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Trinh NTH, Nordeng HME, Bandoli G, Palmsten K, Eberhard-Gran M, Lupattelli A. Antidepressant Fill and Dose Trajectories in Pregnant Women with Depression and/or Anxiety: A Norwegian Registry Linkage Study. Clin Epidemiol 2022; 14:1439-1451. [PMID: 36506004 PMCID: PMC9733444 DOI: 10.2147/clep.s379370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/18/2022] [Indexed: 12/08/2022] Open
Abstract
Background Few studies investigated longitudinal antidepressant exposure during pregnancy and included dosage in the assessment. Methods We conducted a nationwide, registry-linkage study in Norway using data on antidepressant prescription fills in pregnancies lasting ≥32 weeks in women with a delivery between 2009 and 2018 who had a depression/anxiety diagnosis and antidepressant fills prior to pregnancy. Information on antidepressant exposure by week (measured by filled prescriptions) and prescribed average daily dose was used in longitudinal k-means trajectory modelling for a 108-week time window from six months prior to pregnancy to one year after delivery. Factors associated with trajectory group membership were examined using multinomial logistic regression models. Results We included 8,460 pregnancies in 8,092 women. Four antidepressant fill trajectories were identified based on filled antidepressant prescriptions: two distinct discontinuing patterns, one at around the start of pregnancy (30.4%) and one around the end of pregnancy (33.8%); one continuing pattern (20.6%); and one interrupting pattern (15.2%). Using average usual daily dose, we identified low dose discontinuing (60.3%), medium dose reducing (20.6%) and high dose continuing (15.2%) patterns. The multinomial logistic regressions showed that the fill trajectory group membership was strongly associated with: antidepressant type and dose prior to pregnancy and co-medication prior to pregnancy, maternal age, marital status, parity, previous pregnancy loss, and pregnancy planning. Conclusion Longitudinal trajectory modelling revealed distinct antidepressant fill and dosage patterns in the period around pregnancy. Knowledge about factors associated with utilization trajectories might be useful for health-care personnel counselling women about antidepressant use in pregnancy.
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Affiliation(s)
- Nhung T H Trinh
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway,Correspondence: Nhung TH Trinh, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Post box 1068 Blindern, Oslo, 0316, Norway, Email
| | - Hedvig M E Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | | | - Malin Eberhard-Gran
- Norwegian Research Centre for Women’s Health, Women’s and Children’s Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
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Holm DML, Wohlfahrt J, Rasmussen MLH, Corn G, Melbye M. A quantitative comparison of two measures of postpartum depression. BMC Psychiatry 2022; 22:202. [PMID: 35305585 PMCID: PMC8933929 DOI: 10.1186/s12888-022-03836-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Studies investigating the prevalence and risk factors for postpartum depression (PPD) have used different definitions. Some studies have used a high score on the Edinburgh Postnatal Depression Scale (EPDS) to define PPD, whereas others have used information on antidepressant medication use and/or diagnostic information on treatment for depression at a psychiatric hospital. We wanted to compare results using these two approaches to evaluate to what degree results can be compared. Moreover we wanted to evaluate, whether use of EPDS or PPAT (defined below) leads to identification of different risk factor profiles. METHODS We identified women who delivered a child between 1 January 2014 and 31 December 2016 in Copenhagen or in one of the municipalities that were part of the Danish Health Visitors' Child Health Database. The potential risk factors were demographic factors and pregnancy- and obstetrical events. Outcomes of interest were an EPDS score ≥ 13, use of antidepressants (ATC: N06A) and/or a diagnosis of depression (F32) within six months after birth. Use of antidepressants and/or diagnosis of depression will be referred to as postpartum antidepressant treatment (PPAT). Agreement between EPDS ≥ 13 and PPAT was evaluated by the kappa coefficient. Associations between risk factors and the two outcomes (EPDS ≥ 13 and PPAT) were estimated by risk ratios (RR) using log-linear binomial regression. Presence of a systematic difference between RRs based on EPDS ≥ 13 (RREPDS≥13) and PPAT (RRPPAT) was evaluated in a meta-regression approach weighted by inverse-variance and with logarithm of the RRs as outcome. RESULTS The estimated PPD prevalence using EPDS ≥ 13 was 3.2% and of PPAT 0.4%. The agreement between the two measures was small (Kappa = 0.08), but their risk factor profile was very similar with no systematic difference between them. CONCLUSIONS Using the two different methods of case identification produced different prevalence estimates, but a similar risk factor profile. The differences in estimated prevalence and low agreement suggest that the two measures identify different potential PPD cases and using only one of the methods in defining PPD would underestimate PPD prevalence. The similar risk factor profile suggests that the considered risk factors are involved in the general development of PPD.
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Affiliation(s)
- Ditte-Marie Leegaard Holm
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen, Denmark.
| | - Jan Wohlfahrt
- grid.6203.70000 0004 0417 4147Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Marie-Louise Hee Rasmussen
- grid.6203.70000 0004 0417 4147Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Giulia Corn
- grid.6203.70000 0004 0417 4147Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Mads Melbye
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark ,grid.168010.e0000000419368956Department of Genetics, Stanford University School of Medicine, Stanford, CA USA ,grid.418193.60000 0001 1541 4204Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway ,grid.5947.f0000 0001 1516 2393K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway
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Associations Between Maternal Depression, Antidepressant Use During Pregnancy, and Adverse Pregnancy Outcomes: An Individual Participant Data Meta-analysis. Obstet Gynecol 2021; 138:633-646. [PMID: 34623076 DOI: 10.1097/aog.0000000000004538] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the associations of depressive symptoms and antidepressant use during pregnancy with the risks of preterm birth, low birth weight, small for gestational age (SGA), and low Apgar scores. DATA SOURCES MEDLINE, EMBASE, ClinicalTrials.gov, and PsycINFO up to June 2016. METHODS OF STUDY SELECTION Data were sought from studies examining associations of depression, depressive symptoms, or use of antidepressants during pregnancy with gestational age, birth weight, SGA, or Apgar scores. Authors shared the raw data of their studies for incorporation into this individual participant data meta-analysis. TABULATION, INTEGRATION, AND RESULTS We performed one-stage random-effects meta-analyses to estimate odds ratios (ORs) with 95% CIs. The 215 eligible articles resulted in 402,375 women derived from 27 study databases. Increased risks were observed for preterm birth among women with a clinical diagnosis of depression during pregnancy irrespective of antidepressant use (OR 1.6, 95% CI 1.2-2.1) and among women with depression who did not use antidepressants (OR 2.2, 95% CI 1.7-3.0), as well as for low Apgar scores in the former (OR 1.5, 95% CI 1.3-1.7), but not the latter group. Selective serotonin reuptake inhibitor (SSRI) use was associated with preterm birth among women who used antidepressants with or without restriction to women with depressive symptoms or a diagnosis of depression (OR 1.6, 95% CI 1.0-2.5 and OR 1.9, 95% CI 1.2-2.8, respectively), as well as with low Apgar scores among women in the latter group (OR 1.7, 95% CI 1.1-2.8). CONCLUSION Depressive symptoms or a clinical diagnosis of depression during pregnancy are associated with preterm birth and low Apgar scores, even without exposure to antidepressants. However, SSRIs may be independently associated with preterm birth and low Apgar scores. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42016035711.
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A Systematic Review of the Efficacy of Repetitive Transcranial Magnetic Stimulation Treatment for Women with Postpartum Depression. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2030020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Transcranial Magnetic Stimulation (TMS) has a strong evidence base for the treatment of major depressive disorder (MDD), however, there is minimal research investigating the treatment of depression within the postpartum period. This systematic review aims to systematically examine the efficacy and safety of TMS when treating postpartum depression (PPD). Databases Ovid Medline, PsycINFO, EMBASE and PubMed were searched from inception to May 2021, to identify peer-reviewed papers assessing the administration of TMS for PPD treatment. Data were systematically extracted and evaluated regarding clinical psychiatric outcomes, social-relational outcomes, neuropsychological testing, and side effects. This systematic review included one randomised controlled trial, two open-label studies, two conference papers, and two case studies, providing data on 60 participants. TMS appears well tolerated, with no reported major adverse side effects. While the studies reported a general reduction in PPD symptoms, the poor quality of the evidence available indicates that TMS for PPD is unable to be currently recommended. However, the substantial evidence for TMS in the treatment of MDD and the differential response to antidepressant medication in PPD indicates that further research into TMS for PPD is warranted.
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Uguz F, Kirkas A, Aksoy ZK, Yunden S. Use of Psychotropic Medication During Lactation in Postpartum Psychiatric Patients: Results from an 8-Year Clinical Sample. Breastfeed Med 2020; 15:535-537. [PMID: 32522008 DOI: 10.1089/bfm.2020.0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: The aim of this study was to examine the lactation status and prevalence of use of psychotropic medications in perinatal psychiatric patients. Methods: Clinical data collated for a period of 8 years were retrospectively retrieved from patient registers. The sample included a total of 263 postpartum patients who were followed up for at least 4 weeks. Psychiatric diagnoses were ascertained by a structured clinical interview. Results: The most commonly administered psychotropic medications were paroxetine (43.3%), sertraline (31.9%), olanzapine (12.2%), and quetiapine (6.1%). Of the 242 patients who received psychotropic medication, 41 (16.9%) discontinued breastfeeding. The discontinuation in most cases was not due to psychiatrist's recommendation or adverse events due to medications. Conclusion: Paroxetine and sertraline are frequently used by postpartum psychiatric patients in our clinical sample. In addition, the results suggesting that most psychiatric patients included in this study can continue breastfeeding during pharmacotherapy should be confirmed by data derived from further clinical samples.
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Affiliation(s)
- Faruk Uguz
- Department of Psychiatry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
| | - Aysegul Kirkas
- Department of Psychiatry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
| | - Zakire Kubra Aksoy
- Department of Psychiatry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
| | - Sena Yunden
- Department of Psychiatry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
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Abstract
Pregnancy, a sensitive time when two bodies are changing and developing simultaneously, demands careful consideration in assessing and treating mental health conditions. Add to that the restrictions on researching such a vulnerable population, psychiatric nurses face a challenge in providing evidence-based care. The current article focuses on the epidemiology of postpartum depression and long-term consequences, neurobiology of postpartum depression that guides medication selection, and treatment options for supporting postpartum women and their families. [Journal of Psychosocial Nursing and Mental Health Services, 57(11), 9-14.].
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Kapra O, Rotem R, Gross R. The Association Between Prenatal Exposure to Antidepressants and Autism: Some Research and Public Health Aspects. Front Psychiatry 2020; 11:555740. [PMID: 33329095 PMCID: PMC7719777 DOI: 10.3389/fpsyt.2020.555740] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/08/2020] [Indexed: 01/22/2023] Open
Abstract
Use of antidepressants (ADs) in general, and in pregnant notwithstanding, has been increasing globally in recent decades. Associations with a wide range of adverse perinatal and childhood outcomes following prenatal ADs exposure have been observed in registry-based studies, with Autism Spectrum Disorders (ASD) frequently reported. Studies using animal models, sibling analyses, and negative control approaches, have linked dysfunctional serotonin metabolism with ASD, but did not convincingly tease apart the role of maternal mental health from that of ADs. As work to decipher the nature of the AD-ASD association continues, this review raises some public health concerns pertinent to a hypothetical conclusion that this association is causal, including the need to identify specific gestation periods with higher risk, the importance of precise assessment of the ASD potential prevention that might be attributed to AD discontinuation, and the estimation of risks associated with prenatal exposure to untreated depression.
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Affiliation(s)
- Ori Kapra
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel-Aviv, Israel
| | - Ran Rotem
- School of Public Health, Harvard University, Boston, MA, United States.,Morris Kahn Maccabi Health Data Science Institute, Tel-Aviv, Israel
| | - Raz Gross
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel-Aviv, Israel.,Sheba Medical Center, Ramat Gan, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Sun Y, Dreier JW, Liu X, Glejsted Ingstrup K, Mægbæk ML, Munk‐Olsen T, Christensen J. Trend of antidepressants before, during, and after pregnancy across two decades-A population-based study. Brain Behav 2019; 9:e01441. [PMID: 31613060 PMCID: PMC6851806 DOI: 10.1002/brb3.1441] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/14/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Factors that influence antidepressant (AD) prescription and use during pregnancy are multiple including, in particular, the balance between the potential risk of untreated depression and the potential risk of AD treatment. Surveillance of temporal trends of AD use might identify areas requiring further research. We studied the use of ADs before, during, and after pregnancy using national data across two decades in Denmark. METHODS We included 1,232,233 pregnancies leading to live birth in Denmark between 1 January 1997 and 31 December 2016. Information on redemption of AD prescriptions was obtained from the Danish National Prescription Register. RESULTS We identified 29,504 (2.4%) pregnancies having at least one AD prescription (96,232 AD prescriptions) during pregnancy. The majority redeemed more than one prescription (69.7%) often for a single kind of AD (83.5%), and in 94% of the AD-exposed pregnancies, the estimated duration of treatment was 1 month or longer. Prescription of ADs during pregnancy increased steadily from 0.4% in 1997 to 4.6% in 2011, but decreased thereafter to 3.1% in 2016. The proportion of pregnancies with ADs in 2011 was 6.05-fold higher than that in 1997. The temporal trends in AD prescription in the years before and after pregnancy were similar to the trend during pregnancy. The decreasing use of ADs during pregnancy after 2011 was mainly driven by a decrease in the use of selective serotonin reuptake inhibitors (SSRIs), especially citalopram, the main type of SSRIs used in Denmark. CONCLUSION Prescription of ADs during pregnancy in Denmark increased steadily from 1997 to 2011 but decreased sharply thereafter. More research is needed to show whether the same trend exists in other populations, like women of reproductive age, men of reproductive age, and old people, and other countries. We also need to find explanation for the decreasing trend in recent years and potential risk for untreated depression.
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Affiliation(s)
- Yuelian Sun
- Department of NeurologyAarhus University HospitalAarhusDenmark
- Department of Economics and Business EconomicsNational Centre for Register‐Based ResearchAarhus UniversityAarhusDenmark
| | - Julie Werenberg Dreier
- Department of Economics and Business EconomicsNational Centre for Register‐Based ResearchAarhus UniversityAarhusDenmark
| | - Xiaoqin Liu
- Department of Economics and Business EconomicsNational Centre for Register‐Based ResearchAarhus UniversityAarhusDenmark
| | - Katja Glejsted Ingstrup
- Department of Economics and Business EconomicsNational Centre for Register‐Based ResearchAarhus UniversityAarhusDenmark
| | - Merete Lund Mægbæk
- Department of Economics and Business EconomicsNational Centre for Register‐Based ResearchAarhus UniversityAarhusDenmark
| | - Trine Munk‐Olsen
- Department of Economics and Business EconomicsNational Centre for Register‐Based ResearchAarhus UniversityAarhusDenmark
| | - Jakob Christensen
- Department of NeurologyAarhus University HospitalAarhusDenmark
- Department of Economics and Business EconomicsNational Centre for Register‐Based ResearchAarhus UniversityAarhusDenmark
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9
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Ganho-Ávila A, Poleszczyk A, Mohamed MMA, Osório A. Efficacy of rTMS in decreasing postnatal depression symptoms: A systematic review. Psychiatry Res 2019; 279:315-322. [PMID: 31196691 DOI: 10.1016/j.psychres.2019.05.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Repetitive Transcranial Magnetic Stimulation (rTMS) has been suggested as an alternative treatment to postnatal depression (PPD). OBJECTIVES This systematic review aims to examine and summarise evidence on rTMS efficacy in treating depression during the postnatal period. METHODS We included randomized and non-randomized, single arm, and case report studies, with active rTMS and theta-burst stimulation, sham rTMS, pharmacotherapy or no treatment as comparators. Participants included women with PPD, who were administered rTMS after delivery and up to 12 months postpartum. The observed outcomes were response rate and acceptability. RESULTS rTMS shows promising results, with clinically significant decreases in Edinburgh Postnatal Depression Scale (EPDS) scores at week 4 and an overall low risk of dropout. LIMITATIONS The reduced number of reports, the lack of complete datasets and the serious/high risk of bias of the studies warrant cautious interpretations. CONCLUSIONS AND IMPLICATIONS Despite the promising results, existing evidence on rTMS efficacy is limited, and questions remain on what the most beneficial stimulation parameters should be. Future multicentre randomized clinical trials are needed to better ascertain the clinical efficacy of rTMS in the treatment of depression in the postpartum period.
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Affiliation(s)
- Ana Ganho-Ávila
- Faculty of Psychology and Educational Sciences, University of Coimbra, 3001-802 Coimbra, Portugal; Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Rua do Colégio Novo, 3001-802 Coimbra, Portugal.
| | - Anna Poleszczyk
- Department of Clinical Neuropshysiology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Mahmoud M A Mohamed
- Deutsches Forschungszentrum für Künstliche Intelligenz (DFKI GmbH), 10559 Berlin, Germany
| | - Ana Osório
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, 01302-907 São Paulo, Brazil
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Jiang J, Zheng Y, Chen Y, Zahra A, Long C, Yang L. Exposure to prenatal antidepressant alters medial prefrontal-striatal synchronization in mice. Brain Res 2019; 1717:27-34. [DOI: 10.1016/j.brainres.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/21/2019] [Accepted: 04/11/2019] [Indexed: 11/28/2022]
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Lonstein JS. The dynamic serotonin system of the maternal brain. Arch Womens Ment Health 2019; 22:237-243. [PMID: 30032323 PMCID: PMC7001094 DOI: 10.1007/s00737-018-0887-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022]
Abstract
Many pregnant and postpartum women worldwide suffer from high anxiety and/or depression, which can have detrimental effects on maternal and infant well-being. The first-line pharmacotherapies for prepartum and postpartum affective disorders continue to be the selective serotonin reuptake inhibitors (SSRIs), despite the lack of large well-controlled studies demonstrating their efficacy in reproducing women and the potential for fetal/neonatal exposure to the drugs. Prepartum or postpartum use of SSRIs or other drugs that modulate the brain's serotonin system is also troubling because very little is known about the typical, let alone the atypical, changes that occur in the female central serotonin system across reproduction. We do know from a handful of studies of women and female laboratory rodents that numerous aspects of the central serotonin system are naturally dynamic across reproduction and are also affected by pregnancy stress (a major predisposing factor for maternal psychopathology). Thus, it should not be assumed that the maternal central serotonin system being targeted by SSRIs is identical to non-parous females or males. More information about the normative and stress-derailed changes in the maternal central serotonin system is essential for understanding how serotonin is involved in the etiology of, and the best use of SSRIs for potentially treating, affective disorders in the pregnant and postpartum populations.
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Affiliation(s)
- Joseph S. Lonstein
- Department of Psychology & Neuroscience Program, Michigan State University, 108 Giltner Hall, East Lansing, MI 48824, USA
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12
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Laine MK, Masalin S, Rönö K, Kautiainen H, Gissler M, Pennanen P, Eriksson JG. Risk of preterm birth in primiparous women with exposure to antidepressant medication before pregnancy and/or during pregnancy - impact of body mass index. Ann Med 2019; 51:51-57. [PMID: 30299166 PMCID: PMC7857451 DOI: 10.1080/07853890.2018.1534265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Preterm birth is a major cause of infant mortality. It is unknown whether body mass index (BMI) influences the risk of preterm birth in women, who prenatally use antidepressants. MATERIALS AND METHODS The study cohort (N = 6920) consists of all primiparous European born women without previously diagnosed diabetes from the city of Vantaa, Finland, who delivered a singleton child between 2009 and 2015. Data on births, pre-pregnancy BMI and purchases of antidepressants from 12 months before conception until delivery were obtained from Finnish National Registers. RESULTS Of the primiparous women, 9.9% used antidepressants. The overall prevalence of preterm birth was 5.2%. In women with a pre-pregnancy BMI <18.5 kg/m2, the Odds Ratio (OR) for preterm birth among antidepressant users compared with those who were non-users was 1.91 (95% confidence intervals [CI] 0.40 to 9.15, adjusted for age, smoking, education, use of fertility treatments and number of previous pregnancies) while in women with a pre-pregnancy BMI ≥30 kg/m2, the OR was 0.53 (95% CI 0.21-1.36), respectively. DISCUSSION Primiparous women using antidepressants, who were underweight before conception should be closely monitored and provided tailored care in a maternity clinic to minimize the risk of preterm birth. Key messages In primiparous women, one in ten used antidepressant medications before pregnancy and/or during pregnancy. In primiparous women, the prevalence of preterm birth was 5%. Underweight primiparous women using antidepressants should be closely monitored and provided tailored care in a maternity clinic.
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Affiliation(s)
- Merja K Laine
- a Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,b Vantaa Health Centre , Vantaa , Finland
| | - Senja Masalin
- a Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,c Department of Gynecology and Obstetrics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Kristiina Rönö
- c Department of Gynecology and Obstetrics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Hannu Kautiainen
- a Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,d Primary Health Care Unit , Kuopio University Hospital , Kuopio , Finland.,e Folkhälsan Research Center , Helsinki , Finland
| | - Mika Gissler
- f National Institute for Health and Welfare , Helsinki , Finland.,g Karolinska Institute , Stockholm , Sweden
| | | | - Johan G Eriksson
- a Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,e Folkhälsan Research Center , Helsinki , Finland.,h Department of Chronic Disease Prevention , National Institute for Health and Welfare , Helsinki , Finland
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13
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Hagberg KW, Robijn AL, Jick S. Maternal depression and antidepressant use during pregnancy and the risk of autism spectrum disorder in offspring. Clin Epidemiol 2018; 10:1599-1612. [PMID: 30464639 PMCID: PMC6219268 DOI: 10.2147/clep.s180618] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Results of some studies suggest that prenatal antidepressant exposure increases the risk of autism spectrum disorder (ASD) in offspring, while other studies suggest that depression independently increases the risk of having a child with ASD. Thus, confounding by indication is a concern. Objective The aim of this study was to estimate the risk of ASD in offspring of women who were exposed to antidepressants and/or had depression during pregnancy compared to unexposed women. Materials and methods We conducted a cohort study with nested sibling case–control analysis. Using the UK Clinical Practice Research Datalink (CPRD), we identified mother– baby pairs where the mother had ≥12 months of history before the delivery date and the child had ≥3 years of follow-up. Exposures during pregnancy were classified as 1) depression treated with antidepressants, 2) untreated depression, 3) other indications for antidepressant use, and 4) 4:1 match of unexposed women with no history of depression or antidepressant use. We calculated the prevalence of ASD and relative risk (RR) with 95% CI. In the sibling analysis, we compared exposure among ASD cases to that of non-ASD siblings born to the same mother. We calculated ORs and 95% CIs for women with treated and untreated depression, compared to unexposed. Results We identified 2,154 offspring with ASD among 194,494 mother–baby pairs. Compared to unexposed, the RR of ASD was 1.72 (95% CI 1.54–1.93) for treated depression and 1.50 (95% CI 1.28–1.75) for untreated depression, while the RR was not elevated in women who received antidepressants for other indications (RR =0.73, 95% CI 0.41–1.29). Additional analyses to assess the effects of severity of depression suggest that the risk of ASD in offspring increases with increasing severity, not with the antidepressant treatment. The results of the sibling analysis were similar to the main analysis. Conclusion Women with depression during pregnancy have an increased risk of having a child with ASD, regardless of antidepressant use.
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Affiliation(s)
- Katrina Wilcox Hagberg
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA 02421, USA,
| | - Annelies L Robijn
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA 02421, USA,
| | - Susan Jick
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA 02421, USA,
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Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med 2018; 6:2050312118807624. [PMID: 30397472 PMCID: PMC6207970 DOI: 10.1177/2050312118807624] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
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Steinberg JR, Laursen TM, Adler NE, Gasse C, Agerbo E, Munk-Olsen T. Examining the Association of Antidepressant Prescriptions With First Abortion and First Childbirth. JAMA Psychiatry 2018; 75:828-834. [PMID: 29847626 PMCID: PMC6143090 DOI: 10.1001/jamapsychiatry.2018.0849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE The repercussions of abortion for mental health have been used to justify state policies that limit access to abortion in the United States. Much earlier research has relied on self-report of abortion or mental health conditions or on convenience samples. This study uses data that rely on neither. OBJECTIVE To examine whether first-trimester first abortion or first childbirth is associated with an increase in women's initiation of a first-time prescription for an antidepressant. DESIGN, SETTING, AND PARTICIPANTS This study linked data and identified a cohort of women from Danish population registries who were born in Denmark between January 1, 1980, and December 30, 1994. Overall, 396 397 women were included in this study; of these women, 30 834 had a first-trimester first abortion and 85 592 had a first childbirth. MAIN OUTCOMES AND MEASURE First-time antidepressant prescription redemptions were determined and used as indication of an episode of depression or anxiety, and incident rate ratios (IRRs) were calculated comparing women who had an abortion vs women who did not have an abortion and women who had a childbirth vs women who did not have a childbirth. RESULTS Of 396 397 women whose data were analyzed, 17 294 (4.4%) had a record of at least 1 first-trimester abortion and no children, 72 052 (18.2%) had at least 1 childbirth and no abortions, 13 540 (3.4%) had at least 1 abortion and 1 childbirth, and 293 511 (74.1%) had neither an abortion nor a childbirth. A total of 59 465 (15.0%) had a record of first antidepressant use. In the basic and fully adjusted models, relative to women who had not had an abortion, women who had a first abortion had a higher risk of first-time antidepressant use. However, the fully adjusted IRRs that compared women who had an abortion with women who did not have an abortion were not statistically different in the year before the abortion (IRR, 1.46; 95% CI, 1.38-1.54) and the year after the abortion (IRR, 1.54; 95% CI, 1.45-1.62) (P = .10) and decreased as time from the abortion increased (1-5 years: IRR, 1.24; 95% CI, 1.19-1.29; >5 years: IRR, 1.12; 95% CI, 1.05-1.18). The fully adjusted IRRs that compared women who gave birth with women who did not give birth were lower in the year before childbirth (IRR, 0.47; 95% CI, 0.43-0.50) compared with the year after childbirth (IRR, 0.93; 95% CI, 0.88-0.98) (P < .001) and increased as time from the childbirth increased (1-5 years: IRR, 1.52; 95% CI, 1.47-1.56; >5 years: IRR, 1.99; 95% CI, 1.91-2.09). Across all women in the sample, the strongest risk factors associated with antidepressant use in the fully adjusted model were having a previous psychiatric contact (IRR, 3.70; 95% CI, 3.62-3.78), having previously obtained an antianxiety medication (IRR, 3.03; 95% CI, 2.99-3.10), and having previously obtained antipsychotic medication (IRR, 1.88; 95% CI, 1.81-1.96). CONCLUSIONS AND RELEVANCE Women who have abortions are more likely to use antidepressants compared with women who do not have abortions. However, additional aforementioned findings from this study support the conclusion that increased use of antidepressants is not attributable to having had an abortion but to differences in risk factors for depression. Thus, policies based on the notion that abortion harms women's mental health may be misinformed.
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Affiliation(s)
| | - Thomas M. Laursen
- Centre for Integrated Register-Based Research (CIRRAU), National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
| | - Nancy E. Adler
- Department of Psychiatry, University of California, San Francisco
| | - Christiane Gasse
- Centre for Integrated Register-Based Research (CIRRAU), National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- Centre for Integrated Register-Based Research (CIRRAU), National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
| | - Trine Munk-Olsen
- Centre for Integrated Register-Based Research (CIRRAU), National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
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Memantine rescues prenatal citalopram exposure-induced striatal and social abnormalities in mice. Exp Neurol 2018; 307:145-154. [PMID: 29913137 DOI: 10.1016/j.expneurol.2018.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/02/2018] [Accepted: 06/04/2018] [Indexed: 01/21/2023]
Abstract
Prenatal exposure to citalopram (CTM), an antidepressant drug, has been associated with altered behavior, including autism-like symptoms in both human and rodent offspring. However, the neurological basis underlying these abnormal behaviors is not well understood. Here, we examined behavioral, morphological, and biochemical alterations in the male and female offspring of C57BL/6 mouse mothers that had been exposed to CTM during the last trimester of gestation. We observed abnormal behavior such as anxiety, altered locomotion and disordered social interactions in 2-5 months old offspring with prenatal CTM exposure. Using Golgi-Cox staining, we found that CTM caused significantly reduced dendritic length and number of dendritic branches in striatal neurons, as well as altered subunit levels of N-methyl-d-aspartate receptors (NMDARs) and calcium/calmodulin-dependent protein kinase II (CaMKII). Memantine, a selective NMDAR antagonist, improved prenatal CTM-induced abnormal protein levels and social interaction deficits. These results highlight potential mechanisms underlying the abnormal behavior observed in children who are prenatally exposed to CTM.
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Pregnancy and postpartum antidepressant use moderates the effects of sleep on depression. Arch Womens Ment Health 2017; 20:621-632. [PMID: 28488099 PMCID: PMC6940595 DOI: 10.1007/s00737-017-0726-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
This study examined the course of antidepressant use, sleep quality, and depression severity from pregnancy through 6-month postpartum in women with and without a depressive disorder during pregnancy. Women (N = 215) were interviewed during pregnancy, 1- and 6-month postpartum. Mixed linear models were used to examine the longitudinal course and inter-relationships for the time-varying variables of antidepressant use, subjective sleep quality, and depression severity. Pregnant women with a depressive disorder who did not use antidepressants had more variable depression severity over time with improvements in depression severity by 6-month postpartum. In contrast, the depression severity of their medicated counterparts remained stable and high throughout. Pregnant women without a depressive disorder had worse sleep quality when using antidepressants compared with when they were not. Antidepressant use significantly strengthened the magnitude of the effect of sleep quality on depression severity in women with a depressive disorder during pregnancy. When prenatally depressed women use antidepressants, their sleep disturbance is more highly linked to depression severity than when they do not. Furthermore, antidepressants are not adequately treating the sleep disturbance of these women or their remitted counterparts, leaving both groups vulnerable to significant negative mental and physical health outcomes.
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Rasmussen MLH, Strøm M, Wohlfahrt J, Videbech P, Melbye M. Risk, treatment duration, and recurrence risk of postpartum affective disorder in women with no prior psychiatric history: A population-based cohort study. PLoS Med 2017; 14:e1002392. [PMID: 28949960 PMCID: PMC5614423 DOI: 10.1371/journal.pmed.1002392] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 08/18/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Some 5%-15% of all women experience postpartum depression (PPD), which for many is their first psychiatric disorder. The purpose of this study was to estimate the incidence of postpartum affective disorder (AD), duration of treatment, and rate of subsequent postpartum AD and other affective episodes in a nationwide cohort of women with no prior psychiatric history. METHODS AND FINDINGS Linking information from several Danish national registers, we constructed a cohort of 457,317 primiparous mothers with first birth (and subsequent births) from 1 January 1996 to 31 December 2013 (a total of 789,068 births) and no prior psychiatric hospital contacts and/or use of antidepressants. These women were followed from 1 January 1996 to 31 December 2014. Postpartum AD was defined as use of antidepressants and/or hospital contact for PPD within 6 months after childbirth. The main outcome measures were risk of postpartum AD, duration of treatment, and recurrence risk. We observed 4,550 (0.6%) postpartum episodes of AD. The analyses of treatment duration showed that 1 year after the initiation of treatment for their first episode, 27.9% of women were still in treatment; after 4 years, 5.4%. The recurrence risk of postpartum AD for women with a PPD hospital contact after first birth was 55.4 per 100 person-years; for women with postpartum antidepressant medication after first birth, it was 35.0 per 100 person-years. The rate of postpartum AD after second birth for women with no history of postpartum AD was 1.2 per 100 person-years. After adjusting for year of birth and mother's age, women with PPD hospital contact after first birth had a 46.4 times higher rate (95% CI 31.5-68.4) and women with postpartum antidepressant medication after their first birth had a 26.9 times higher rate (95% CI 21.9-33.2) of a recurrent postpartum episode after their second birth compared to women with no postpartum AD history. Limitations include the use of registry data to identify cases and limited confounder control. CONCLUSIONS In this study, an episode of postpartum AD was observed for 0.6% of childbirths among women with no prior psychiatric history. The observed episodes were characterized by a relatively short treatment duration, yet the women had a notably high rate of later AD and recurrent episodes of postpartum AD. The recurrence risk of postpartum AD was markedly higher among women with PPD hospital contact after first birth compared to women with postpartum antidepressant medication after first birth. Our results underline the necessity of measures targeted at specific vulnerable groups, such as women who experience PPD as a first psychiatric episode.
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Affiliation(s)
| | - Marin Strøm
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jan Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Glostrup, Denmark
| | - Mads Melbye
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
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Vu H, Shaya FT. Predicting Factors of Depression, Antidepressant Use and Positive Response to Antidepressants in Perinatal and Postpartum Women. Clin Pract Epidemiol Ment Health 2017; 13:49-60. [PMID: 28761500 PMCID: PMC5510557 DOI: 10.2174/1745017901713010049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/30/2017] [Accepted: 05/15/2017] [Indexed: 11/22/2022]
Abstract
Background: In the United States, there is a disparity in knowledge of nationwide depression prevalence, the antidepressant use and the antidepressant responses during perinatal/postpartum periods. Objective: This study investigated the predicting factors of depression, antidepressant use and positive antidepressant response during the perinatal/postpartum periods. Method: The 2007-2012 National Health and Nutrition Examination Surveys (NHANES) were combined to identify adult pregnant women, those within the 18-month postpartum period (n=492) and their depression statuses via demographics, health care accessibility, antidepressant use and illicit drug use information. The characteristics of different study groups were compared (depression versus no-depression groups, antidepressant users versus non-antidepressant users, and antidepressant responders versus antidepressant non-responders). Multivariable logistic regression analysis was used to predict factors of perinatal depression (PND)/ postpartum depression (PPD), antidepressant use and antidepressant positive response in PND/PPD. Results: PND/PPD individuals had higher rates of mental health visits. No predicting factor for developing PND/PPD was shown. Antidepressant users were significantly older with insurance and recent health checkups/ mental visits. Being below the poverty level and having some health care accessibility are predictors for being on antidepressants. Recent non-illicit drug use is a predictor for PND/PPD symptom improvement while on antidepressants. Conclusion: The group of those with social-economic disadvantages was more likely to be on antidepressants for PND/PPD. Illicit drug users were less likely to show improvement with antidepressants. The safety and efficacy of antidepressant use during this period is controversial. More studies need to focus on the barriers involving antidepressant treatments, the safety and outcomes of antidepressants for PND/PPD management.
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Affiliation(s)
- Huyen Vu
- University of Maryland School of Pharmacy, Department of Pharmacy Practice and Science, Baltimore, MD, USA
| | - Fadia T Shaya
- University of Maryland School of Pharmacy, Department of Pharmaceutical Health Services Research Baltimore, MD, USA
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Andalib S, Emamhadi MR, Yousefzadeh-Chabok S, Shakouri SK, Høilund-Carlsen PF, Vafaee MS, Michel TM. Maternal SSRI exposure increases the risk of autistic offspring: A meta-analysis and systematic review. Eur Psychiatry 2017; 45:161-166. [PMID: 28917161 DOI: 10.1016/j.eurpsy.2017.06.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/01/2017] [Accepted: 06/04/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are the most common antidepressants used to preclude maternal pregnancy depression. There is a growing body of literature assessing the association of prenatal exposure to SSRIs with autism spectrum disorder (ASD). The present systematic review and meta-analysis reviewed the medical literature and pooled the results of the association of prenatal exposure to SSRIs with ASD. METHODS Published investigations in English by June 2016 with keywords of selective serotonin reuptake inhibitors, SSRI, autism spectrum disorder, ASD, pregnancy, childhood, children, neurodevelopment were identified using databases PubMed and PMC, MEDLINE, EMBASE, SCOPUS, and Google Scholar. Cochran's Q statistic-value (Q), degree of freedom (df), and I2 indices (variation in odds ratio [OR] attributable to heterogeneity) were calculated to analyze the risk of heterogeneity of the within- and between-study variability. Pooled odds ratio (OR) and 95% confidence interval (CI) were reported by a Mantel-Haenszel test. RESULTS There was a non-significant heterogeneity for the included studies ([Q=3.61, df=6, P=0.730], I2=0%). The pooled results showed a significant association between prenatal SSRI exposure and ASD (OR=1.82, 95% CI=1.59-2.10, Z=8.49, P=0.00). CONCLUSION The evidence from the present study suggests that prenatal exposure to SSRIs is associated with a higher risk of ASD.
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Affiliation(s)
- S Andalib
- Neuroscience Research Center, Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - M R Emamhadi
- Brachial Plexus and Peripheral Nerve Injury Center, Guilan University of Medical Sciences, Rasht, Iran
| | - S Yousefzadeh-Chabok
- Neuroscience Research Center, Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - S K Shakouri
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - P F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - M S Vafaee
- Department of Nuclear Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark; Department of Psychiatry, Psychiatry Region of Southern, Odense, Denmark; Research Unit of Psychiatry, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Applied Neuroscience, BRIDGE, Odense University Hospital, University of Southern Denmark, Psychiatry in the Region of Southern Denmark, Odense, Denmark; Neurosciences Research Center, Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - T M Michel
- Department of Psychiatry, Psychiatry Region of Southern, Odense, Denmark; Research Unit of Psychiatry, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Applied Neuroscience, BRIDGE, Odense University Hospital, University of Southern Denmark, Psychiatry in the Region of Southern Denmark, Odense, Denmark; Neurosciences Research Center, Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Shankar R, Badker R, Brain U, Oberlander TF, Misri S. Predictors of Recovery from Depression and Anxiety in Women: A Longitudinal Study from Childbirth to 6 Years. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:318-326. [PMID: 28525732 PMCID: PMC5459226 DOI: 10.1177/0706743716677725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study prospectively examined maternal biopsychosocial predictors of recovery from comorbid depression and anxiety from 25 weeks' gestation to 6 years postbirth. Specifically, the study investigated the influence of 1) maternal factors and 2) the child's behaviours and physical health on the course of the mother's depressed mood and anxiety. METHODS Eighty-six women diagnosed with antenatal depression/anxiety were recruited through the Reproductive Mental Health Program and family practices in Vancouver. Based on the trajectory and status of their symptom remission, participants were categorised into 3 groups: full recovery, partial recovery, and no recovery. The following measures were completed over 6 years: Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) at baseline; Parental Stress Index (PSI) added at 6 months postpartum; Beck Anxiety Inventory (BAI), Beck Depression Inventory II (BDI-II), and Child Behavior Checklist (CBCL) at 3 years postbirth; and HAM-A, HAM-D, MacArthur Health and Behavior Questionnaire (HBQ-P), and PSI at 6 years postbirth. RESULTS Factors that predicted full recovery from depression included the absence of maternal health concerns, low total parental stress, and few child behavioural issues, whereas low levels of spousal stress were a significant factor in achieving full recovery from anxiety. CONCLUSION A variety of maternal and child-related factors govern full recovery or sustained remission of depression/anxiety in the postpartum up to 6 years postbirth. Early awareness of these predictors could lead to timely interventions, ensuring long-term maternal-child well-being.
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Affiliation(s)
- Radhika Shankar
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Rinette Badker
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Ursula Brain
- Child and Family Research Institute, Vancouver, British Columbia
| | | | - Shaila Misri
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
- Shaila Misri, MD, FRCPC, Reproductive Mental Health Program, BC Women’s Hospital, Mental Health Building, P1-228, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada.
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Di Florio A, Putnam K, Altemus M, Apter G, Bergink V, Bilszta J, Brock R, Buist A, Deligiannidis KM, Devouche E, Epperson CN, Guille C, Kim D, Lichtenstein P, Magnusson PKE, Martinez P, Munk-Olsen T, Newport J, Payne J, Penninx BW, O’Hara M, Robertson-Blackmore E, Roza SJ, Sharkey KM, Stuart S, Tiemeier H, Viktorin A, Schmidt PJ, Sullivan PF, Stowe ZN, Wisner KL, Jones I, Rubinow DR, Meltzer-Brody S. The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale. Psychol Med 2017; 47:787-799. [PMID: 27866476 PMCID: PMC5369767 DOI: 10.1017/s0033291716002087] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset. METHOD Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA. RESULTS Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) 0.01), but not between European countries (∆*CFI < 0.01). CONCLUSIONS Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.
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Affiliation(s)
- A. Di Florio
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University School of Medicine, Cardiff, UK
| | - K. Putnam
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. Altemus
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - G. Apter
- Erasme Hospital, Paris Diderot University, Paris, France
| | - V. Bergink
- Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
- Department of Economics and Business, National Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - J. Bilszta
- Women’s Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - R. Brock
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | - A. Buist
- Women’s Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - K. M. Deligiannidis
- Departments of Psychiatry and Obstetrics and Gynecology, Hofstra Northwell School of Medicine, Glen Oaks, NY, USA
| | - E. Devouche
- Erasme Hospital, Paris Descartes University, Paris, France
| | - C. N. Epperson
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - C. Guille
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - D. Kim
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - P. Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - P. K. E. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - P. Martinez
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Health and Human Services, Bethesda, MD, USA
| | - T. Munk-Olsen
- Department of Economics and Business, National Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - J. Newport
- Department of Psychiatry, University of Miami, Miami, FL, USA
| | - J. Payne
- Department of Psychiatry, The Johns Hopkins University, Baltimore, MD, USA
| | - B. W. Penninx
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - M. O’Hara
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | | | - S. J. Roza
- Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - K. M. Sharkey
- Department of Psychiatry, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - S. Stuart
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | - H. Tiemeier
- Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - A. Viktorin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - P. J. Schmidt
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Health and Human Services, Bethesda, MD, USA
| | - P. F. Sullivan
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Z. N. Stowe
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K. L. Wisner
- Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - I. Jones
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University School of Medicine, Cardiff, UK
| | - D. R. Rubinow
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S. Meltzer-Brody
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Broeks SC, Thisted Horsdal H, Glejsted Ingstrup K, Gasse C. Psychopharmacological drug utilization patterns in pregnant women with bipolar disorder - A nationwide register-based study. J Affect Disord 2017; 210:158-165. [PMID: 28040641 DOI: 10.1016/j.jad.2016.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/30/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bipolar disorder is often associated with a lifetime indication for treatment with psychotropic drugs, thus pregnant women face the dilemma whether to continue treatment or not. This study describes the psychopharmacological drug utilization patterns among women with bipolar disorder from 12 months preconception to 12 months postpartum. METHODS We conducted a register-based cohort study among all Danish women aged 15-55 with a diagnosis of bipolar disorder, who gave birth to their first and singleton child between January 1997 and December 2012. Psychotropic drug use was determined by prescriptions obtained from the Danish National Prescription Registry. RESULTS We identified 336 women. The proportion of women redeeming prescriptions for any psychotropic drug decreased during pregnancy, from 54.8% in the 3 months preconception to 36.6% in the third trimester (p<0.001). Lithium dosing increased significantly during pregnancy. A total of 35 (41.2%) of the women on psychotropic monotherapy and 37 (50.0%) of the women on psychotropic polypharmacy used an antidepressant without concomitant use of a mood-stabilizer at some time during pregnancy. LIMITATIONS Only redemption of prescriptions was assessable, thus we were not able to assess compliance and discontinuation of treatment before the end of the treatment duration. There was no information on drug use during hospitalizations. CONCLUSIONS We found a decrease in the proportion of women redeeming prescriptions during pregnancy. There was a high prevalence of antidepressant use without a mood-stabilizer, potentially putting women at risk for a switch to mania - although this is still debated. This calls for further investigation.
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Affiliation(s)
- S C Broeks
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - H Thisted Horsdal
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - K Glejsted Ingstrup
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - C Gasse
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
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Antenatal exposure to antidepressants is associated with altered brain development in very preterm-born neonates. Neuroscience 2017; 342:252-262. [DOI: 10.1016/j.neuroscience.2016.11.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 11/21/2022]
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Munk-Olsen T, Maegbaek ML, Johannsen BM, Liu X, Howard LM, di Florio A, Bergink V, Meltzer-Brody S. Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence. Transl Psychiatry 2016; 6:e919. [PMID: 27754485 PMCID: PMC5315550 DOI: 10.1038/tp.2016.190] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/15/2016] [Accepted: 08/17/2016] [Indexed: 11/20/2022] Open
Abstract
Perinatal psychiatric episodes comprise various disorders and symptom severity, which are diagnosed and treated in multiple treatment settings. To date, no studies have quantified the incidence and prevalence of perinatal psychiatric episodes treated in primary and secondary care, which we aimed to do in the present study. We designed a descriptive prospective study and included information from Danish population registers to study first-time ever and recurrent psychiatric episodes during the perinatal period, including treatment at psychiatric facilities and general practitioners (GPs). This was done for all women who had records of one or more singleton births from 1998 until 2012. In total, we had information on 822 439 children born to 491 242 unique mothers. Results showed first-time psychiatric episodes treated at inpatient facilities were rare during pregnancy, but increased significantly shortly following childbirth (0.02 vs 0.25 per 1000 births). In comparison, first-time psychiatric episodes treated at outpatient facilities were more common, and showed little variation across pregnancy and postpartum. For every single birth resulting in postpartum episodes treated at inpatient psychiatric facilities, 2.5 births were followed by an episode treated at outpatient psychiatric facility and 12 births by GP-provided pharmacological treatment. We interpret our results the following way: treated severe and moderate psychiatric disorders have different risk patterns in relation to pregnancy and childbirth, which suggests differences in the underlying etiology. We further speculate varying treatment incidence and prevalence in pregnancy vs postpartum may indicate that the current Diagnostic and Statistical Manual of Mental Disorders-5 peripartum specifier not adequately describes at-risk periods across moderate and severe perinatal psychiatric episodes.
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Affiliation(s)
- T Munk-Olsen
- Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark,CIRRAU-Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark,National Center for Register-Based Research Aarhus University, Fuglesangs Allé 4, Aarhus 8210, Denmark. E-mail:
| | - M L Maegbaek
- Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - B M Johannsen
- Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - X Liu
- Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - L M Howard
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - A di Florio
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - V Bergink
- Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark,Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - S Meltzer-Brody
- UNC Center for Women's Mood Disorder, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Yazdanimehr R, Omidi A, Sadat Z, Akbari H. The Effect of Mindfulness-integrated Cognitive Behavior Therapy on Depression and Anxiety among Pregnant Women: a Randomized Clinical Trial. J Caring Sci 2016; 5:195-204. [PMID: 27752485 PMCID: PMC5045953 DOI: 10.15171/jcs.2016.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 02/20/2016] [Indexed: 11/09/2022] Open
Abstract
Introduction: Pregnancy can be associated with different psychological problems such as depression and anxiety. These problems are often neglected and left untreated. This study aimed to examine the effect of mindfulness-integrated cognitive behavior therapy on depression and anxiety among pregnant women. Methods: A convenient sample of 80 pregnant women were selected. Participants were randomly allocated to either the experimental or the control groups. Participants in the experimental group received mindfulness-integrated cognitive behavior therapy while women in the control group only received routine prenatal care services. A demographic questionnaire, the Edinburgh Postnatal Depression Scale, and the Beck Anxiety Inventory were used for data collection. Descriptive statistics measures such as frequency, mean, and standard deviation as well as the repeated-measures analysis of variance test were used for data analysis. Results: After the study intervention, the mean scores of anxiety and depression in the experimental group were significantly lower than the control group. Conclusion: Mindfulness-integrated cognitive behavior therapy can significantly alleviate pregnant women's depression and anxiety. So implementation of this method alongside with other prenatal care services is recommended.
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Affiliation(s)
- Reza Yazdanimehr
- Department of Clinical Psychology, Faculty of Medicine, Kashan University of
Medical Sciences, Kashan, Iran
| | - Abdollah Omidi
- Department of Clinical Psychology, Faculty of Medicine, Kashan University of
Medical Sciences, Kashan, Iran
| | - Zohreh Sadat
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan,
Iran
| | - Hossein Akbari
- Department of Biostatistics and Public Health, Faculty of Health, Kashan
University of Medical Sciences, Kashan, Iran
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Esscher A, Essén B, Innala E, Papadopoulos FC, Skalkidou A, Sundström-Poromaa I, Högberg U. Suicides during pregnancy and 1 year postpartum in Sweden, 1980-2007. Br J Psychiatry 2016; 208:462-9. [PMID: 26494874 DOI: 10.1192/bjp.bp.114.161711] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 02/05/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although the incidence of suicide among women who have given birth during the past 12 months is lower than that of women who have not given birth, suicide remains one of the most common causes of death during the year following delivery in high-income countries, such as Sweden. AIMS To characterise women who died by suicide during pregnancy and postpartum from a maternal care perspective. METHOD We traced deaths (n = 103) through linkage of the Swedish Cause of Death Register with the Medical Birth and National Patient Registers. We analysed register data and obstetric medical records. RESULTS The maternal suicide ratio was 3.7 per 100 000 live births for the period 1980-2007, with small magnitude variation over time. The suicide ratio was higher in women born in low-income countries (odds ratio 3.1 (95% CI 1.3-7.7)). Violent suicide methods were common, especially during the first 6 months postpartum. In all, 77 women had received psychiatric care at some point, but 26 women had no documented psychiatric care. Antenatal documentation of psychiatric history was inconsistent. At postpartum discharge, only 20 women had a plan for psychiatric follow-up. CONCLUSIONS Suicide prevention calls for increased clinical awareness and cross-disciplinary maternal care approaches to identify and support women at risk.
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Affiliation(s)
- Annika Esscher
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Birgitta Essén
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Eva Innala
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Fotios C Papadopoulos
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Alkistis Skalkidou
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Inger Sundström-Poromaa
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Ulf Högberg
- Annika Esscher, MD, PhD, Birgitta Essén, MD, PhD, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University Hospital, Uppsala; Eva Innala, MD, PhD, Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå; Fotios C. Papadopoulos, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala; Alkistis Skalkidou, MD, PhD, Inger Sundström-Poromaa, MD, PhD, Ulf Högberg, PhD, MD, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
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Lupu D, Pop A, Cherfan J, Kiss B, Loghin F. In vitro modulation of estrogen receptor activity by norfluoxetine. ACTA ACUST UNITED AC 2015; 88:386-90. [PMID: 26609274 PMCID: PMC4632900 DOI: 10.15386/cjmed-476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 12/17/2022]
Abstract
Background and aims Selective serotonin reuptake inhibitors (SSRIs) are antidepressants increasingly prescribed for pregnancy and postpartum depression. However, these compounds can cross the placenta and also pass into breast milk, thus reaching the fetus and infant during critical developmental stages, potentially causing adverse effects. Fluoxetine, a widely used SSRI, has been shown to affect (neuro)endocrine signaling in various organisms, including humans. This compound can also interact with estrogen receptors in vitro and cause an estrogen-dependent uterotrophic response in rodents. Consequently, the aim of the present study was to assess if the active metabolite of fluoxetine, namely norfluoxetine (NFLX), shares the same capacity for estrogen receptor interaction. Methods The in vitro (anti)estrogenic activity of norfluoxetine was assessed using a firefly luciferase reporter construct in the T47D-Kbluc breast cancer cell line. These cells express nuclear estrogen receptors (ERs) that can activate the transcription of the luciferase reporter gene upon binding of ER agonists. Light emission was monitored in case of cells exposed to norfluoxetine or mixtures of norfluoxetine-estradiol. Cell viability was assessed using a resazurin-based assay. Results During individual testing, NFLX was able to induce a significant increase in luciferase activity compared to control, but only at the highest concentration tested (10 μM). In binary mixtures with estradiol (30 pM constant concentration) a significant increase in luminescence was observed at low submicromolar norfluoxetine concentrations compared to estradiol alone. Conclusion Norfluoxetine can induce estrogenic effects in vitro and can potentiate the activity of estradiol. However, further studies are needed to clarify if these observed estrogenic effects may have detrimental consequences for human exposure.
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Affiliation(s)
- Diana Lupu
- Department of Toxicology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca Pop
- Department of Toxicology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Julien Cherfan
- Department of Toxicology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Béla Kiss
- Department of Toxicology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Felicia Loghin
- Department of Toxicology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Nygaard L, Rossen CB, Buus N. Balancing Risk: A Grounded Theory Study of Pregnant Women's Decisions to (Dis)Continue Antidepressant Therapy. Issues Ment Health Nurs 2015; 36:485-92. [PMID: 26309167 DOI: 10.3109/01612840.2015.1004605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study explored how eight pregnant women diagnosed with depression managed the decision whether or not to take antidepressants during pregnancy. In total, 11 interviews were conducted and analysed by means of constructivist grounded theory. The major category constructed was Balancing risk, with two minor categories: Assessing depression and antidepressants and Evaluating the impact of significant others. The participants tried to make the safest decision, taking all aspects of their life into consideration. They described successful decision-making in the context of managing social norms that surround pregnancy, in a way that was acceptable to themselves, their significant others and healthcare professionals.
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Affiliation(s)
- Lene Nygaard
- a Odense University Hospital , Department of Obstetrics and Gynaecology , Odense, Denmark
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Munk-Olsen T, Pedersen HS, Laursen TM, Fenger-Grøn M, Vedsted P, Vestergaard M. Use of primary health care prior to a postpartum psychiatric episode. Scand J Prim Health Care 2015; 33:127-33. [PMID: 26174691 PMCID: PMC4834500 DOI: 10.3109/02813432.2015.1041832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Childbirth is a strong trigger of psychiatric episodes. Nevertheless, use of primary care before these episodes is not quantified. The aim was to study the use of general practice in Denmark from two years before to one year after childbirth in women who developed postpartum psychiatric disorders. DESIGN A matched cohort study was conducted including women who gave birth in the period 1996-2010. Women were divided into four groups: (i) all mothers with postpartum psychiatric episodes 0-3 months after birth, n = 939; 2: All mothers with a postpartum psychiatric episode 3-12 months after birth, n = 1 436; and (iii) two comparison groups of mothers, total n = 6 630 among 320 620 eligible women. SETTING Denmark. SUBJECTS Women born in Denmark after 1 January 1960, restricting the cohort to women who gave birth to their first singleton child between 1 January 1996 and 20 October 2010. MAIN OUTCOME MEASURES The main outcome measures were consultation rates, consultation rate ratios, and rate differences. RESULTS Women who developed a psychiatric episode after childbirth had higher GP consultation rates before, during, and after the pregnancy. Women with a psychiatric episode 0-3 months postpartum had 6.89 (95% CI 6.60; 7.18) mean number of consultations during pregnancy, corresponding to 1.52 (95% CI 1.22; 1.82) more visits than the comparison group. CONCLUSION Women with a postpartum psychiatric episode had higher use of GP-based primary health care services years before the childbirth, and in this specific group of patients childbirth itself triggered a marked increase in the number of GP contacts postpartum.
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Affiliation(s)
- Trine Munk-Olsen
- National Centre for Register-based Research, Department of Economics and Business; School of Business and Social Sciences, Aarhus University, Denmark, The Initiative for Integrative Psychiatric Research (iPSYCH)
- Correspondence: Trine Munk-Olsen, National Centre for Register-based Research, Department of Economics and Business; School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus V, Denmark. Tel: + 45 871 65749. Fax: + 45 871 64601. E-mail:
| | - Henrik Søndergaard Pedersen
- Research Unit for General Practice, Department of Public Health, Faculty of Health, Aarhus University, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-based Research, Department of Economics and Business; School of Business and Social Sciences, Aarhus University, Denmark, The Initiative for Integrative Psychiatric Research (iPSYCH)
| | - Morten Fenger-Grøn
- Research Unit for General Practice, Department of Public Health, Faculty of Health, Aarhus University, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Faculty of Health, Aarhus University, Denmark
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Barbui C, Ostuzzi G. Beneficial and harmful consequences of prepartum and postpartum antidepressant exposure. EVIDENCE-BASED MENTAL HEALTH 2014; 17:69-71. [PMID: 24938274 DOI: 10.1136/eb-2014-101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Corrado Barbui
- Department of Public Health and Community Medicine, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- Department of Public Health and Community Medicine, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
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Kim DR, Epperson CN, Weiss AR, Wisner KL. Pharmacotherapy of postpartum depression: an update. Expert Opin Pharmacother 2014; 15:1223-34. [PMID: 24773410 DOI: 10.1517/14656566.2014.911842] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Postpartum depression (PPD) is a common and serious illness that affects up to 14% of women in the first month after childbirth. We present an update on the pharmacologic treatment of PPD, although there continues to be a lack of large, randomized controlled trials (RCTs). AREAS COVERED A review of the literature on the use of antidepressants, hormonal supplements and omega-3 fatty acids for the prevention and the treatment of PPD published since the original review in 2009 and the authors' opinion on the current status of the pharmacological treatment of PPD are covered. An electronic search was performed by using PubMed, Medline and PsychINFO. Inclusion criteria were: i) empirical articles in peer-reviewed English-language journals; ii) well-validated measures of depression; and iii) a uniform scoring system for depression among the sample. EXPERT OPINION Since the last Expert Opinion review, four antidepressant treatment studies and one prevention study of PPD have been published. Six RCTs evaluating the use of omega-3 fatty acids (four for prevention and two for treatment) have been published. There continues to be lack of data regarding the pharmacotherapy of PPD. However, serotonin reuptake inhibitors should be considered first-line for women with PPD after it has been determined that the proper diagnosis is not bipolar disorder. It is important to individualize treatment for women with PPD and consider the risks and benefits of treatment while breastfeeding.
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Affiliation(s)
- Deborah R Kim
- University of Pennsylvania, Perelman School of Medicine, Penn Center for Women's Behavioral Wellness, Department of Psychiatry , Philadelphia, PA 19104 , USA
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Huybrechts KF, Sanghani RS, Avorn J, Urato AC. Preterm birth and antidepressant medication use during pregnancy: a systematic review and meta-analysis. PLoS One 2014; 9:e92778. [PMID: 24671232 PMCID: PMC3966829 DOI: 10.1371/journal.pone.0092778] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/25/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Preterm birth is a major contributor to neonatal morbidity and mortality and its rate has been increasing over the past two decades. Antidepressant medication use during pregnancy has also been rising, with rates up to 7.5% in the US. The objective was to systematically review the literature to determine the strength of the available evidence relating to a possible association between antidepressant use during pregnancy and preterm birth. METHODS We conducted a computerized search in PUBMED, MEDLINE and PsycINFO through September 2012, supplemented with a manual search of reference lists, to identify original published research on preterm birth rates in women taking antidepressants during pregnancy. Data were independently extracted by two reviewers, and absolute and relative risks abstracted or calculated. Our a priori design was to group studies by level of confounding adjustment and by timing of antidepressant use during pregnancy; we used random-effects models to calculate summary measures of effect. RESULTS Forty-one studies met inclusion criteria. Pooled adjusted odds ratios (95% CI) were 1.53 (1.40-1.66) for antidepressant use at any time and 1.96 (1.62-2.38) for 3rd trimester use. Controlling for a diagnosis of depression did not eliminate the effect. There was no increased risk [1.16 (0.92-1.45)] in studies that identified patients based on 1st trimester exposure. Sensitivity analyses demonstrated unmeasured confounding would have to be strong to account for the observed association. DISCUSSION Published evidence is consistent with an increased risk of preterm birth in women taking antidepressants during the 2nd and 3rd trimesters, although the possibility of residual confounding cannot be completely ruled out.
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Affiliation(s)
- Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Reesha Shah Sanghani
- Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jerry Avorn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Adam C. Urato
- MetroWest Medical Center, Tufts University School of Medicine, Framingham, Massachusetts, United States of America
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Sharma V, Sommerdyk C. Are antidepressants effective in the treatment of postpartum depression? A systematic review. Prim Care Companion CNS Disord 2013; 15:13r01529. [PMID: 24800125 PMCID: PMC3977774 DOI: 10.4088/pcc.13r01529] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/29/2013] [Indexed: 12/02/2022] Open
Abstract
Objective: In spite of the paucity of randomized controlled trials of antidepressants in postpartum depression, these drugs are the most commonly used agents in the pharmacologic treatment of postpartum depression. This article reviews the literature on the efficacy of antidepressants in randomized controlled trials of postpartum depression. Data Sources: Four electronic databases, MEDLINE/PubMed (1966–2013), PsycINFO (1806–2013), EMBASE (1980–2013), and the Cochrane Database of Systematic Reviews, were searched using a combination of the keywords antidepressive agents/therapeutic use, antidepressant drugs, antidepressant agent/drug therapy, depression, postpartum/drug therapy, postpartum depression, and puerperal depression/drug therapy. Study Selection: The reference lists of articles identified were also searched. All relevant articles published in English were included. A total of 124 articles were identified. The efficacy of antidepressants has been studied in 6 randomized controlled trials, of which 3 were placebo-controlled studies. Results: Placebo-controlled randomized data do not support the notion that antidepressants are efficacious in postpartum depression. However, the methodological flaws of studies have to be kept in mind while interpreting the results of these studies. Conclusions: Due to the paucity of controlled data and methodological limitations of studies, the question about the efficacy of antidepressants in postpartum depression cannot be answered unequivocally.
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Affiliation(s)
- Verinder Sharma
- Department of Psychiatry, Western University (Dr Sharma), and Mood and Anxiety Disorders Program, Regional Mental Health Care (Dr Sharma and Ms Sommerdyk), London, Ontario, Canada
| | - Christina Sommerdyk
- Department of Psychiatry, Western University (Dr Sharma), and Mood and Anxiety Disorders Program, Regional Mental Health Care (Dr Sharma and Ms Sommerdyk), London, Ontario, Canada
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Sørensen MJ, Grønborg TK, Christensen J, Parner ET, Vestergaard M, Schendel D, Pedersen LH. Antidepressant exposure in pregnancy and risk of autism spectrum disorders. Clin Epidemiol 2013; 5:449-59. [PMID: 24255601 PMCID: PMC3832387 DOI: 10.2147/clep.s53009] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Both the use of antidepressant medication during pregnancy and the prevalence of autism spectrum disorder have increased during recent years. A causal link has recently been suggested, but the association may be confounded by the underlying indication for antidepressant use. We investigated the association between maternal use of antidepressant medication in pregnancy and autism, controlling for potential confounding factors. Methods We identified all children born alive in Denmark 1996–2006 (n=668,468) and their parents in the Danish Civil Registration System. We obtained information on the mother’s prescriptions filled during pregnancy from the Danish National Prescription Registry, and on diagnoses of autism spectrum disorders in the children and diagnoses of psychiatric disorders in the parents from the Danish Psychiatric Central Register. In a cohort analysis, we estimated hazard ratios of autism spectrum disorders in children exposed to antidepressant medication during pregnancy compared with children who were not exposed, using Cox proportional hazards regression analysis. Furthermore, we estimated the risk for autism spectrum disorder in a sibling design. Results Children exposed prenatally to antidepressants had an adjusted hazard ratio of 1.5 (95% confidence interval [CI] 1.2–1.9) for autism spectrum disorder compared with unexposed children. Restricting the analysis to children of women with a diagnosis of affective disorder, the adjusted hazard ratio was 1.2 (95% CI 0.7–2.1), and the risk was further reduced when exposed children were compared with their unexposed siblings (adjusted hazard ratio 1.1; 95% CI 0.5–2.3). Conclusion After controlling for important confounding factors, there was no significant association between prenatal exposure to antidepressant medication and autism spectrum disorders in the offspring.
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Affiliation(s)
- Merete Juul Sørensen
- Regional Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
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Battle CL, Salisbury AL, Schofield CA, Ortiz-Hernandez S. Perinatal antidepressant use: understanding women's preferences and concerns. J Psychiatr Pract 2013; 19:443-53. [PMID: 24241498 PMCID: PMC4277178 DOI: 10.1097/01.pra.0000438183.74359.46] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Perinatal depression is prevalent and linked with a host of adverse consequences for women and newborns. Rates of engagement in depression treatment are, however, strikingly low among pregnant and postpartum women, with the majority of affected women receiving no mental health treatment. Research indicates that perinatal women are extremely reluctant to take antidepressant medications, yet the nature of women's concerns and treatment decision- making patterns have not been well documented. Developing a clearer understanding of women's treatment preferences and behaviors may help identify solutions to the under-treatment of perinatal depression. In this mixed methods study, we conducted in-depth interviews with 61 pregnant women, approximately half of whom were experiencing clinical levels of depression. In addition to assessing psychiatric diagnoses, symptoms, and functional impairment, we conducted qualitative interviews addressing women's preferences for depression treatment, concerns, and decision-making patterns. Consistent with prior reports, women were significantly more likely to voice a preference for non-pharmacologic depression treatments, as opposed to antidepressant medications. Many depressed women reported a great degree of uncertainty regarding how to treat their depression, and those with more severe depression symptoms were more likely to endorse decisional conflict. Analysis of qualitative comments yielded detailed information about the nature of women's concerns and preferences related to use of antidepressant medications and other aspects of treatment engagement. We discuss findings in the context of improving patient-centered care for perinatal depression.
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MESH Headings
- Adult
- Antidepressive Agents/therapeutic use
- Complementary Therapies/psychology
- Decision Making/physiology
- Depression, Postpartum/diagnosis
- Depression, Postpartum/psychology
- Depression, Postpartum/therapy
- Depressive Disorder, Major/diagnosis
- Depressive Disorder, Major/psychology
- Depressive Disorder, Major/therapy
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Interview, Psychological
- Patient Preference/psychology
- Postpartum Period
- Pregnancy
- Pregnancy Complications/diagnosis
- Pregnancy Complications/psychology
- Pregnancy Complications/therapy
- Pregnancy Trimester, Second
- Psychiatric Status Rating Scales
- Psychotherapy/methods
- Qualitative Research
- Severity of Illness Index
- Young Adult
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Affiliation(s)
- Cynthia L Battle
- BATTLE: Warren Alpert Medical School of Brown University, Butler Hospital, and Women & Infants' Hospital of Rhode Island, Providence, RI; SALISBURY: Warren Alpert Medical School of Brown University and Women & Infants' Hospital of Rhode Island; SCHOFIELD: Warren Alpert Medical School of Brown University and Skidmore College, Saratoga Springs, NY; ORTIZ- HERNANDEZ: George Washington University, Washington, DC
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Jimenez-Solem E, Andersen JT, Petersen M, Broedbaek K, Andersen NL, Torp-Pedersen C, Poulsen HE. Prevalence of antidepressant use during pregnancy in Denmark, a nation-wide cohort study. PLoS One 2013; 8:e63034. [PMID: 23638179 PMCID: PMC3636192 DOI: 10.1371/journal.pone.0063034] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/27/2013] [Indexed: 11/19/2022] Open
Abstract
AIM The aim of this study was to assess the prevalence and patterns of exposure to antidepressants before, during and after pregnancy in a cohort including all pregnant women in Denmark between 1997 and 2010. METHODS We performed a retrospective cohort study including 912 322 pregnancies. Information was retrieved from the Danish Birth Registry and The Register of Medicinal Product Statistics to identify women redeeming an antidepressant prescription during pregnancy. Exposure periods were based on standard treatment doses and dispensed pack sizes. RESULTS We identified 19 740 pregnancies exposed to an antidepressant at some point during pregnancy. The rate of exposure increased from 0.2% in 1997 to 3.2% in 2010. We found that the rate of exposure was halved during the first 3 months of pregnancy. In contrast, we describe a clear increase in exposure after pregnancy among pre-delivery treatment-naïve women. CONCLUSIONS In spite of uncertainty concerning antidepressants' safety during pregnancy we find a 16-fold increase in exposure rates between 1997 and 2010. The rates describe a sharp decrease in exposure during pregnancy that is probably caused by physicians' hesitation to prescribe antidepressants and women's fear of unwanted effects on the unborn child. More studies are needed to clarify the consequences of antidepressant discontinuation during pregnancy.
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Affiliation(s)
- Espen Jimenez-Solem
- Laboratory of Clinical Pharmacology Q7642, Rigshospitalet, Copenhagen, Denmark.
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