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Richards MC, Ferrario CA, Yan Y, McDonald NM. The Impact of Postpartum Depression on the Early Mother-Infant Relationship during the COVID-19 Pandemic: Perception versus Reality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:164. [PMID: 38397655 PMCID: PMC10888393 DOI: 10.3390/ijerph21020164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Postpartum depression (PPD) can interfere with the establishment of affective bonds between infant and mother, which is important for the cognitive, social-emotional, and physical development of the child. Rates of PPD have increased during the COVID-19 pandemic, likely due to the added stress and limited support available to new parents. The present study examined whether parenting-related stress, perceived bonding impairments, the quality of observed mother-infant interactions, and salivary oxytocin levels differ between depressed and non-depressed mothers, along with differential impacts of COVID-19 on depressed mothers. Participants included 70 mothers (45 depressed, 25 controls) with infants aged 2-6 months. All data were collected remotely to ease participant burden during the pandemic. Depression was associated with experiences of heightened parenting-related stress and bonding difficulties. These differences were not observed during mother-infant interactions or in salivary oxytocin levels. Differences in COVID-19-related experiences were minimal, though depressed mothers rated slightly higher stress associated with returning to work and financial impacts of the pandemic. Findings highlight the importance of early intervention for PPD to mitigate long-term effects on mothers, children, and families. Additionally, they underscore the need for early intervention to support the developing mother-infant dyad relationship during this crucial time.
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Weidner K, Bartmann C, Leinweber J. [Traumatic childbirth and trauma-sensitive obstetric support]. DER NERVENARZT 2023; 94:811-820. [PMID: 37351670 DOI: 10.1007/s00115-023-01510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/24/2023]
Abstract
Childbirth can be a very happy and empowering experience for women but also one of suffering and despair. Biographical traumatic experiences, especially sexual, physical and emotional violence, are risk factors for a traumatic childbirth experience with the danger of subsequent trauma sequelae and impaired mother-child bonding; however, obstetrically indicated interventions or poor communication in the delivery room can also primarily be experienced as traumatic.In recent years, policies affecting traumatic childbirth experience have been controversially and sometimes emotionally discussed. In the clinical obstetric routine there is often a fine line between medically necessary rapid interventions and emotionally supportive trauma-sensitive and preventive obstetric care. The following article addresses the causes and prevention strategies of traumatic childbirth experiences from obstetric, midwifery and psychotherapeutic perspectives.
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Affiliation(s)
- Kerstin Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Medizinische Fakultät, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Catharina Bartmann
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Deutschland
| | - Julia Leinweber
- Institut für Hebammenwissenschaft, Charité Universitätsmedizin Berlin, Virchowweg 23, 10117, Berlin, Deutschland
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Zheng L, Yang H, Dallmann A. Antidepressants and Antipsychotics in Human Pregnancy: Transfer Across the Placenta and Opportunities for Modeling Studies. J Clin Pharmacol 2022; 62 Suppl 1:S115-S128. [PMID: 36106784 DOI: 10.1002/jcph.2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022]
Abstract
There is limited information about the transfer of antidepressants and antipsychotics across the human placenta. The objective of the current review was to systematically screen the scientific literature using relevant keywords to collect quantitative data on placental transfer of these drugs in humans and to give an overview of current modeling approaches used in this context. The collected data encompassed clinically measured fetal:maternal (F:M) concentration ratios (ie, the ratio between drug concentrations measured in the umbilical cord and drug concentrations measured in the mother) and transfer data obtained from ex vivo cotyledon perfusion experiments. These data were found for 18 antidepressants and some of their pharmacologically active metabolites, and for 10 antipsychotics and the metabolites thereof. Based on the collected data, similar maternal and fetal exposure could be observed for only a few compounds (eg, norfluoxetine and desvenlafaxine), whereas for most drugs (eg, paroxetine, sertraline, and quetiapine), fetal exposure appeared to be on average lower than maternal exposure. Venlafaxine appeared to be an exception in that the data indicated equivalent or higher concentrations in the umbilical cord than in the mother. Physiologically based pharmacokinetic (PBPK) models were sporadically used to investigate maternal pharmacokinetics of antidepressants or antipsychotics (eg, for sertraline, aripiprazole, and olanzapine), although without explicitly addressing fetal drug exposure. It is recommended that PBPK modeling is applied more frequently to these drugs. Although no substitute for clinical studies, these tools can help to better understand pregnancy-induced pharmacokinetic changes and ultimately contribute to a more evidence-based pharmacotherapy of depression and psychosis in pregnant subjects.
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Affiliation(s)
- Liang Zheng
- Department of Clinical Pharmacology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Hongyi Yang
- Department of Clinical Pharmacy and Pharmacy Administration, West China School of Pharmacy, Sichuan University, Chengdu, China.,Chengdu Gencore Pharmaceutical Technology Co., Ltd, Chengdu, China
| | - André Dallmann
- Pharmacometrics/Modeling and Simulation, Research and Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
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Guo P, Cui N, Mao M, Zhang X, Chen D, Xu P, Wang X, Zhang W, Zheng Q, Zhang L, Xiang Z, Jin Y, Feng S. Cross-cultural adaptation and psychometric properties of the Chinese version of the postpartum depression literacy scale. Front Psychol 2022; 13:966770. [PMID: 36017447 PMCID: PMC9397490 DOI: 10.3389/fpsyg.2022.966770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aim The postpartum depression literacy (PoDLi) of perinatal women is closely related to the occurrence, recognition, and treatment of postpartum depression, therefore valid instruments for evaluating the level of PoDLi are of great significance for both research and clinical practice. This study aimed to cross-culturally adapt the postpartum depression literacy scale (PoDLiS) into Chinese and to test its psychometric properties among Chinese perinatal women. Materials and methods A cross-sectional study was conducted from April to May 2022 in a tertiary hospital in Hangzhou, Zhejiang Province, China. 619 out of the 650 perinatal women that were approached via a convenience sampling method completed the Chinese version of the PoDLiS (C-PoDLiS). Content validity [the content validity index of items (I-CVI) and scale-level content validity index (S-CVI)] was evaluated by an expert panel. Psychometric properties, including item analysis, structure validity (exploratory factor analysis, confirmatory factor analysis), convergent and discriminant validity, reliability (internal consistency, test-retest reliability), criterion validity (concurrent validity, predictive validity), and floor/ceiling effect were examined. Results The final version of C-PoDLiS is a six-factor structure consisting of 27 items, which explained 61.00% of the total variance. Adequate content validity (I-CVI = 0.833–1.00, S-CVI = 0.920) was ensured by the expert panel. The modified confirmatory factor analysis model revealed that the 6-factor model fitted the data well (χ2/df = 1.532, root mean square error of approximation = 0.042, goodness of fit = 0.900, incremental fit index = 0.949, comparative fit index = 0.948, Tucker–Lewis index = 0.940). The total Cronbach’s α was 0.862, the total McDonald’s ω was 0.869, and the test-retest reliability coefficient was 0.856. Results of convergent validity (average variance extracted = 0.486–0.722) and discriminant validity provided good or acceptable psychometric support. Significant correlations between scores of the C-PoDLiS and Mental health literacy scale (r = 0.155–0.581, p < 0.01) and Attitudes toward seeking professional psychological help short form scale (r = 0.361–0.432, p < 0.01) supported good concurrent and predictive validity, respectively. No floor/ceiling effect was found. Conclusion The C-PoDLiS was demonstrated to be a sound instrument with good reliability and validity for evaluating Chinese perinatal women’s PoDLi levels. Its use in the future can facilitate data aggregation and outcome comparisons across different studies on this topic.
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Affiliation(s)
- Pingping Guo
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Nianqi Cui
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Minna Mao
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuehui Zhang
- School of Nursing, Jining Medical University, Jining, China
| | - Dandan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Xu
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojuan Wang
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Zhang
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiong Zheng
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Le Zhang
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenzhen Xiang
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yin Jin
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Suwen Feng
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Suwen Feng,
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Passage of venlafaxine in human milk during 12 months of lactation: a case report Letter to the editor. Ther Drug Monit 2022; 44:707-708. [DOI: 10.1097/ftd.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/04/2022] [Indexed: 11/25/2022]
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Bandelow B, Werner AM, Kopp I, Rudolf S, Wiltink J, Beutel ME. The German Guidelines for the treatment of anxiety disorders: first revision. Eur Arch Psychiatry Clin Neurosci 2022; 272:571-582. [PMID: 34609587 PMCID: PMC8490968 DOI: 10.1007/s00406-021-01324-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/27/2021] [Indexed: 12/28/2022]
Abstract
Starting in 2019, the 2014 German Guidelines for Anxiety Disorders (Bandelow et al. Eur Arch Psychiatry Clin Neurosci 265:363-373, 2015) have been revised by a consensus group consisting of 35 experts representing the 29 leading German specialist societies and patient self-help organizations. While the first version of the guideline was based on 403 randomized controlled studies (RCTs), 92 additional RCTs have been included in this revision. According to the consensus committee, anxiety disorders should be treated with psychotherapy, pharmacological drugs, or their combination. Cognitive behavioral therapy (CBT) was regarded as the psychological treatment with the highest level of evidence. Psychodynamic therapy (PDT) was recommended when CBT was not effective or unavailable or when PDT was preferred by the patient informed about more effective alternatives. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are recommended as first-line drugs for anxiety disorders. Medications should be continued for 6-12 months after remission. When either medications or psychotherapy were not effective, treatment should be switched to the other approach or to their combination. For patients non-responsive to standard treatments, a number of alternative strategies have been suggested. An individual treatment plan should consider efficacy, side effects, costs and the preference of the patient. Changes in the revision include recommendations regarding virtual reality exposure therapy, Internet interventions and systemic therapy. The recommendations are not only applicable for Germany but may also be helpful for developing treatment plans in all other countries.
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Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, University of Göttingen, von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Antonia M. Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ina Kopp
- AWMF Institute for Medical Science Management, Mainz, Germany
| | - Sebastian Rudolf
- Helios Clinic for Psychiatry and Psychosomatic Medicine, Schleswig, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Sachdeva J, Nagle Yang S, Gopalan P, Worley LLM, Mittal L, Shirvani N, Spada M, Albertini E, Shenai N, Moore Simas TA, Byatt N. Ensuring Trauma Informed Care in the Obstetric Setting: A vital role for the Psychiatrist. J Acad Consult Liaison Psychiatry 2022; 63:485-496. [PMID: 35513261 DOI: 10.1016/j.jaclp.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Trauma is highly prevalent, and women are twice as likely as men to develop post-traumatic stress disorder following a traumatic exposure. Consequently, many women entering the perinatal period have trauma histories. In the perinatal period, a trauma history, can negatively impact treatment engagement and adversely affect the experience of pregnancy, postpartum and parenting. A trauma informed care approach can mitigate these effects. OBJECTIVES This review aims to summarize literature that can aid psychiatrists in 1) identifying signs and symptoms of trauma in perinatal women 2) integrating elements of trauma informed care into perinatal mental health care, and 3) offering interventions that can minimize adverse outcomes for perinatal women and their children. METHODS A PubMed search was conducted with keywords including trauma, pregnancy, perinatal, post-traumatic stress disorder (PTSD), postpartum PTSD, trauma informed care. RESULTS Perinatal care, given its somewhat invasive nature, has the potential to traumatize or cause re-traumatization. Trauma related disorders are common and can present or worsen in the perinatal period. Trauma can manifest in multiple forms in this population, including exacerbation of pre-existing PTSD, new onset acute stress disorder in the perinatal period or postpartum PTSD secondary to traumatic childbirth. Unaddressed trauma can adversely affect the experience of pregnancy, postpartum and parenting. Psychiatrists caring for women in the perinatal period, are in an ideal position to screen for trauma and offer appropriate intervention. A trauma informed approach to obstetric care can help clinical teams respond to the unique trauma-related challenges that can arise during obstetric care. Trauma informed care, with its emphasis on establishing a culture of safety, transparency, trustworthiness, collaboration, and mutuality can empower health care providers and systems with powerful tools to respond to trauma and its myriad effects in a strengths-based manner. By applying a trauma-informed lens, psychiatrists can help their obstetric colleagues provide patient-centered compassionate care and treatment. CONCLUSIONS Applying a trauma informed approach to evaluation and treatment of perinatal populations could decrease the toll trauma has on affected women and their children.
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Affiliation(s)
- Jyoti Sachdeva
- Associate Professor of Psychiatry and Obstetrics and Gynecology, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, 260 Stetson St. Suite 3200, Cincinnati, OH 45219.
| | - Sarah Nagle Yang
- Associate Professor of Psychiatry, University of Colorado School of Medicine
| | - Priya Gopalan
- Associate Professor of Psychiatry, University of Pittsburgh School of Medicine
| | - Linda L M Worley
- Professor of Psychiatry and Obstetrics and Gynecology, University of Arkansas for Medical Sciences
| | - Leena Mittal
- Chief, Division of Women's Mental Health , Brigham and Women's Hospital , Instructor of Psychiatry, Harvard Medical School
| | | | - Meredith Spada
- Assistant Professor of Psychiatry, University of Pittsburgh School of Medicine
| | | | - Neeta Shenai
- Assistant Professor of Psychiatry, University of Pittsburgh School of Medicine
| | - Tiffany A Moore Simas
- Professor of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School/UMass Memorial Health
| | - Nancy Byatt
- Professor with Tenure of Psychiatry, Obstetrics & Gynecology and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School/UMass Memorial Heal
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Richards MC. Building Bridges in Child and Adolescent Psychiatry Training: Providing Maternal-Infant Mental Health Care Through Creation of a Perinatal Collaborative Care Program. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:87-88. [PMID: 34845706 PMCID: PMC8628827 DOI: 10.1007/s40596-021-01567-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
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10
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Maalouli WM, Hilliard BS. Venlafaxine-induced encephalopathy in term newborn. SAGE Open Med Case Rep 2020; 8:2050313X20952981. [PMID: 32922797 PMCID: PMC7457629 DOI: 10.1177/2050313x20952981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 08/03/2020] [Indexed: 11/17/2022] Open
Abstract
The use of venlafaxine, a selective serotonin and norepinephrine reuptake inhibitor, for the management of depression in women of childbearing age has been on the rise, and there have been multiple case reports in the literature tying venlafaxine in-utero exposure to a form of neonatal encephalopathy presenting as neonatal abstinence syndrome. We present the case of a 5-day-old term infant whose mother was on venlafaxine throughout her pregnancy and presented with hypothermia, poor feeding, and decreased activity level. She subsequently had a negative sepsis workup and required nasogastric tube feedings for 2 weeks with spontaneous recovery and no clinical sequelae post-discharge. This case highlights the non-trivial potential risk of venlafaxine withdrawal in exposed newborns and the need for close observation. We propose a management framework for such situations in affected infants.
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Affiliation(s)
- Walid M Maalouli
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Brian S Hilliard
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
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McKee K, Admon LK, Winkelman TNA, Muzik M, Hall S, Dalton VK, Zivin K. Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006-2015. BMC WOMENS HEALTH 2020; 20:150. [PMID: 32703202 PMCID: PMC7376899 DOI: 10.1186/s12905-020-00996-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
Background National estimates of perinatal mood and anxiety disorders (PMAD) and serious mental illness (SMI) among delivering women over time, as well as associated outcomes and costs, are lacking. The prevalence of perinatal mood and anxiety disorders and serious mental illness from 2006 to 2015 were estimated as well as associated risk of adverse obstetric outcomes, including severe maternal morbidity and mortality (SMMM), and delivery costs. Methods The study was a serial, cross-sectional analysis of National Inpatient Sample data. The prevalence of PMAD and SMI was estimated among delivering women as well as obstetric outcomes, healthcare utilization, and delivery costs using adjusted weighted logistic with predictive margins and generalized linear regression models, respectively. Results The study included an estimated 39,025,974 delivery hospitalizations from 2006 to 2015 in the U.S. PMAD increased from 18.4 (95% CI 16.4–20.0) to 40.4 (95% CI 39.3–41.6) per 1000 deliveries. SMI also increased among delivering women over time, from 4.2 (95% CI 3.9–4.6) to 8.1 (95% CI 7.9–8.4) per 1000 deliveries. Medicaid covered 72% (95% CI 71.2–72.9) of deliveries complicated by SMI compared to 44% (95% CI 43.1–45.0) and 43.5% (95% CI 42.5–44.5) among PMAD and all other deliveries, respectively. Women with PMAD and SMI experienced higher incidence of SMMM, and increased hospital transfers, lengths of stay, and delivery-related costs compared to other deliveries (P < .001 for all). Conclusion Over the past decade, the prevalence of both PMAD and SMI among delivering women increased substantially across the United States, and affected women had more adverse obstetric outcomes and delivery-related costs compared to other deliveries.
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Affiliation(s)
- Kimberly McKee
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, USA.
| | - Lindsay K Admon
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Program on Women's Healthcare Effectiveness Research, University of Michigan, Ann Arbor, MI, USA
| | - Tyler N A Winkelman
- Division of General Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA.,Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Maria Muzik
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie Hall
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Vanessa K Dalton
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Program on Women's Healthcare Effectiveness Research, University of Michigan, Ann Arbor, MI, USA
| | - Kara Zivin
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Program on Women's Healthcare Effectiveness Research, University of Michigan, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Health Policy & Management, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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12
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Paulzen M, Schoretsanitis G, Gründer G, Franz C, Stingl JC, Augustin M. Pregnancy exposure to venlafaxine-Therapeutic drug monitoring in maternal blood, amniotic fluid and umbilical cord blood and obstetrical outcomes. J Affect Disord 2020; 266:578-584. [PMID: 32056930 DOI: 10.1016/j.jad.2020.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 01/19/2020] [Accepted: 02/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND For treatment with psychotropic drugs during pregnancy, extended therapeutic drug monitoring is recommended for individual therapy adjustment. We measured venlafaxine (VEN), O-desmethylvenlafaxine (ODV) and active moiety, AM (sum of VEN+ODV) concentrations in maternal serum, amniotic fluid and umbilical cord blood. METHODS Concentrations of VEN, ODVEN and AM were measured in nine mother-infant pairs at time of delivery; in five cases, amniotic fluid samples were available. Concentrations are reported as median values, first (Q1) and third (Q3) quartiles and ranges. Penetration ratio was calculated by dividing concentrations of VEN, ODVEN and AM in amniotic fluid and umbilical cord blood by maternal serum concentrations. RESULTS Median daily dosage of venlafaxine was 75 mg (range 37.5-225 mg). There were no significant correlations between daily dose, maternal serum, umbilical cord blood and amniotic fluid concentrations. Median penetration ratio into amniotic fluid was 2.5 (range 0.56-4.48). Median penetration ratio into fetal circulation was 1.05 (range 0.62-2.08). Median concentration of AM was 223.8 ng/mL, range 33.9-338.0 ng/mL (maternal serum), 789.0 ng/mL, range 309-1052.5 ng/mL (amniotic fluid) and 291.0 ng/mL, range 21.1-448.4 ng/mL (cord blood). DISCUSSION VEN, ODVEN and AM concentrations in maternal serum, amniotic fluid and umbilical cord blood indicate that the fetus might have been exposed to relatively high concentrations throughout pregnancy. High concentrations in amniotic fluid indicate an increased penetration into and/or accumulation within amniotic fluid and a decreased elimination out of amniotic fluid. Findings indicate that fetal in-utero exposition to venlafaxine is higher compared to other antidepressants.
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Affiliation(s)
- Michael Paulzen
- Alexianer Hospital Aachen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA-Translational Brain Medicine, Aachen, Germany
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA; Hofstra Northwell School of Medicine, Hempstead, New York, USA; The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Cordula Franz
- Department of Gynecology and Obstetrics, RWTH Aachen University, Aachen, Germany
| | - Julia C Stingl
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Marc Augustin
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA-Translational Brain Medicine, Aachen, Germany; Protestant University of Applied Sciences Bochum, Immanuel-Kant-Str. 18-20, 44803 Bochum, Germany.
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Obuchowicz E, Bielecka-Wajdman A, Zieliński M, Machnik G, Gołyszny M, Ludyga T. Imipramine and Venlafaxine Differentially Affect Primary Glial Cultures of Prenatally Stressed Rats. Front Pharmacol 2020; 10:1687. [PMID: 32076407 PMCID: PMC7006619 DOI: 10.3389/fphar.2019.01687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/24/2019] [Indexed: 12/25/2022] Open
Abstract
Here, we examine the effects of prenatal administration of two antidepressants—imipramine (IMI) and venlafaxine (VEN)—on morphology and activity of a primary glial culture. Microglia are targeted by antidepressants used for antenatal depression and are important regulators of central nervous system development. In this study, female Wistar rats were assigned to one of four groups: a control group that received water ad libitum (1), and groups that received additionally once daily either water (2), IMI (10 mg/kg) (3), or VEN (20 mg/kg) (4) by oral gavage from gestation day 7 to 22. Oral gavage administration induced prenatal stress. Cell cultures were obtained from the brains of 1-day-old pups. Prenatal stress caused a disturbance of sensorimotor function in pups. Prenatal stress also produced alterations in the glial cultures, specifically, an increased percentage of microglia in the mixed glial cultures and an increased percentage of dead cells. Moreover, increased levels of IL1-β, TNF-α, NO, and an increased expression of CX3CR1 mRNA were found in microglia. However, the ratio of Bax/Bcl2 mRNA was reduced. Prenatal stress increased the vulnerability of microglia to lipopolysaccharide (LPS). The mixed glial culture derived from pups exposed to IMI showed greater morphological changes and the highest percentage of microglia. Microglia were characterized by the largest increase in the production of pro-inflammatory cytokines and NO, and the greatest reduction in the expression of CX3CR1 mRNA. Exposure to IMI reduced the effects of LPS on IL-1β production and Bax/Bcl2 mRNA, and exacerbated the effects of LPS on CX3CR1 mRNA expression. Prenatal administration of VEN induced protective effects on microglia, as measured by all studied parameters. Taken together, our data suggest that, by disturbing microglia function, exposure to even mild forms of chronic prenatal stress may predispose individuals to psychiatric or neurodevelopmental disorders. These data also indicate that chronic mild stress sensitizes microglia to immune challenges, which may lead to enhanced neuronal damage in the embryonic brain. The observed detrimental effects of IMI on microglial activity under conditions of prenatal stress may help to explain the teratogenic effects of IMI reported in the literature.
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Affiliation(s)
- Ewa Obuchowicz
- Department of Pharmacology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Anna Bielecka-Wajdman
- Department of Pharmacology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Michał Zieliński
- Department of Pharmacology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Grzegorz Machnik
- Department of Internal Medicine and Clinical Pharmacology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Miłosz Gołyszny
- Department of Pharmacology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Tomasz Ludyga
- Department of Pharmacology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
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Bandelow B. Current and Novel Psychopharmacological Drugs for Anxiety Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:347-365. [PMID: 32002937 DOI: 10.1007/978-981-32-9705-0_19] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anxiety disorders, including panic disorder/agoraphobia (PDA), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and others, are the most prevalent mental disorders. In this paper, recommendations are given for the psychopharmacological treatment of these disorders which are based on comprehensive treatment guidelines, meta-analyses, and systematic reviews of available randomized controlled studies. Anxiety disorders can effectively be treated with psychotherapy, pharmacotherapy, or a combination of both. First-line drugs are the selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Benzodiazepines are not recommended for routine use due to their possible addiction potential. Other treatment options include the calcium modulator pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. Drug treatment can be combined with psychological treatments. Novel treatment strategies include medications that act on GABA, glutamate, and other neurotransmitter systems. After remission, medications should be continued for 6 to 12 months.
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Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany.
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15
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Erickson NL, Hancock GR, Oberlander TF, Brain U, Grunau RE, Gartstein MA. Prenatal SSRI antidepressant use and maternal internalizing symptoms during pregnancy and postpartum: Exploring effects on infant temperament trajectories for boys and girls. J Affect Disord 2019; 258:179-194. [PMID: 31437600 DOI: 10.1016/j.jad.2019.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The severity and treatment of depression/anxiety during pregnancy and postpartum has important implications for maternal and child well-being. Yet, little is known about prenatal SSRI use and early child socioemotional development. This study explores effects of prenatal SSRI exposure, and pre- and postnatal internalizing symptoms on trajectories of infant temperament, identifying potential differences for boys and girls. METHODS Using latent growth models, sex differences in infant temperament trajectories from 3- to 10-months were examined in relation to prenatal and postpartum internalizing symptoms and prenatal SSRI exposure among 185 mother-infant dyads. RESULTS For girls, prenatal internalizing symptoms were associated with greater initial distress to limitations, and lower duration of orienting, smiling/laughter, and soothability. Postnatal symptoms predicted slower decreases in girls' duration of orienting. SSRI exposure predicted decreases in distress to limitations and slower increases in smiling and laughter. For boys, maternal internalizing symptoms did not generally affect temperament profiles. SSRI exposure was associated with higher initial activity level and slower declines in distress to limitations. LIMITATIONS Only parent-report indicators of infant temperament across 10 months of infancy were provided. Maternal internalizing symptoms were measured at discrete times during pregnancy and postpartum, with no analysis of changes in symptoms across time. CONCLUSIONS Prenatal SSRI treatment, and both prenatal and postpartum internalizing symptoms, exert unique effects on infant temperament. Overall, the present study suggests sex-dependent fetal programming effects that should be further evaluated in future research. Results have implications for perinatal mental health treatment and perceived impacts on child socioemotional development.
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Affiliation(s)
- Nora L Erickson
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, United States.
| | - Gregory R Hancock
- Department of Measurement, Statistics & Evaluation, University of Maryland, College Park, MD, United States
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Ursula Brain
- Department of Pediatrics, University of British Columbia, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Ruth E Grunau
- Department of Pediatrics, University of British Columbia, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Maria A Gartstein
- Department of Psychology, Washington State University, Pullman, WA, United States
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Coffman KL, Ash P. Medicating During Pregnancy. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:380-381. [PMID: 32047385 PMCID: PMC7011295 DOI: 10.1176/appi.focus.20190034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Kelly L Coffman
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
| | - Peter Ash
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
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17
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Menke RA, Swanson L, Erickson NL, Reglan G, Thompson S, Bullard KH, Rosenblum K, Lopez JP, Muzik M. Childhood adversity and sleep are associated with symptom severity in perinatal women presenting for psychiatric care. Arch Womens Ment Health 2019; 22:457-465. [PMID: 30276477 PMCID: PMC6443486 DOI: 10.1007/s00737-018-0914-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/17/2018] [Indexed: 01/21/2023]
Abstract
This study leverages psychiatric intake data from treatment-seeking perinatal women aiming to explore the understudied associations between childhood adversity, sleep quality, and severity of perinatal mental illness in this population. The sample is 578 perinatal women presenting for initial evaluation to a university-based perinatal psychiatry clinic. At intake, we collected demographics, adverse childhood experiences (ACEs), sleep quality, and diagnosis and symptom severity of depression, anxiety, and posttraumatic stress disorder (PTSD). Clinician-rated diagnoses showed that 65% of women met criteria for major depression, 23% for generalized anxiety disorder and 4% for PTSD; almost 30% of women had childhood adversity and 98.2% reported poor perinatal sleep quality. Regression analyses revealed differential associations between ACEs and sleep quality and perinatal mood symptoms; ACEs were significantly associated with pregnancy and postpartum PTSD, whereas sleep quality was associated with perinatal depression and generalized anxiety. Screening for ACEs and sleep quality during perinatal intake has high clinical utility, as these two factors significantly contribute to symptom severity across peripartum.
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Affiliation(s)
- Rena A Menke
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Leslie Swanson
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Nora L Erickson
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Greta Reglan
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Stephanie Thompson
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | | | - Katherine Rosenblum
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
- Center for Human Growth & Development, University of Michigan, 300 N. Ingalls St, Ann Arbor, MI, 48104, USA
| | - Juan P Lopez
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA.
- Center for Human Growth & Development, University of Michigan, 300 N. Ingalls St, Ann Arbor, MI, 48104, USA.
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18
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Denton LK, Creeley CE, Stavola B, Hall K, Foltz BD. An analysis of online pregnancy message boards: Mother-to-mother advice on medication use. Women Birth 2018; 33:e48-e58. [PMID: 30545755 DOI: 10.1016/j.wombi.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022]
Abstract
PROBLEM AND BACKGROUND Psychotropic medication use is increasingly common among pregnant women. Many women solicit information from other mothers about the safety of these medications for use during pregnancy, yet little is known about the specific advice they receive. AIM The purpose of the current study was to examine the type of feedback women receive on a popular internet message board about psychotropic medication use during pregnancy. METHODS A modified Consensual Qualitative Research approach was used to analyze 1728 comments posted by Babycenter.com users about the safety of the use of six common psychotropic medications during pregnancy. Researchers analyzed the comments for overall themes and core ideas. FINDINGS Results found that comments were comprised of six themes: (1) Personal Anecdotes, (2) Suggesting Alternative Solutions, (3) Directives, (4) Judgement, (5) Social Support, (6) Skepticism & Mistrust, and (7) Risks vs. Benefits. While many comments conveyed emotional support, or encouraged women to seek professional advice, others contained inaccurate and/or contradictory information, or harsh criticism. CONCLUSION Given that the decision about the use of medication during pregnancy has implications for the health of the mother and fetus, it is important for care providers to be aware of what feedback women may receive from this source. Providers should address questions and concerns that women have about safety of these medications and recognize how the social context of the internet impacts the emotional health of pregnant women faced with these decisions.
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Affiliation(s)
- Lisa K Denton
- Department of Psychology, State University of New York at Fredonia, W357 Thompson Hall, Fredonia NY 14063, United States.
| | - Catherine E Creeley
- Department of Psychology, State University of New York at Fredonia, W357 Thompson Hall, Fredonia NY 14063, United States
| | - Brianna Stavola
- Department of Sociocultural and Justice Sciences, State University of New York at Fredonia, W363 Thompson Hall, Fredonia NY 14063, United States
| | - Kara Hall
- Department of Psychology, State University of New York at Fredonia, W357 Thompson Hall, Fredonia NY 14063, United States
| | - Brad D Foltz
- Department of Athletics, Georgetown University, 37th Street Northwest, Washington, DC 20007, United States
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19
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Lupattelli A, Twigg MJ, Zagorodnikova K, Moretti ME, Drozd M, Panchaud A, Rieutord A, Juraski RG, Odalovic M, Kennedy D, Rudolf G, Juch H, Nordeng H. Self-reported perinatal depressive symptoms and postnatal symptom severity after treatment with antidepressants in pregnancy: a cross-sectional study across 12 European countries using the Edinburgh Postnatal Depression Scale. Clin Epidemiol 2018; 10:655-669. [PMID: 29922092 PMCID: PMC5997125 DOI: 10.2147/clep.s156210] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE This study aimed at exploring the prevalence of self-reported antenatal and postnatal depressive symptoms by severity across multiple countries and the association between antidepressant treatment in pregnancy and postnatal symptom severity. MATERIALS AND METHODS This was a multinational web-based study conducted across 12 European countries (n=8069). Uniform data collection was ensured via an electronic questionnaire. Pregnant women at any gestational week and mothers of children with <1 year of age could participate. We used the Edinburgh Postnatal Depression Scale (EPDS) to measure the prevalence of antenatal and postnatal depressive symptoms according to severity, which were corrected by survey weight adjustment (descriptive analysis). Within mothers with a psychiatric disorder (n=173), we estimated the association between antidepressant treatment in pregnancy and postnatal depressive symptom severity, as standardized EPDS mean scores, via the inverse probability of treatment weight (association analysis). RESULTS In the descriptive analysis (n=8069), the period prevalence of moderate-to-very severe depressive symptoms was higher in the western and eastern regions relative to the northern region, both in the antenatal period (6.8%-7.5% vs 4.3%) and in the postnatal period (7.6% vs 4.7%). One in two mothers with psychiatric disorders used an antidepressant in pregnancy (86 of 173). In the association analysis, women medicated at any time during pregnancy (adjusted β=-0.34, 95% confidence interval [CI] =-0.66, -0.02) had a significant postnatal symptom severity reduction compared with the nonmedicated counterpart. This effect was larger (β=-0.74, 95% CI =-1.24, -0.24) when the analysis was restricted to mothers within 6 months after childbirth. CONCLUSION The prevalence of self-reported antenatal and postnatal depressive symptoms differs across European countries. Among women with psychiatric disorders, those who had been on treatment with antidepressants during pregnancy were less likely to report postnatal depressive symptoms, particularly within the 6-month period after childbirth, compared with the nonmedicated counterpart.
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Affiliation(s)
- Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy and PharmaTox Strategic Research Initiative, University of Oslo, Oslo, Norway
| | - Michael J Twigg
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Ksenia Zagorodnikova
- Northwest Medical Center for Drug Safety in Pregnancy and Lactation, Northwest State Medical University named after I. I. Mechnikov, St. Petersburg, Russia
| | - Myla E Moretti
- Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mariola Drozd
- Department of Applied Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Alice Panchaud
- School of Pharmaceutical Sciences, University of Geneva and Lausanne, Geneva, Switzerland
- Division of Clinical Pharmacology and Swiss Teratogen Information Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Andre Rieutord
- Pharmacy Service, Hospital Antoine-Béclère, GH HUPS, APHP, Clamart France and Européenne de Formation pour les Pharmaciens, Clamart, France
| | - Romana Gjergja Juraski
- Children’s Hospital Srebrnjak, Medical School of Osijek, Josip Juraj Strossmayer University, Osijek, Croatia
| | - Marina Odalovic
- Faculty of Pharmacy, University of Belgrade, Beograd, Serbia
| | - Debra Kennedy
- MotherSafe, Royal Hospital for Women, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
| | - Gorazd Rudolf
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Herbert Juch
- Cell Biology, Histology and Embryology, Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University Graz, Graz, Austria
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy and PharmaTox Strategic Research Initiative, University of Oslo, Oslo, Norway
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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20
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Dubovicky M, Belovicova K, Csatlosova K, Bogi E. Risks of using SSRI / SNRI antidepressants during pregnancy and lactation. Interdiscip Toxicol 2018; 10:30-34. [PMID: 30123033 PMCID: PMC6096863 DOI: 10.1515/intox-2017-0004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/17/2017] [Indexed: 01/12/2023] Open
Abstract
At present, affective disorders are among the most commonly diagnosed mental diseases. In pregnancy, they can occur as pre-delivery depression, recurrent depressive disorder or postnatal depression. The estimated prevalence of depressive disorders in pregnancy is approximately 9–16%, with some statistics reporting up to 20%. Approximately 2–3% of pregnant women take antidepressants during pregnancy, and the number of mothers treated increases by birth to 5–7%. Treatment of depression during pregnancy and breastfeeding is a controversial issue, as antidepressants can negatively affect the developing fetus. According to epidemiological studies, the effects of treated depression in pregnancy are related to premature birth, decreased body weight of the child, intrauterine growth retardation, neonatal adaptive syndrome, and persistent pulmonary hypertension. However, untreated depression can adversely affect maternal health and increase the risk of preeclampsia and eclampsia, as well as of subsequent postnatal depression, which can lead to disruption of the mother-child relationship. Based on the above mentioned facts, the basic question arises as to whether or not to treat depression during pregnancy and lactation.
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Affiliation(s)
- Michal Dubovicky
- Institute of Experimental Pharmacology and Toxicology, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Kristína Belovicova
- Institute of Experimental Pharmacology and Toxicology, Slovak Academy of Sciences, Bratislava, Slovak Republic.,Department of Pharmacology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic
| | - Kristína Csatlosova
- Institute of Experimental Pharmacology and Toxicology, Slovak Academy of Sciences, Bratislava, Slovak Republic.,Department of Pharmacology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic
| | - Eszter Bogi
- Institute of Experimental Pharmacology and Toxicology, Slovak Academy of Sciences, Bratislava, Slovak Republic
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21
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Abstract
Anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, social anxiety disorder, and others) are the most prevalent psychiatric disorders, and are associated with a high burden of illness. Anxiety disorders are often underrecognized and undertreated in primary care. Treatment is indicated when a patient shows marked distress or suffers from complications resulting from the disorder. The treatment recommendations given in this article are based on guidelines, meta-analyses, and systematic reviews of randomized controlled studies. Anxiety disorders should be treated with psychological therapy, pharmacotherapy, or a combination of both. Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence. First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other treatment options include pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. After remission, medications should be continued for 6 to 12 months. When developing a treatment plan, efficacy, adverse effects, interactions, costs, and the preference of the patient should be considered.
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Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center, Gottingen, Germany
| | - Sophie Michaelis
- Department of Psychiatry and Psychotherapy, University Medical Center, Gottingen, Germany
| | - Dirk Wedekind
- Department of Psychiatry and Psychotherapy, University Medical Center, Gottingen, Germany
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22
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Westin AA, Brekke M, Molden E, Skogvoll E, Spigset O. Selective serotonin reuptake inhibitors and venlafaxine in pregnancy: Changes in drug disposition. PLoS One 2017; 12:e0181082. [PMID: 28708853 PMCID: PMC5510868 DOI: 10.1371/journal.pone.0181082] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/26/2017] [Indexed: 01/24/2023] Open
Abstract
Background Pregnancy may cause changes in drug disposition. The clinical consequences may be profound and even counterintuitive; in some cases pregnant women may need more than twice their usual drug dose in order to maintain therapeutic drug levels. For antidepressants, evidence on drug disposition in pregnancy is scarce. The aim of this study was to determine the effects of pregnancy on serum levels of selective serotonin reuptake inhibitors (SSRIs) and venlafaxine in a large and naturalistic patient material, in order to provide tentative dose recommendations for pregnant women. Methods Using patient data from two routine therapeutic drug monitoring (TDM) services in Norway with linkage to the national birth registry, dose-adjusted serum drug concentrations of SSRIs and venlafaxine during pregnancy were compared to the women’s own baseline (non-pregnant) values, using a linear mixed model. Findings Overall, the TDM databases contained 196,726 serum concentration measurements from 54,393 women. After data linkage and drug selection (SSRIs or venlafaxine only), we identified 367 analyses obtained from a total of 290 pregnancies in 281 women, and 420 baseline observations from the same women. Serum concentrations in the third trimester were significantly lower than baseline for paroxetine (–51%; 95% confidence interval [CI], –66%, –30%; p<0.001), fluvoxamine (–56%; CI, –75%, –23%; p = 0.004) and citalopram (–24%; CI, –38%, –7%; p = 0,007), and higher than baseline for sertraline (+68%; CI, +37%, +106%; p<0.001). For escitalopram, fluoxetine and venlafaxine concentrations did not change significantly. Conclusions For paroxetine and fluvoxamine the pronounced decline in maternal drug serum concentrations in pregnancy may necessitate a dose increase of about 100% during the third trimester in order to maintain stable concentrations. For fluoxetine, venlafaxine, citalopram, escitalopram and sertraline, the present study indicates that dose adjustments are generally not necessary during pregnancy.
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Affiliation(s)
| | - Malin Brekke
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
- Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Eirik Skogvoll
- Department of Anaesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway
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23
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De Long NE, Hardy DB, Ma N, Holloway AC. Increased incidence of non-alcoholic fatty liver disease in male rat offspring exposed to fluoxetine during fetal and neonatal life involves the NLRP3 inflammasome and augmented de novo hepatic lipogenesis. J Appl Toxicol 2017; 37:1507-1516. [PMID: 28677866 DOI: 10.1002/jat.3502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/25/2017] [Indexed: 01/07/2023]
Abstract
Up to 10% of women take selective serotonin reuptake inhibitors (SSRI) during pregnancy. Children exposed to SSRIs in utero have an increased risk of being overweight suggesting that fetal exposure to SSRIs can cause permanent metabolic changes. We have previously shown in rats that fetal and neonatal exposure to the SSRI antidepressant fluoxetine results in metabolic perturbations including increased hepatic triglyceride content; a hallmark of non-alcoholic fatty liver disease (NAFLD). Therefore, the aim of this study was to identify the mechanism(s) underlying the fluoxetine-induced increase in intrahepatic triglyceride content. Female nulliparous Wistar rats were given vehicle or fluoxetine (10 mg/kg/day) orally for 2 weeks prior to mating until weaning. At 6 months of age, we assessed whether SSRI exposure altered components of the hepatic triglyceride biosynthesis pathway in the offspring and examined the molecular mechanisms underlying these changes. Male SSRI-exposed offspring had a significant increase in the steady-state mRNA levels of Elovl6 and Dgat1 and core components of the NLRP3 inflammasome (apoptosis-associated speck-like protein containing a caspase activation recruitment domain [ASC] and caspase-1). Augmented expression of Asc in the SSRI-exposed offspring coincided with increased histone acetylation in the proximal promoter region. Given that we have previously demonstrated that antenatal exposure to SSRIs can lead to fatty liver in the offspring, this raises concerns regarding the long-term metabolic sequelae of fetal SSRI exposure. Moreover, this study suggests that elevated hepatic triglyceride levels observed in the SSRI-exposed offspring may be due, in part, to activation of the NLRP3 inflammasome and augmentation of de novo lipogenesis.
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Affiliation(s)
- Nicole E De Long
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada, L8S 4K1
| | - Daniel B Hardy
- Department of Obstetrics and Gynecology, Physiology and Pharmacology, University of Western Ontario, London, Ontario, N6A 3K6
| | - Noelle Ma
- Department of Obstetrics and Gynecology, Physiology and Pharmacology, University of Western Ontario, London, Ontario, N6A 3K6
| | - Alison C Holloway
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada, L8S 4K1
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