Entries in SSRIs (2)


Depression During Pregnancy: Weighing Risks, Benefits of SSRIs

Comstock/Thinkstock(ROTTERDAM, Netherlands) -- After two years of trying, Tricia Stream was overjoyed to find herself pregnant with twins. But her mind quickly turned to the drug she'd been taking to treat her depression.

"I didn't know what to do," said Stream, 31, who had been taking the selective serotonin reuptake inhibitor Zoloft for seven years. "I was so worried about having a depressive episode, and I was really worried about postpartum depression. But I didn't want to expose my babies to the drug."

Left untreated, depression during pregnancy can increase the risk of pre-eclampsia, low birth weight and maternal suicide. But treating prenatal depression with certain antidepressants carries risks, too. A new study suggests SSRIs may increase the risk of preterm birth and delay fetal head growth.

"Our findings further raise the question whether maternal SSRI treatment during pregnancy is better or worse for the fetus than untreated maternal depression," wrote study author Hanan El Marroun of Erasmus Medical Center in Rotterdam, the Netherlands. "Clinicians must carefully weigh the known risks of untreated depression during pregnancy and the possible adverse effects of SSRIs."

The study followed 7,696 pregnant women, 570 of whom had untreated depressive symptoms and 99 of whom took SSRIs for depression.

"Untreated depressive symptoms were associated with a reduction in total body growth, including the fetal head, during pregnancy," the authors wrote. "In contrast, prenatal SSRI use was related to a reduced growth of the fetal head, whereas prenatal SSRI use did not affect growth of the fetal body."

While delayed fetal head growth may be linked behavioral problems and psychiatric disorders, the authors caution "we must be careful not to infer an association of SSRI use in pregnancy with future developmental problems."

Babies born to women taking SSRIs were also more likely to be born preterm, according to the study, which was published Monday in Archives of General Psychiatry.

But for some women, the benefits of taking SSRIs during pregnancy far exceed the risks.

"If we are talking about a woman who can't take care of her health as a result of battling with moderate to severe depression, she faces risks to herself as well as the baby that are associated with untreated depression during pregnancy," said Dr. Sudeepta Varma, clinical assistant professor of psychiatry at NYU Langone School of Medicine. "All doctors want to ensure healthy mom and baby. But if you don't take care of the mom, there may be no baby to speak of."

After weighing the benefits and the risks with her obstetrician and psychiatrist, Stream decided to keep taking Zoloft during her pregnancy.

"For me, there was more concern about the effects of depression than the effects of taking antidepressants," she said, describing the "I don't care" attitude typical of her depressive episodes.

Aside from miserable morning sickness, Stream's pregnancy was progressing fine until week 22, when she was admitted to the hospital with a weakened cervix. And despite drugs to prevent preterm birth, she went into labor at 27 weeks.

"I definitely felt the guilt, overwhelmingly," said Stream, describing how she felt "unable to protect them, unable to keep them healthy. They were Memorial Day babies when they were supposed to be Labor Day babies."

Logan and Caden Stream came out crying at 2 pounds, a good sign given their early arrival. And for three months, the tiny pink "Muppets" were hooked up to machines in the neonatal intensive care unit. Stream said she can't imagine how she would have fared off Zoloft.

"It probably would have made me feel like I was going to lose my children, as opposed to having a fighting spirit," she said. "I needed that strength."

After three months, the boys were strong enough to go home. And last week, a letter from a high-risk neonatologist said the 21-month-old twins had "no lasting effects of prematurity."

"That's the best news I ever could have gotten," said Stream. "I'm going to frame that."

Copyright 2012 ABC News Radio


Depression Raises Women's Stroke Risk

Creatas Images/Thinkstock(BOSTON) -- Depression puts middle-aged and older women at significant risk of suffering potentially debilitating strokes, according to a study published Thursday. Depressed women who reported taking such popular antidepressants as Prozac, Zoloft and Celexa were "perhaps at even higher risk," the study's senior author said.

"There is something about being depressed that increases your risk of stroke," said Dr. Kathryn Rexrode, an internist at Brigham and Women's Hospital in Boston. However, she took pains to say that women taking antidepressants should not interpret the findings as a signal that "stopping SSRIs is going to make your risk of stroke go down. There is no data about that." (SSRIs, or selective serotonin reuptake inhibitors, are the most commonly prescribed antidepressants.)

"I don't think the medications themselves are the primary cause of the risk," Rexrode said. Instead, she suggested that women who medicate their depression might suffer from more severe symptoms than those who don't opt for the pills.

The bottom line, she said, was that regardless of the mechanism, doctors need to be made aware of the relationship between depression and strokes. "We ought to intensify efforts to reduce that risk through the usual risk factors for stroke, and we ought to test and research interventions we can to do help modify that risk."

Strokes constitute the nation's third-leading cause of death. Strokes that don't kill often leave sufferers with trouble speaking, thinking and with limited use of their limbs. As a result, strokes are a leading cause of permanent disability.

The findings, which appear in Stroke: Journal of the American Heart Association, were drawn from the landmark Nurses' Health Study, which began in 1976 and has followed more than 120,000 women for numerous health conditions. Researchers studying stroke risk followed 80,574 of them, predominantly white, female RNs, with an average age of 66, without any stroke history.

Study participants underwent periodic evaluations for depression, and were asked every couple of years if they'd taken antidepressants or had been diagnosed with depression by a doctor. At the beginning of the study, 22.3 percent of the women were depressed, meaning that they scored high for symptoms of depression, had taken antidepressants or had a formal diagnosis of depression.

During six years of follow-up, researchers documented 1,033 strokes. They calculated that depression increased a woman's risk of stroke by 29 percent, compared with women who never reported being depressed. Among depressed women taking any of the SSRIs, stroke risk was 39 percent higher than among women who never reported being depressed or taking antidepressants.

Rexrode said that depression might interfere with a woman's ability to control such risk factors as diabetes and hypertension through medication, or by making important lifestyle changes.

Rexrode and her co-authors could not explain the mechanism linking depression and strokes, but suggested that depression might increase inflammation, which is known to damage blood vessels in the heart and brain. Depression also can alter neurological functions and the body's response to stress, and may make blood more likely to clot.

Copyright 2011 ABC News Radio

ABC News Radio