Following the publication of the Women's Health Initiative report in 2002, there was a dramatic drop in the use of hormone-replacement therapy (HRT) due to concerns about increased risk of heart disease, breast cancer, and stroke. Since that time, various non-hormonal alternatives have been utilized for the treatment of menopausal symptoms, including gabapentin and various serotonin reuptake inhibitors.
The PPHN story has been a bit of a rollercoaster. Just to review…
Selective serotonin reuptake inhibitor (SSRI) antidepressants may affect platelet aggregation and thus may increase the risk of bleeding. Several studies have sought to determine if exposure to SSRI antidepressants in late pregnancy is associated with an increased risk of postpartum hemorrhage.
Sexual side effects may occur in 40% to 70% of patients treated with serotonin reuptake inhibitors (SRIs) and is a common reason for poor compliance with treatment and eventual discontinuation. When sexual side effects occur, they tend to emerge early, are persistent, and rarely resolve spontaneously. A new study, reviewed in Medscape, suggests that exercise may help to reduce sexual side effects:
About 75% of women with regular menstrual cycles report unpleasant physical or psychological symptoms premenstrually. For the majority of women, these symptoms are mild and tolerable. However, some women have more severe and disabling symptoms, or premenstrual dysphoric disorder (PMDD). Several years ago, a large, multicenter trial of calcium supplementation found that calcium (600 mg twice a day) significantly reduced both the physical and emotional symptoms of PMS; however, it has not been clear whether calcium supplementation might be effective for more severe premenstrual symptoms or PMDD.
Serotonin reuptake inhibitors (SSRIs) are frequently combined with benzodiazepines for the management of anxiety disorders or major depression with comorbid anxiety. While we have data regarding the reproductive safety of both the SSRIs and benzodiazepines, we have much less information on outcomes in women taking SSRIs and benzodiazepines together. A previous study (Oberlander 2008) found that neither the use of an SSRI alone nor the use of a benzodiazepine alone increased the risk for congenital malformation; however, in this study, the combined use of the two drugs increased the risk of cardiovascular defect. A recent study reassesses the risk of major malformation in women taking SSRIs combined with benzodiazepines.
It is estimated that autism spectrum disorders (ASD) affect about 1% to 2% of children. Research carried out in twins and families indicate that ASD is highly heritable; however, it is generally believed that while genetic factors play an important role, there is an interplay between genetic and environmental factors in the etiology of this disorder. Various environmental exposures have been implicated, including vaccinations, mercury, air pollution, insecticides, and infection.
For the treatment of menopausal vasomotor symptoms (VMS), such as hot flashes and night sweats, selective serotonin reuptake inhibitors (SSRIs) are effective and well-tolerated. Positive effects are observed within 4 weeks of the initiation of treatment. However, we do not know how long treatment with an SSRI must be continued in order to maintain control of VMS. Nor do we know if VMS will recur after discontinuation of SSRI or if recurrent VMS may be less frequent or less bothersome after receiving SSRI treatment. A recent report from Dr. Hadine Joffe and colleagues at the Center for Women’s Mental Health assessed the recurrence of vasomotor symptoms in women treated with SSRIs.
A substantial proportion of women transitioning into menopause experience a new onset or recurrence of depressive symptoms. A new study from the Center for Women’s Mental Health indicates that duloxetine (Cymbalta) is effective for the treatment of depression and may also have a beneficial effect on vasomotor symptoms (hot flashes and night sweats).
Some studies have shown an association between in utero exposure to antidepressants and various pregnancy outcomes, including preterm delivery, low birth weight, and lower Apgar scores; however, these outcomes have also been observed in infants born to depressed mothers who are not taking medication. Thus, it has been difficult to determine if there is a causal relationship between antidepressant exposure and these negative pregnancy outcomes or if untreated maternal depression is itself responsible for these negative outcomes.
