Paxil

Although it’s rare for mothers to attempt suicide following the birth of their child, when it happens it can have a long-lasting effect on the family and the child. In a study published in the August 2008 issue of the American Journal of Obstetrics and Gynecology, researchers attempted to ferret out the risk factors for postpartum suicide.

Studying hospitalization and birth records from Washington state from 1992 to 2001, they found that certain factors were associated with the risk of postpartum suicide attempts. Women who had been previously hospitalized for psychiatric disorders were at the greatest risk, being 27 times more likely to attempt suicide than women without any history of psychiatric hospitalization. Women with a history of substance abuse were 6 times as likely to attempt suicide, while a history of both psychiatric hospitalization and substances abuse increased the risk by 11 times.

According to study author Katherine A Comtois, PhD, “screening for past history of psychiatric and substance abuse diagnoses as a part of routine prenatal care may be a means of identifying women at high risk of postpartum suicide attempt, although a recent review of prenatal screening for depression cited insufficient evidence to recommend screening as a way to improve outcomes.”

The authors further add that future studies should look at whether screening for these risk factors will prevent postpartum suicide attempts.

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A link between Paxil and brain defects in babies born to women who took Paxil during their pregnancies has recently received much attention in the U.S. media. This link was highlighted in a 2007 study revealing that women who take certain SSRIs (selective serotonin reuptake inhibitors)—including Paxil—during pregnancy may be at a significantly higher risk of having a baby with a brain defect.

Paxil Use During Pregnancy

SSRIs are prescribed as a treatment for depression and other disorders, and it may be inevitable that some women are taking Paxil while they are pregnant — whether they know that they are pregnant or have not yet found out about the pregnancy.

In some cases, a woman whose pregnancy is known is being treated with Paxil because of severe depression that has not been successfully treated with a less risky medication or therapy; in such circumstances, the ratio of the benefits vs. risks of Paxil must be considered.

In other cases, a woman becomes pregnant while she is taking Paxil, but she doesn’t know about the pregnancy for weeks or perhaps months. About half of the pregnancies in the U.S. are unintended, and a woman may not be concerned about the Paxil-brain defect connection until she finds out she is pregnant.

Unfortunately, birth defects (including brain defects) are most likely to develop during the first trimester of a pregnancy, when a fetus is in its earliest stages of development. Even so, other birth defects can and do arise later in pregnancy.

Anencephaly

A significant connection between pregnant women’s Paxil use and brain defects came to light in a 2007 report published in The New England Journal of Medicine. This study found that women who took SSRIs such as Paxil during their pregnancy had a 2.4 percent higher risk of having a baby with anencephaly (no forebrain). Anencephaly is a heart-breaking condition for any parent; the baby is severely malformed and unable to function normally. A baby with anencephaly will die before or within a few days of birth.

Craniosynostosis

The same study, which gathered data from a large nationwide review of birth defects from the U.S. Centers for Disease Control and Prevention, also found a link between the use during pregnancy of SSRIs such as Paxil and a brain defect called craniosynostosis, a condition in which the skull of the fetus forms too early, preventing the brain from growing properly. Craniosynostosis is a very severe, life-threatening and debilitating brain defect.

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Expectant mothers can safely use prescribed antidepressants during their first trimester, according to a new study from the Université de Montréal and Ste. Justine Hospital.

“This is the first study to investigate the impact of antidepressant use during the first trimester of pregnancy in mothers with psychiatric disorders,” said Dr. Anick Berard. “In terms of birth malformations in this population, we found no difference between women who used antidepressants and those who did not use antidepressants during their first trimester.”The research team used data from the Quebec Pregnancy Registry to analyze the records of 2,329 new mothers diagnosed with a psychiatric disorder and treated with antidepressants for at least 30 days before pregnancy. The group included women who delivered live born and stillborn children, while birth defects were considered anything from facial malformations to heart anomalies.

“The duration of antidepressant use in the first trimester of pregnancy was not associated with an increased risk of birth malformations,” Berard said. “We hope these findings help clinicians and women decide whether to continue antidepressant therapy during pregnancy.”

The study was published in the May edition of the British Journal of Psychiatry.

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Expectant mothers can safely use prescribed antidepressants during their first trimester, according to a new study from the Université de Montréal and Ste. Justine Hospital published in the May edition of the British Journal of Psychiatry.

Dr. Anick Bérard and her team found that antidepressants have no effect on foetal development. “This is the first study to investigate the impact of antidepressant use during the first trimester of pregnancy in mothers with psychiatric disorders,” she said. “In terms of birth malformations in this population, we found no difference between women who used antidepressants and those who did not use antidepressants during their first trimester.”

Dr. Anick Bérard and her team found that antidepressants have no effect on foetal development. “This is the first study to investigate the impact of antidepressant use during the first trimester of pregnancy in mothers with psychiatric disorders,” she said. “In terms of birth malformations in this population, we found no difference between women who used antidepressants and those who did not use antidepressants during their first trimester.”

The research team used data from the Quebec Pregnancy Registry, established by their group, to analyze the records of 2,329 new mothers diagnosed with a psychiatric disorder and treated with antidepressants for at least 30 days before pregnancy. Also included in the registry were women who delivered liveborn and stillborn children, while birth defects were considered anything from facial malformations to heart anomalies.

“The duration of antidepressant use in the first trimester of pregnancy was not associated with an increased risk of birth malformations,” explained Dr. Bérard. “We hope these findings help clinicians and women decide whether to continue antidepressant therapy during pregnancy.”

This study was supported by the Fonds de la Recherche en Santé du Québec (FRSQ), the Réseau Québécois de Recherche sur l’Usage des Médicaments and the Network for the Wellbeing of Children.

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Expectant mothers can safely use prescribed antidepressants during their first trimester, according to a new study from the Université de Montréal and Ste. Justine Hospital published in the May edition of the British Journal of Psychiatry.

Dr. Anick Bérard and her team found that antidepressants have no effect on foetal development. “This is the first study to investigate the impact of antidepressant use during the first trimester of pregnancy in mothers with psychiatric disorders,” she said. “In terms of birth malformations in this population, we found no difference between women who used antidepressants and those who did not use antidepressants during their first trimester.”

The research team used data from the Quebec Pregnancy Registry, established by their group, to analyze the records of 2,329 new mothers diagnosed with a psychiatric disorder and treated with antidepressants for at least 30 days before pregnancy. Also included in the registry were women who delivered liveborn and stillborn children, while birth defects were considered anything from facial malformations to heart anomalies.

“The duration of antidepressant use in the first trimester of pregnancy was not associated with an increased risk of birth malformations,” explained Dr. Bérard. “We hope these findings help clinicians and women decide whether to continue antidepressant therapy during pregnancy.”

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Meds don’t cause birth defects

Montreal researchers say pregnant women can continue taking antidepressants because the drugs do not pose a risk to their babies.

Published in the highly regarded British Journal of Psychiatry, the Montreal study found anti- depressants have little impact on the fetus and do not increase a woman’s risk of delivering babies with birth defects.

Anick Bérard of the Université de Montréal and Ste. Justine Hospital analyzed data from 2,329 pregnant women in Quebec between 1998 to 2002. The women had been diagnosed with at least one psychiatric disorder and treated with antidepressants for at least 30 days before pregnancy.

Bérard, a senior researcher, said it’s the first study to investigate the impact of antidepressant use during the first trimester of pregnancy in mothers with psychiatric disorders.

The study found little to link birth defects or malformations to antidepressants. The finding is significant because of the widespread use of antidepressants. Since one in two pregnancies is unplanned, women who are already on antidepressants often think they must discontinue the medication for the good of their babies, Bérard said.

“We’re fearful of having another thalidomide on our hands,” she said, referring to the sedative and anti-morning sickness pill widely prescribed to pregnant women in 1950s and 1960s that caused severe birth defects in thousands of children in North America.

According to Statistics Canada, the proportion of expectant mothers using antidepressants rose to 14 per cent in 2007 from 12 per cent five years ago. The issue remains controversial because of conflicting results in previous studies.

“Some say it’s good, others say it’s real nasty,” said Bérard, director of the research unit examining medication and pregnancy at Ste. Justine Hospital.

Antidepressants have been linked to premature births, smaller babies, heart defects and death from hypertension.

In 2005, Health Canada and the U.S. Food and Drug Administration issued warnings about higher risks of heart defects in babies whose mothers took the antidepressant Paxil while pregnant. Last year, Bérard’s team found Paxil was linked to an increase in heart defects, but only when taken in high doses prescribed to severely depressed women. An estimated one per cent of all babies are born with heart defects. Paxil raised the risk to three per cent, Bérard noted.

No drug is without risk, Bérard said. But left untreated, depression can also increase the chance of preterm birth and postpartum depression, other studies show.

Bérard’s findings are supported in independent research from the Motherisk Program at the Hospital for Sick Children and the University of Toronto.

“Women are terrified. Health Canada and the FDA warnings were premature,” said Adrienne Einarson.

Einarson’s findings, published in the American Journal of Psychiatry last month, show that Paxil does not increase the risk of cardiovascular birth defects.

“There is no increased risks for birth defects; that’s one thing we are sure about,” she said.

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Here are a few suggestions on how you and your loved ones can help to prevent the onset or escalation of ppd-related symptoms:

Surround yourself with family, friends, loved ones. Talk to your loved ones about how you’re feeling and don’t be afraid to ask for help if you do not feel able to perform your daily tasks – you don’t have to be super-mom!

Attend a moms-only support group. Many women report that being surrounded by other mothers was immensely successful in curbing their symptoms of depression. Because the baby blues are so common, this is a great opportunity for mothers to share their experiences and know they’re not alone.

Don’t expect too much from yourself. Becoming a mother, especially when it’s for the first time, can be extremely stressful. Don’t push yourself and set reasonable limits for what you are able to achieve.
Take care of yourself! Be sure to make time for yourself and make your own well-being a priority. Getting out of the house for a little while each day (without your child!) may help you to keep your focus and regain composure.

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If any of the following symptoms endure for more than two weeks after childbirth, women should seek medical attention:

* Feelings of anxiety, guilt, sadness, worthlessness, restlessness or irritability
* Sleep disturbances
* Lack of interest in social or other activities you previously enjoyed
* Lack of feeling or feelings of resentment, anger or fear about motherhood, your partner or your child
* Trouble focusing
* Eating more or less than usual
* Unexplained, uncontrollable weeping
* Headaches, chest pains of other physical symptoms with no other apparent reason

In some cases, mothers may also contemplate suicide or even fantasize about harming their children as well as themselves. Unlike those suffering from postpartum psychosis, women experiencing postpartum depression are highly unlikely to commit such acts.

Who is at Risk?

Although there is no certain cause of postpartum depression, there are known risk factors for acquiring ppd. If you have experienced any of the following, you and your family should be extra vigilant in monitoring your mood levels during and after pregnancy:

* Previous incident of postpartum depression (this puts you at a 50-80% greater risk).
* Family history of depression or being treated for depression before pregnancy. A family history of bipolar disorder or psychosis also puts you at a greater risk for developing postpartum psychosis.
* Social isolation, lack of support or a life changing event such as divorce, death or loss of employment.
* Difficult pregnancy that caused disruption to normal routine (for example, being bedridden).
* Having a history of severe PMS or PMDD.
* History of thyroid problems

What are the Treatment Options?

For those suffering from postpartum depression, medical treatment options will most likely include:

* Psychiatric evaluation and/or individual or group therapy
* Antidepressants or other medications. Some doctors may recommend a mother take antidepressants for more severe symptoms of ppd, however, women should understand the risks involved in taking such medications if she is pregnant or breastfeeding.

Although it is recommended that women experiencing symptoms of postpartum depression seek medical attention, some alternative treatments include:

* A diet rich in omega-3 fatty acids. Recent studies have shown that these polyunsaturated fatty acids may be an effective treatment for those suffering from a range of depression related mood disorders.
* Some naturopaths suggest that certain blood tests may detect postpartum depression before its symptoms have been manifested. They suggest that women experiencing poor circulation, dizziness, unusual bleeding or clotting during their period or pale complexion be tested for blood deficiencies. Treatment options include acupuncture, herbal supplements and dietary or lifestyle changes.

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For many women, childbirth is the most meaningful moment of their lives. But at a time when a mother is supposed be filled with joy and love, some women may experience feelings of anxiety, fear, guilt or depression. Although it is not known exactly how many women suffer from depression, it is widely viewed as the most common complication of childbirth.

Postpartum Depression and the “Baby Blues”

The “baby blues”, which occurs when a woman experiences signs of depression after childbirth, is viewed as a common effect of pregnancy. In fact, anywhere between 50-80% of women report feeling sad, anxious, weepy or generally emotionally unstable before or after the birth of their baby. Fluctuating levels of the female sex hormones estrogen and progesterone is responsible for this.

During pregnancy the levels of these hormones increase dramatically. Therefore, after pregnancy, as the hormones return to their normal amounts, women may become susceptible to depression or mood disorders – just as our moods may be affected during PMS for the same reason. In fact, the baby blues may be marked by some of the same symptoms of postpartum; however, its duration is much shorter. The baby blues generally peaks 3-5 days after childbirth and will endure no longer than two weeks.

Postpartum (which literally means “after-birth”) depression (PPD), on the other hand, affects about 10-20% of new mothers and can begin anytime within the first year after childbirth. As of yet it is unknown how long postpartum depression can endure. The level of severity, environment as well as overall mental health may influence how long the symptoms will last.

Postpartum psychosis, which is a much more severe and dangerous form of postpartum depression is extremely rare and only affects about 3 women in every 1000. Signs of postpartum psychosis usually occur within the first few weeks postpartum.

In some cases childbirth may result in low thyroid levels, which may also be a cause of depression. There is a standard blood test than can be done to determine whether this is the case; and if it is, there are medications that can alleviate the symptoms.

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