Antidepressants In Pregnancy. Are they Safe?

Depression is a common condition that afflicts women. Depressed pregnant women are at risk of preterm labor and worsening of their depression. Hence, treatment of these patients is important. That is why two recent articles that appeared in the New England Journal of Medicine about drug treatment of depression in pregnancy are important.

Previous studies implicated the selective serotonin reuptake inhibitors (SSRI's) like Paxil, Prozac and Zoloft in causing birth defects. These two new studies agree that the SSRI's have low risk of causing fetal abnormalities. Pregnant women who have depression should take comfort that they can take the SSRI's without having to worry about having abnormal babies. The abnormalities found in previous studies are rare.

Reference: New England Journal of Medicine.

Depressed Women May Have Premature Babies

A study done in England on depressed pregnant women showed the severely depressed women who were not taking medications had premature labor.

That depression produces stress hormones is exemplified by this study. Dr. O'Keane, a perinatal psychiatrist at the King's College in London measured corticotrophin releasing hormone (CRF) in 25 depressed pregnant women who were not on any antidepressant medications and 35 pregnant women who had no depression.

Levels of CRF and cortisol, hormones related to stress and also produced  by the placenta in pregnancy were found to be higher in women with depression.

While none of the mothers that were not depressed had premature deliveries, on the average, the depressed mothers had their babies 2 days earlier and 3 of them had premature deliveries.

During the follow up visit, the babies whose mothers had depression had high levels of cortisol in their saliva, a sign that their mothers' stress had effect on them..

The study involved a few patients. More studies are needed to elucidate the findings of this interesting small study. The take home message is that depressed pregnant patients' stress may have effect on their unborn babies. The effect may even continue after delivery. Hence pregnant women who are depressed should be treated with antidepressants despite the fear that some of the antidepressants may have effect on the newborn babies.

 

Reference: From issue 2599 of New Scientist magazine, 14 April 2007, page 18

Estrogen Therapy is good for the Young Postmenopausal Woman’s Heart.

The estrogen therapy controversy has not been put to rest yet. The WHI study that was highly publicized showed that postmenopausal women who took estrogen did not benefit from the estrogen replacement therapy and may even be at an increased risk of having heart disease.

In 1994, the Women Health Initiative trial using estrogen alone showed no adverse effect from the estrogen therapy. That study was stopped prematurely.

A study published by Manson and her colleagues in the most recent New England Journal of Medicine showed that estrogen therapy in younger women (50 -59 years), who have recently undergone hysterectomy with removal of their ovaries and hence have had surgical menopause, have protection against heart disease by keeping the lumen of the blood vessels open. Without the estrogen, calcium is deposited in the walls of the blood vessels thus causing narrowing.

The take home message is that in women who have had hysterectomy with removal of their ovaries in their 40’s to early 50’s, estrogen replacement therapy may be beneficial to the heart as it slows down the narrowing of the blood vessels.