Selective serotonin reuptake inhibitors (SSRIs) account for approximately 62% of all antidepressants prescribed in the United States. There have been several recent studies suggesting that SSRIs may lower bone mineral density in individuals over the age of 65. However, depression itself has been shown to decrease bone mineral density and has also been associated with an increased risk of hip fractures in older women.
The most recent issue of the New England Journal of Medicine includes the presentation of a case from the Center for Women's Mental Health of a woman with bipolar disorder who developed postpartum psychosis after the birth of her child. The case highlights some of the clinical challenges in treating patients with bipolar disorder during pregnancy and the postpartum period and reviews the current literature on postpartum psychosis.
St. John's wort (Hypericum perforatum) is an herbal preparation which has been shown, in some studies, to be effective for the treatment of mild to moderate depressive symptoms. St. John's wort is now one of the most commonly used herbal products in the United States and is widely used in Europe.
Depo-Provera (DMPA), also known as the birth control shot, is a highly effective form of contraception that lasts for 3 months, and thus requires only 4 injections per year. DMPA contains a long-lasting form of depot medroxyprogesterone acetate that works as a contraceptive agent by preventing the ovaries from releasing an egg each month. Potential side effects of DMPA include bone density loss, weight gain, and mood worsening. Although depression is listed in the packet insert as a side effect of the injection, available research addressing this side effect are limited and contradictory.
The link between maternal depression and anxiety during pregnancy and adverse neonatal outcome has been well-documented in the medical literature and reviewed on our website. A recent study published in the journal Early Human Development suggests that a mother's stress during pregnancy may also negatively affect her baby's sleep patterns.
Previous studies have suggested that prenatal stress may be associated with a spectrum of adverse pregnancy outcomes, including preterm birth and low birth weight (reviewed in Hobel et al, 2008). A recent study from Danish researchers has investigated the impact of psychological stress on risk for stillbirth.
Is the use of hormonal contraception safe for women older than 35 years?
If a woman does not breastfeed following delivery, prolactin levels decrease and fertility returns to normal, and pregnancy is possible. Even if a woman decides to breastfeed, she should still use some form of contraception, as prolactin levels vary depending on individual breastfeeding styles. Women may be fertile and become pregnant even before the resumption of their menstrual cycles.
Women receiving tamoxifen for the treatment or prevention of breast cancer should be aware of possible drug-drug interactions with specific antidepressant medications (e.g., SSRI). These antidepressants are used widely to treat depression and anxiety disorders. In addition, multiple studies have shown that these antidepressants are an effective non-hormonal treatment for hot flashes; over 25% of women who are experiencing hot flashes related to tamoxifen therapy are now prescribed antidepressants to manage their symptoms.
The U.S. Food and Drug Administration (FDA) has proposed major revisions to prescription drug labeling in order to provide more accurate and helpful information on the effects of medications used during pregnancy and breastfeeding. As it stands, the current system used by the FDA classifies the reproductive safety of medications using five risk categories (A, B, C, D and X) based on data derived from human and animal studies. While widely used to make decisions regarding the use of medications during pregnancy, many have criticized this system of classification, indicating that this type of drug labeling is often not helpful and, even worse, may be misleading.
