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Researchers have discovered a potential cause for postpartum depression, at least in animal studies.

According to Istvan Mody and Jamie Maguire of the David Geffen School of Medicine at the University of California, Los Angeles, dysregulation of a class of proteins called GABA receptors on the surface of certain neurons in the brain may be a cause of postpartum depression or psychosis.

In addition to binding with GABA, the GABA receptor sites can also bind with molecules called neurosteroids, which were the molecules of interest in this particular study. Neurosteroids are produced from hormones like progesterone. When progesterone levels rise sharply during pregnancy, neurosteroid levels also rise.

In order to keep a constant level of GABA receptor-derived inhibition - which the investigators theorize is necessary - the number of receptors must stay in synch with the level of neurosteroids. In other words, as neurosteroid levels rise during pregnancy, fewer receptor sites are necessary to provide the same amount of inhibition. Where things go wrong is after the birth, when neurosteroid levels drop, but there is not a corresponding increase in the number of receptor sites.

These findings provide a model that scientists can work with as they attempt to better understand postpartum depression, which could speed up the process of finding a treatment for it, the authors note. It should be kept in mind, however, that this is an animal model and it cannot be determined if the same process is at work in human postpartum depression. The next step, say the authors, is determining the applicability of the model to humans.

The results were published in the July 31 issue of Neuron.

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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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Most people believe that pregnancy is perhaps one of the happiest days of every woman’s life. Contrary to this, not all future mothers are ecstatic or joyous during their pregnancy. In fact, many women suffer from minor to serious cases of depression while they are pregnant. During pregnancy, hormonal changes occur in a woman’s body. Pregnancy hormones make women more susceptible to anxiety and depression problems. As sudden feelings of sadness and low moods are generally regarded as expectable effects of pregnancy, women tend to ignore such signs, without knowing that they are probably suffering from depression. For such reason, doctors always remind pregnant women to observe their mood swings in order to determine if they are already showing symptoms of depression. It is also frequently advised to pregnant mothers to update their doctors on the times they feel unnaturally low or sad, for mental and emotional health are very essential in pregnancy.

Antidepressant medications in pregnancy

Treatments for depression that are commonly recommended to pregnant women are psychotherapy and prescription drugs. For mild or non-severe cases of depression, medical experts only recommend therapy sessions as treatment.

Medications, on the other hand, are advised to severe cases of depression. These antidepressant medications are the ones prescribed by doctors as therapy drugs to use during pregnancy. Despite the efficiency of medications as treatment for serious cases of depression among pregnant women, some people are still reluctant to adhere in drug treatments for a number of safety issues.

Depression treatments for pregnant women are more carefully considered by doctors for these involve two patients: the mother and the baby. In consultations, doctors should let the future mothers know the benefits and risks associated in their recommended treatment, particularly the medications.

Risks in using antidepressant medications on pregnancy

Despite the notable side effects associated on the use of prescription drugs, women are not really prohibited on using antidepressant medications during pregnancy. Studies on the benefits and risks of these medications help people in choosing which prescription drugs work best. Clinical evidences also guide pregnant women which medications are safer to use and which ones should be avoided.
The following are three common types of antidepressant medications that pregnant women should avoid:

1. Paxil : Paxil is one type of antidepressant drug that is associated with fetal heart defects once taken during the first few months of pregnancy. Medical experts do not recommend the intake of Paxil medication to pregnant women. As for the risks on the baby, continuous intake of SSRI antidepressants may result to temporary withdrawal symptoms such as sleep disturbances and gastrointestinal complications.
2. Tricyclic antidepressants : Tricyclic antidepressants are the older classifications of antidepressants. Pregnant women are discouraged to use these types of medications, for these may pose higher risk for unborn babies to have physical deformities.
3. Selective serotonin reuptake inhibitors

When pregnant women take antidepressant medications like Celexa and Prozac, their unborn babies are more susceptible to develop serious lung complications. Despite such possible side effect on pregnancy, serotonin reuptake inhibitors medications are proven to be effective drug therapy for depression.

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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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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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Paxil is a postpartum miracle pill. Paxil saved me after having my first baby. I had a bad case of postpartum blues and had no idea what was going on. I had my first child at a young age, so I didn’t know much. After having my baby I became very depressed. I should have been the happiest person in the world but instead I was very sad.

I wouldn’t let anyone hold my baby, feed my baby, or change my baby’s diaper, including my husband. I would sit in the chair holding him and just cry for hours. I kept thinking to myself that he may just stop breathing and die. I was scared to lay him down because I felt that I may never hold him again, I felt like he may die at anytime.

This went on for a week, then someone told me I had postpartum depression. I called my doctor and told him what was going on and he told me that I definitely had postpartum depression and he was going to call me a prescription in.

He told me not to worry because many new mothers get postpartum blues. After taking paxil for about a week I began feeling better, feeling happy, and feeling like myself. For the first time since the birth of my baby, I was able to enjoy being a mother.

I was going through a bad depression before I took paxil. If I would have went on without paxil, I probably would have ended up in a mental hospital. Paxil is not habit forming, but you will need to be slowly taken off of it. Don’t try to quit cold turkey because you will more than likely have a bad relapse.

Avoid alcohol while taking paxil, it seems to make the depression worse. If you are nursing your baby, you can not take paxil because it will pass into your milk and on to your baby.

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