“Treating depression in pregnancy - WPVI” plus 4 more

Treating depression in pregnancy - WPVI
Talk, Drug Therapy May Ease Depression in Pregnancy - ABC News
Are Antidepressants Safe During Pregnancy? - WebMD
Should Pregnant Women Take Antidepressants? - eMaxHealth.com
Baby is delivered as swine flu kills pregnant mom - St. Petersburg Times

Posted: 21 Aug 2009 02:54 PM PDT

August 21, 2009 (WPVI) -- The first-ever concrete guidelines are released to help doctors and patients decide the best way to treat depression in pregnancy.

The guidelines are a joint effort by the American Psychiatric Association and the American College of Obstetricians and Gynecologists.

As many as 23-percent of pregnant women will experience depression. And while treating with medication comes with risks,doctors say not treating depression can also cause problems.

"It's been shown women untreated in depression can have smaller babies and there are issues after delivery with slower development," Dr. Dana Farabaugh of Drexel University College of Medicine OB/GYN said.

The new guidelines show for some patients with severe, recurrent depression, it may be safer to treat with medication. Other women may do well with psychotherapy.

The guidelines also call for open communication between the OB doctor, a psychiatrist and the patient.

"You need to treat all the aspects of the patient and communication is the best way to go about that," Dr. Farabaugh said.

To read more on the guidelines, visit: www.psych.org

Are Antidepressants Safe During Pregnancy?

Aug. 21, 2009 -- Women who take antidepressants face a difficult choice when they become pregnant, and for many the risks vs. benefits of continuing treatment are not clear, a joint report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists finds.

The report confirms that there are far more questions than answers about the dangers antidepressants pose to the babies born to women who take them.

It also presents guidelines to help doctors and patients identify who should and should not consider stopping drug treatment.

Pregnant women who experience psychotic episodes, have bipolar disorder, or who are suicidal or have a history of suicide attempts should not be taken off antidepressants, the report concludes.

"We know that untreated depression poses real risks to babies. That is not conjecture," Yale University School of Medicine ob-gyn Charles Lockwood, MD, tells WebMD. "We know much less about the risks associated with antidepressant use. It is clear that more study is needed."

According to one study, the rate of antidepressant use during pregnancy more than doubled between 1999 and 2003. The study found that in 2003, one in eight women took an antidepressant at some point during her pregnancy.

Greater use of selective serotonin reuptake inhibitor (SSRI) antidepressants like Prozac, Paxil, and Zoloft were largely responsible for the increase.

These drugs were generally considered safe for pregnant women at the time, but safety concerns soon emerged, especially regarding Paxil.

Separate studies from Sweden and the U.S. suggested an increased risk for congenital heart defects in babies born to women who took Paxil during pregnancy.

The reports led the FDA to issue an advisory in December 2005 warning about the potential risk based on early results of two studies.

But the joint panel found the evidence linking Paxil use during pregnancy to heart problems in newborns to be inconclusive.

Lockwood tells WebMD that if the risk is real, it is probably not limited to Paxil alone.

"It is very likely to be a class effect and not just this one drug," he says.

Miscarriage, Low Birth Weight, and Preterm Birth

SSRI use during pregnancy has also been linked in some studies to an increased risk for miscarriage, low birth weight, and preterm delivery.

But once again, the report found no definitive link between the use of the antidepressants and these pregnancy outcomes.

"Antidepressant use in pregnancy is well studied, but available research has not yet adequately controlled for other factors that may influence birth outcomes including maternal illness or behaviors that can adversely affect pregnancy," the joint panel writes.

The report was published in both the American Psychiatric Association journal General Hospital Psychiatry and the American College of Obstetricians and Gynecology journal Obstetrics and Gynecology.

The joint panel concludes that a gradual reducing of antidepressant dosages and stopping antidepressants altogether may be appropriate for women who hope to become pregnant if they have had mild or no symptoms for six months or longer.

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Should Pregnant Women Take Antidepressants? - eMaxHealth.com

Posted: 21 Aug 2009 08:09 PM PDT

The risks associated with the use of antidepressants by pregnant women is the focus of a just-released joint report from the American College of Obstetricians and Gynecologists (ACOG) and the American Psychiatric Association (APA). Although the report provides some important guidelines for pregnant women about possible antidepressant use, it also leaves many questions unanswered about the dangers the drugs pose to the infants.

The dilemma has several facets. Accurate diagnosis of depression during pregnancy can be problematic because its symptoms are similar to those women experience during pregnancy, such as mood swings, low energy level, and changes in appetite. Research has shown that while depression is associated with premature births and changes in fetal growth, use of antidepressants may also cause medical problems for newborns. Thus, if a pregnancy woman is depressed, doctors may be hesitant to treat them because of the unknowns regarding drug treatment.

For example, research shows that in 2003, one in eight pregnant women took an antidepressant during her pregnancy. This rate of use reflects a two-fold increase in antidepressant use during pregnancy between 1999 and 2003. Drugs such as Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine), which belong to the drug class of selective serotonin reuptake inhibitors (SSRIs), were associated with the increase.

Despite early reports that these SSRIs were safe for pregnant women, studies soon came out indicating that use of Paxil during pregnancy increased the risk for congenital heart defects in the delivered infants. A subsequent study, however, reported that the evidence was inconclusive. Other studies have suggested that use of SSRIs during pregnancy is associated with an increased risk of premature birth, miscarriage, and low birth weight.

In another example, a study published in the August 18, 2009 issue of Depression and Anxiety reported a significant increase in incidence rate in preterm births associated with the use of various antidepressants (including but not limited to bupropion, citalopram, paroxetine, venlafaxine, and sertraline) during pregnancy. In another article, which reported on a study of the same group of pregnant women, the researchers found no significant difference in the number of infants born with major malformation of women who had taken antidepressants during pregnancy and those who had not.

So, should pregnant women take antidepressants? The guidelines presented in the jointly prepared ACOG/APA report include a recommendation that women who plan to become pregnant should gradually reduce their use of antidepressants and stop them completely if they have had mild or no symptoms for at least six months. No woman, however, should stop taking her medication without her doctor's supervision.

Among some of the other recommendations from the ACOG/APA report are the following:

* Pregnant women who are psychiatrically stable who want to keep taking antidepressants should talk to their ob-gyn and psychiatrist about the potential risks and benefits

* Pregnant women should not attempt to stop their antidepressant use if they have severe depression

* Pregnant women who suffer recurrent depression or those who still have symptoms despite drug treatment may benefit from psychotherapy

* Women who are pregnant but not taking medication for depression may benefit from psychotherapy rather than antidepressant medication

* Any pregnant woman who has psychotic or suicidal symptoms should see a psychiatrist immediately for treatment

Additional recommendations can be read in the joint report, "Depression during Pregnancy: Treatment Recommendations."

SOURCES:
American Psychiatric Association and American College of Obstetricians and Gynecologists joint report
DG News August 21, 2009
Einarson A et al. Depression and Anxiety 2009 Aug 18; Epub before print
Einarson A et al. Canadian Journal of Psychiatry 2009 Apr; 54(4): 242-46
WebMD August 21, 2009

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Baby is delivered as swine flu kills pregnant mom - St. Petersburg Times

Posted: 21 Aug 2009 06:36 PM PDT

In Print: Saturday, August 22, 2009

TAMPA — A 22-year-old pregnant woman died Thursday after becoming ill with swine flu, according to the Hillsborough County Health Department.

The baby was delivered and is at a local hospital, said Health Department spokesman Steve Huard. He did not release further details of the case, citing federal patient confidentiality laws.

National health experts say pregnant women are more vulnerable than most people to severe complications from the swine flu virus, formally know as H1N1, which emerged in the spring. A higher proportion of pregnant flu victims have been hospitalized, some of whom have died, preliminary studies indicate.

Pregnant women recently were declared a high-priority group to receive the H1N1 vaccine when it becomes available in the fall.

The woman who died Thursday did not appear to have other underlying medical conditions that would increase her vulnerability to swine flu, Huard said.

The case appears to mark the first swine-flu-related death of a pregnant woman in the region. It is the sixth confirmed death in Hillsborough linked to the virus.

Florida has had 59 deaths involving laboratory confirmed H1N1, according to the latest figures released Wednesday. A South Florida infant died in July after being delivered prematurely while her mother, suffering from swine flu, was in a medically induced coma. The mother survived.

Changes in women's bodies during pregnancy make it harder for them to shake off both seasonal flu and the swine flu virus, which has become a global pandemic.

As pregnancy advances into the second and third trimesters, women's lung capacity decreases, making it tougher to tolerate a respiratory infection like influenza.

Pregnancy also affects the immune system, making it more difficult for a woman to fight the virus.

Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322. For more health news, visit www.tampabay.com/health.

[Last modified: Aug 21, 2009 09:24 PM]