Tag Archives: research

Danish research and SSRI use during pregnancy

An article at medpage.com heralds a new study released September 25, 2009 by Danish researchers. The article carries the sensationalized title “SSRIs in Pregnancy Hike Risk of Heart Defects.”

While the title itself raises eyebrows, the researchers themselves state that they were unable to conclude if the results were because of medication or the underlying depression. Also important to keep in mind is that this research is based on women who had prescriptions filled for SSRIs but does not appear to have checked to see if these women actually took the medication. Instead, they rely on data from a national registry.

Pedersen and colleagues analyzed national registry data on more than 493,000 births in Denmark from 1996 to 2003. The data included prescriptions filled by mothers-to-be as well as the medical status of their babies at birth.”

And directly from the study:

Our results, however, depend on a correlation between redemptions of prescriptions and drug use. Non-compliance might be a problem for this type of exposure definition and could mask true associations if some of the “exposed” were in fact unexposed.

The most interesting piece to come out of this research is that of the studied SSRI’s, Paxil appeared to have the least risk of septal heart defects. I find this very interesting considering that Paxil is the only SSRI to currently carry a heart defect specific warning.

As with all studies and research, you should always examine all sides and aspects and educate yourself rather than relying on the word of others when making your final decision. Ask yourself if the person presenting the information has your best interest at heart or is merely trying to frighten you with inflated facts and figures. (Click here to read a previous post full of tips on how to find solid medical advice on the web.)

Dr. Shoshana Bennett, author of “Pregnant on Prozac” released this statement regarding this research:

Finally, treatment for the serious and potentially life-threatening illness of prenatal depression (for both mom and therefore baby) is being formally discussed. Fifteen percent of clinically depressed pregnant women try to take their lives – a bit more risky for the baby than mom taking an antidepressant, wouldn’t you say? If the pregnant woman can be non-depressed without a medication, that’s optimal. Some form(s) of treatment, however is essential. If natural and alternative approaches to wellness are not enough, it is regarded by those in the know to be safer for her (and her developing baby) to take an antidepressant than to remain depressed. Depression itself – it is quite clear from the research – crosses the placenta and alters the uterine environment causing negative consequences to the baby. In the latest research there appears to be low (0.9%) chance of a septal heart defect in babies whose mothers had taken certain antidepressants. However, what fear-mongers do not report, is that the researchers themselves could not be sure whether it’s the antidepressant or the underlying depression itself that caused the defect. Women need all relevant information and education about options for treatment during pregnancy so they can make the best decision for themselves and their family. Watch out for alarmists who are not interested in actual data – they are simply invested in promoting fear in women who are at their most vulnerable.

Shoshana Bennett, Ph.D.

http://DrShosh.com

Increased risk was determined by “redemption” of more than one SSRI prescription. Those who redeemed more than one prescription had infants with a higher percentage of septal heart defects. But again this begets the question of whether or not this result lay with the SSRI or the underlying depression/mental illness/stress the mother may have been experiencing in order to receive said prescription.

Bottom line here: Don’t think for a second that becoming a Mom starts at birth. It starts at conception. And we owe ourselves AND our infants the best start possible. This means researching by asking questions and seeking out solid answers. It means finding physicians who will be your co-pilot instead of an uncooperative Auto-Pilot unaware of the pot-holes facing them. It means putting together the best support you can with what you have access to at the time. I happen to agree that a SSRI free pregnancy is absolutely optimal. I also think you should run (not walk) out of any doctor’s office if said doctor is quicker with the script pad than the warm shoulder. But we have to remember that every situation is different. Every person is different and every pregnancy is different. And sometimes we may just have to take medication. It doesn’t make you weaker, it doesn’t make you stupid, and it doesn’t make you a bad mom. And above all, remember that the decision to take or not to take a SSRI during pregnancy is your decision. Make it with an empowered spirit, stick to it, and don’t look back.

Dr. Zachary Stowe reprimanded by Emory

Dr. Zachary Stowe, a well-known researcher in the field of anti-depressant usage during pregnancy and postpartum, has been disciplined by Emory University for failing to disclose a conflict of interest while conducting research using a NIH grant during 2007 and 2008. Dr. Charles Nemeroff, also of Emory, was also found to have existing conflicts while conducting research just a few months ago.

These disheartening discoveries are becoming too commonplace. What’s happened to honest, decent morals? What’s happened to working for the greater good instead of the not-so-almighty dollar?

I must say that my initial reaction was one of very deep disappointment as this is all unfolding in my own backyard. Emory is one of the most well known resources for Postpartum support here in Georgia. Without Emory, there’s not much left to the support and knowledge of Postpartum Mood Disorders and their treatment here. (Trust me, I’ve worked to find one!)

I sincerely hope both Dr. Nemeroff and Dr. Stowe have learned important lessons through all of this. I also hope other researchers will realize the importance of honesty when disclosing relationships during research.

The public deserves un-biased data when it comes to our health. Has that even become too much to ask for?

“The Motherhood Project” needs participants!

  © 2004 Rebecca Alden  www.tinge.net

© 2004 Rebecca Alden www.tinge.net

Call for participation:

We are two advanced doctoral students researching the effects of pregnancy and motherhood on the lives of women for our dissertations. With your much needed help, we would like to learn more about the process of becoming a mother and how it may inform a woman’s identity, relationships, spirituality, mental health, and general well-being.

Our online survey is easy to take and will take only 30-60min of your time now and again after you give birth. Most of all, we hope it serves as an opportunity for you to reflect on your experience and guide others in their path.

If you are pregnant and in your 2nd or 3rd trimester, please consider participating. For more information and the survey:

click on: “The Motherhood Project”

Please feel free to pass on the link to others.
We welcome multiple perspectives from women of diverse backgrounds!

Mother’s criticism causes distinct neural activity in formerly depressed women

Not too many research articles make me say “Whoa!”

This one is a very interesting exception and it’s not even directly linked to Postpartum Mood Disorders.

Via fMRI, researchers examined the brain patterns of formerly depressed v. non-depressed women as they listened to their mothers speak. These recorded statements varied from praise to criticism.

After listening to the statements, both groups had similar verbal reactions.

But their brain patterns revealed a much different story.

As the formerly depressed women listened to the criticisms, something interesting happened.

Individuals who had never been depressed showed increased activity in the dorsolateral prefrontal cortex and the anterior cingulate cortex, which are brain areas involved in the cognitive control of emotion. The formerly depressed individuals did not show activity in these areas, but instead showed increased activity in the amygdala, a part of the brain that is responsive to potentially threatening stimuli. Previous research has shown similar activity in these neural systems among individuals who are currently depressed.

Researchers aren’t sure if this reaction is a “scar” from depression or if the brain reacted this way prior to depression.

So if Mom’s criticism is a little harder to take in the midst of a Postpartum Mood Disorder, it’s really not your fault. (And no, she’s really not out to get you)

US Practitioners confident in use of EPDS; not charting results

A study entitled “Universal Screening for Postpartum Depression: an inquiry into provider attitudes and practice”, presented January 2009 at the 29th Annual Meeting of the Society for Maternal Fetal Medicine, January 2009, evaluated usage of the EPDS in an academic based clinical center and also evaluated the practitioner’s knowledge of and attitude towards the EPDS.

A total of 512 records were studied with a rather large difference between percentage of documented screens and reported rates of confidence and knowledge of screening. Only 39% of records included notated screens, 35% charted counseling with patients about their results,  even though 94% of practitioners reported they are responsible for and comfortable with making a diagnosis of a Postpartum Mood Disorder.

The study’s authors concluded that even though practitioners are confident they are not charting the results.

What does this mean?

Either practitioners are not as confident as they claim and really are not screening at a higher suspected level or they are truly confident and not documenting the patient’s complete visit. Whatever the case may be, something needs to change. Increased documentation of Postpartum Mood Disorders would allow for better understanding of how many women really do suffer. It also raises the question if more women than we think are seeking treatment and this information is just not making into the documentation. But at least these practitioners are asking the questions and not wording their way out of it much like a recent UK based study, right?