risk of depression among new parents. While we are now more aware of depression in mothers after delivery and making greater efforts to screen for postpartum depression, the article points out that both parents are at risk for depression and that the risk extends well beyond the immediate postpartum period.
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.
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.
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.
While postpartum depression (PPD) is typically considered to be a woman’s illness, a number of studies have suggested that, although men do not experience any of the dramatic physiologic or hormonal changes that go along with pregnancy, new fathers may also suffer from PPD. The most recent study was a meta-analysis published in the May 19th issue of the Journal of the American Medical Association.
