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Galbally M, Watson SJ, Nguyen T, Boyce P. Fetal SSRI antidepressant exposure and infant sleep: Findings from the MPEWS pregnancy cohort study. Infant Behav Dev 2023; 72:101849. [PMID: 37390573 DOI: 10.1016/j.infbeh.2023.101849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 05/05/2023] [Accepted: 06/03/2023] [Indexed: 07/02/2023]
Abstract
This longitudinal study examines the association between fetal Selective Serotonergic Reuptake Inhibitor antidepressant exposure and infant sleep behaviours at six and 12 months of age and focus on three of the most commonly prescribed antidepressants in pregnancy. This study utilises data on 698 women recruited at less than 20 weeks of pregnancy and are followed up at six and 12 months postpartum. Women were recruited into one of three groups: those taking either sertraline, citalopram or escitalopram antidepressants in pregnancy (n = 85); women with a depressive disorder who were not taking antidepressants (non-medicated depressed, NMD; n = 82); and, and a control group of women (n = 531). At six and 12 months, data were collected on breastfeeding and sleep location and infant sleep was measured using the Brief Infant Sleep Questionnaire. Antidepressants sertraline, escitalopram and citalopram were not associated with increased infant waking or time awake. However, sertraline was associated with longer time for an infant to go to sleep. This study provides reassurance that SSRI antidepressants and, in particular, sertraline, escitalopram and citalopram are not associated with infant sleep behaviours that are commonly regarded as problematic including night waking. Further replication of these findings, including with direct measures of infant sleep, are recommended.
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Affiliation(s)
- Megan Galbally
- School of Clinical Sciences, Monash University, Australia; Health Futures Institute, Murdoch University, Murdoch, Australia; The University of Western Australia Faculty of Medicine Dentistry and Health Sciences, School of Medicine, Australia.
| | - Stuart J Watson
- School of Clinical Sciences, Monash University, Australia; Health Futures Institute, Murdoch University, Murdoch, Australia
| | - Thinh Nguyen
- The University of Western Australia Faculty of Medicine Dentistry and Health Sciences, School of Medicine, Australia; Peel and Rockingham/Kwinana Health Service, Mental Health, Australia
| | - Philip Boyce
- Specialty of Psychiatry, Westmead Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Australia
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2
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Hussain-Shamsy N, Somerton S, Stewart DE, Grigoriadis S, Metcalfe K, Oberlander TF, Schram C, Taylor VH, Dennis CL, Vigod SN. The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy. BMC Med Inform Decis Mak 2022; 22:130. [PMID: 35562801 PMCID: PMC9099318 DOI: 10.1186/s12911-022-01870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background People with moderate to severe depression in pregnancy must weigh potential risks of untreated or incompletely treated depression against the small, but uncertain risks of fetal antidepressant drug exposure. Clinical support alone appears insufficient for helping individuals with this complex decision. A patient decision aid (PDA) has the potential to be a useful tool for this population. The objective of our work was to use internationally recognized guidelines from the International Patient Decision Aids Standards Collaboration to develop an evidence-based PDA for antidepressant use in pregnancy. Methods A three-phased development process was used whereby, informed by patient and physician perspectives and evidence synthesis, a steering committee commissioned a web-based PDA for those deciding whether or not to start or continue antidepressant treatment for depression in pregnancy (Phase 1). A prototype was developed (Phase 2) and iteratively revised based on feedback during field testing based on a user-centred process (Phase 3). Results We developed a web-based PDA for people deciding whether to start or continue antidepressant use for depression in pregnancy. It has five interactive sections: (1) information on depression and treatment; (2) reasons to start/continue an antidepressant and to start/stop antidepressant medication; (3) user assessment of values regarding each issue; (4) opportunity to reflect on factors that contribute to decision making; and (5) a printable PDF that summarizes the user’s journey through the PDA. Conclusions This tool, which exclusively focuses on depression treatment with Selective Serotonin Reuptake Inhibitors and Serotonin–Norepinephrine Reuptake Inhibitors, can be used by individuals making decisions about antidepressant use to treat depression during pregnancy. Limitations of the PDA are that it is not for other conditions, nor other medications that can be used for depression, and in its pilot form cannot be used by women who do not speak English or who have a visual impairment. Pending further study, it has the potential to enhance quality of care and patient experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01870-1.
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Affiliation(s)
- Neesha Hussain-Shamsy
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada
| | - Sarah Somerton
- Garry Hurvitz Centre for Brain and Mental Health, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada
| | - Donna E Stewart
- Centre for Mental Health, University Health Network, Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON, Canada.,Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada
| | - Sophie Grigoriadis
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre and Research Institute, 2075 Bayview Avenue, Toronto, ON, Canada.,Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Kelly Metcalfe
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada
| | - Tim F Oberlander
- BC Children's Hospital, 4500 Oak Street, Vancouver, BC, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada
| | - Carrie Schram
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada
| | - Simone N Vigod
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada. .,Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada. .,Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
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Einspieler C, Prayer D, Marschik PB. Fetal movements: the origin of human behaviour. Dev Med Child Neurol 2021; 63:1142-1148. [PMID: 33973235 DOI: 10.1111/dmcn.14918] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 02/01/2023]
Abstract
The study of the onset and ontogeny of human behaviour has made it clear that a multitude of fetal movement patterns are spontaneously generated, and that there is a close association between activity and the development of peripheral and central structures. The embryo starts moving by 7.5 week's gestation; 2 to 3 weeks later, a number of movement patterns including general movements, isolated limb and head movements, hiccup, and breathing movements, appear. Some movements (e.g. yawning, smiling, 'pointing'; we show these in eight videos in this review) precede life-long patterns; others have intrauterine functions, such as sucking/swallowing for amniotic fluid regulation, breathing movements for lung development, or eye movements for retinal cell diversity. In cases of developmental brain dysfunction, fetal general movements alter their sequence and gestalt, which suggests a dysfunction of the developing nervous system. The scarcity of longitudinal studies calls for further comprehensive research on the predictive value of prenatal functional deviations. What this paper adds Motor output can occur in the absence of sensory input. Structural development is activity-dependent. Fetal general movements are among the first movement patterns to occur. Pregnancy-related and maternal factors impact quantity and modulation of fetal general movements. Prenatal general movement assessment has not yet brought the expected breakthrough.
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Affiliation(s)
- Christa Einspieler
- Research Unit iDN, Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Peter B Marschik
- Research Unit iDN, Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria.,Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen and LeibnizScience Campus Primate Cognition, Göttingen, Germany.,Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
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4
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Postnatal Fluoxetine Treatment Alters Perineuronal Net Formation and Maintenance in the Hippocampus. eNeuro 2021; 8:ENEURO.0424-20.2021. [PMID: 33622703 PMCID: PMC8046023 DOI: 10.1523/eneuro.0424-20.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/20/2023] Open
Abstract
Elevation of serotonin via postnatal fluoxetine (PNFlx) treatment during critical temporal windows is hypothesized to perturb the development of limbic circuits thus establishing a substratum for persistent disruption of mood-related behavior. We examined the impact of PNFlx treatment on the formation and maintenance of perineuronal nets (PNNs), extracellular matrix (ECM) structures that deposit primarily around inhibitory interneurons, and mark the closure of critical period plasticity. PNFlx treatment evoked a significant decline in PNN number, with a robust reduction in PNNs deposited around parvalbumin (PV) interneurons, within the CA1 and CA3 hippocampal subfields at postnatal day (P)21 in Sprague Dawley rat pups. While the reduction in CA1 subfield PNN number was still observed in adulthood, we observed no change in colocalization of PV-positive interneurons with PNNs in the hippocampi of adult PNFlx animals. PNFlx treatment did not alter hippocampal PV, calretinin (CalR), or Reelin-positive neuron numbers in PNFlx animals at P21 or in adulthood. We did observe a small, but significant increase in somatostatin (SST)-positive interneurons in the DG subfield of PNFlx-treated animals in adulthood. This was accompanied by altered GABA-A receptor subunit composition, increased dendritic complexity of apical dendrites of CA1 pyramidal neurons, and enhanced neuronal activation revealed by increased c-Fos-positive cell numbers within hippocampi of PNFlx-treated animals in adulthood. These results indicate that PNFlx treatment alters the formation of PNNs within the hippocampus, raising the possibility of a disruption of excitation-inhibition (E/I) balance within this key limbic brain region.
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Antenatal Antidepressant Prescription Associated With Reduced Fetal Femur Length but Not Estimated Fetal Weight: A Retrospective Ultrasonographic Study. J Clin Psychopharmacol 2021; 41:571-578. [PMID: 34412105 PMCID: PMC8440368 DOI: 10.1097/jcp.0000000000001446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE/BACKGROUND Antidepressants are among the most frequently prescribed medications during pregnancy and may affect fetal weight. Associations between antenatal antidepressant use and ultrasonographic measures of fetal development have rarely been examined. We hypothesized that the prescription of an antenatal antidepressant would be associated with lower estimated fetal weight (EFW). METHODS/PROCEDURES A retrospective analysis of routine ultrasonographic data extracted from electronic medical records was performed on a cohort of pregnant women with psychiatric diagnoses and grouped according to the presence of an antenatal antidepressant prescription (n = 32 antidepressant-prescribed and n = 44 antidepressant prescription-free). After stratifying for gestational age, comparisons included 13 ultrasonographic parameters, frequency of oligohydramnios and polyhydramnios and growth deceleration, and maternal serum protein markers assessed per routine care, including α-fetoprotein, free β-human chorionic gonadotropin, and unconjugated estriol levels, using t tests, nonparametric and Fisher tests, and effect sizes (ESs) were computed. FINDINGS/RESULTS No statistically significant EFW differences between groups at any time point were detected (P > 0.05). Antenatal antidepressant prescription was associated with lower femur length at weeks 33 to 40 (P = 0.046, ES = 0.75) and greater left ventricular diameter at weeks 25 to 32 (P = 0.04, ES = 1.18). No differences for frequency of oligohydramnios or polyhydramnios or growth deceleration were observed (P > 0.05). We did not detect group differences for maternal proteins (P > 0.05). IMPLICATIONS/CONCLUSIONS Our evidence suggested a lack of association between antenatal antidepressant prescription and lower EFW but indicated an association with lower femur length and greater left ventricular diameter in mid-late gestation. Future research should examine the clinical implications of these findings.
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6
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Campbell KSJ, Collier AC, Irvine MA, Brain U, Rurak DW, Oberlander TF, Lim KI. Maternal Serotonin Reuptake Inhibitor Antidepressants Have Acute Effects on Fetal Heart Rate Variability in Late Gestation. Front Psychiatry 2021; 12:680177. [PMID: 34483982 PMCID: PMC8415315 DOI: 10.3389/fpsyt.2021.680177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/14/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants increases risk for adverse neurodevelopmental outcomes, yet little is known about whether effects are present before birth. In relation to maternal SRI pharmacokinetics, this study investigated chronic and acute effects of prenatal SRI exposure on third-trimester fetal heart rate variability (HRV), while evaluating confounding effects of maternal depressed mood. Methods: At 36-weeks' gestation, cardiotocograph measures of fetal HR and HRV were obtained from 148 pregnant women [four groups: SRI-Depressed (n = 31), SRI-Non-Depressed (n = 18), Depressed (unmedicated; n = 42), and Control (n = 57)] before, and ~5-h after, typical SRI dose. Maternal plasma drug concentrations were quantified at baseline (pre-dose) and four time-points post-dose. Mixed effects modeling investigated group differences between baseline/pre-dose and post-dose fetal HR outcomes. Post hoc analyses investigated sex differences and dose-dependent SRI effects. Results: Maternal SRI plasma concentrations were lowest during the baseline/pre-dose fetal assessment (trough) and increased to a peak at the post-dose assessment; concentration-time curves varied widely between individuals. No group differences in fetal HR or HRV were observed at baseline/pre-dose; however, following maternal SRI dose, short-term HRV decreased in both SRI-exposed fetal groups. In the SRI-Depressed group, these post-dose decreases were displayed by male fetuses, but not females. Further, episodes of high HRV decreased post-dose relative to baseline, but only among SRI-Non-Depressed group fetuses. Higher maternal SRI doses also predicted a greater number of fetal HR decelerations. Fetuses exposed to unmedicated maternal depressed mood did not differ from Controls. Conclusions: Prenatal SRI exposure had acute post-dose effects on fetal HRV in late gestation, which differed depending on maternal mood response to SRI pharmacotherapy. Importantly, fetal SRI effects were sex-specific among mothers with persistent depressive symptoms, as only male fetuses displayed acute HRV decreases. At trough (pre-dose), chronic fetal SRI effects were not identified; however, concurrent changes in maternal SRI plasma levels suggest that fetal drug exposure is inconsistent. Acute SRI-related changes in fetal HRV may reflect a pharmacologic mechanism, a transient impairment in autonomic functioning, or an early adaption to altered serotonergic signaling, which may differ between males and females. Replication is needed to determine significance with postnatal development.
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Affiliation(s)
- Kayleigh S J Campbell
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Abby C Collier
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Irvine
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ursula Brain
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Dan W Rurak
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Tim F Oberlander
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth I Lim
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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Salisbury AL, Papandonatos GD, Stroud LR, Smith AK, Brennan PA. Prenatal antidepressant exposures and gastrointestinal complaints in childhood: A gut-brain axis connection? Dev Psychobiol 2020; 62:816-828. [PMID: 32167584 PMCID: PMC7709733 DOI: 10.1002/dev.21966] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/27/2019] [Accepted: 02/13/2020] [Indexed: 01/16/2023]
Abstract
Selective serotonin/norepinephrine reuptake inhibitors (collectively, SRIs) are the most commonly prescribed antidepressant agents for the treatment of depression in pregnancy. SRIs affect maternal and placental serotonin signaling, which might impact fetal brain development. Alterations in serotonin signaling might also impact the developing gut-brain axis (GBA) via alterations in the fetal enteric nervous system (ENS). Emerging evidence suggests that gestational SRI exposure may be associated with offspring gastrointestinal problems. However, prospective human studies of the effects of fetal SRI exposure on the ENS and function are absent in the literature. In this paper we present data demonstrating significant associations between prenatal SRI exposure and children's gastrointestinal (GI) problems in two well-characterized, prospective cohorts of preschool and later childhood individuals. The results support the hypothesis that prenatal SRI exposure can increase the risk for childhood GI difficulties. Further research is warranted on the potential SRI-induced changes to the child gut including the role of the microbiome and the GBA in the development of GI problems.
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Affiliation(s)
- Amy L. Salisbury
- Brown Center for the Study of Children at Risk, Women and Infants Hospital of Rhode Island, Providence, RI, USA
- Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Laura R. Stroud
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Alicia K. Smith
- Department of Gynecology and Obstetrics, Dept of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA 30322
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Karimipour M, Ahmadi A, Zirak Javanmard M, Jafari A, Mohebi M, Hosseinalipour E. The effects of exposure to fluoxetine during lactation on testicular tissue and sperm parameters in mice offspring. VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2020; 11:35-42. [PMID: 32537105 PMCID: PMC7282220 DOI: 10.30466/vrf.2018.82090.2082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/25/2018] [Indexed: 11/02/2022]
Abstract
Fluoxetine is a selective serotonin reuptake inhibitor is commonly prescribed to treat maternal depression in pregnancy and lactation. This study aimed to investigate the effects of maternal exposure to fluoxetine via lactation on testicular tissue, sperm parameters including count, motility, viability, and normal morphology and testicular oxidative stress status in male mice offspring. Ten mice dams were divided into control and experimental groups. The control group received water and the experimental group received fluoxetine (20.00 mg kg-1) by gavage daily from postnatal days of 0-21. Histology of testis, sperm parameters and oxidative stress in the testicular tissue were analyzed at 80 days after birth in their male offspring (n = 8). Significant reductions in the body and testes weights were observed in animals exposed to fluoxetine. Additionally, fluoxetine exposure significantly reduced all sperm parameters, tubular diameter and epithelial height of the seminiferous tubules as well as Leydig cells number. Significant increases in the testicular malondialdehyde levels and percentage of sperm with chromatin/DNA damage were observed in mice exposed to fluoxetine compared to control. These findings suggest that maternal exposure to fluoxetine during lactation in mice has a negative effect on the testicular tissue of their offspring and impairs the spermatogenesis process which in turn can induce infertility.
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Affiliation(s)
- Mojtaba Karimipour
- Department of Anatomy and Histology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Abbas Ahmadi
- Department of Basic Sciences, Faculty of Veterinary Medicine, Urmia University , Urmia, Iran
| | - Masoumeh Zirak Javanmard
- Department of Anatomy and Histology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Abbas Jafari
- Department of Occupational Health, School of Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Maryam Mohebi
- Department of Anatomy and Histology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Elnaz Hosseinalipour
- Department of Anatomy and Histology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
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Wilson C, Li S, Hannan AJ, Renoir T. Antidepressant-like effects of ketamine in a mouse model of serotonergic dysfunction. Neuropharmacology 2020; 168:107998. [PMID: 32061666 DOI: 10.1016/j.neuropharm.2020.107998] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 12/28/2022]
Abstract
Traditional monoaminergic treatments of depression frequently exhibit suboptimal tolerability and effectiveness. The 'short' (s) allele variant of 5-HTTLPR is known to compromise transcriptional efficacy of the serotonin transporter (5-HTT) and can reduce treatment response to traditional antidepressants (e.g. selective serotonin reuptake inhibitors or SSRIs). This study sought to establish the 5-HTT knock-out (KO) line as a mouse model of SSRI-resistant depression and assess its response to a novel glutamatergic antidepressant, ketamine, a non-competitive N-methyl-d-aspartate receptor (NMDAR) antagonist. Following acute antidepressant treatment, 5-HTT KO mice and wild-type (WT) controls were subjected to the forced-swim test (FST), one of the most widely used techniques to detect acute antidepressant response. As hypothesised, when assessed 30 min after administration in the FST, the SSRI sertraline (20 mg/kg, i.p.) produced antidepressant-like effects in WT control but not in 5-HTT KO mice. In contrast, ketamine (20 mg/kg, i.p.) induced antidepressant-like effects in both genotypes. 5-HTT KO mice also exhibited a reduced locomotor response to both MK-801 (another NMDAR antagonist) and ketamine, and reduced GluN2A protein levels in the hippocampus, suggesting glutamatergic dysfunction in this model. These results highlight the utility of 5-HTT KO mice as a relevant model of SSRI-resistant depression and demonstrate that ketamine can produce acute antidepressant-like effects in conditions of 5-HTT deficiency. These findings extend existing literature that indicates ketamine is effective in ameliorating symptoms of treatment-resistant depression and may have implications for understanding the cellular and molecular mechanisms underlying the antidepressant effects of ketamine. This article is part of the special issue entitled 'Serotonin Research: Crossing Scales and Boundaries'.
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Affiliation(s)
- Carey Wilson
- Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Parkville, Australia; Melbourne School of Psychological Science, University of Melbourne, Parkville, Australia
| | - Shanshan Li
- Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Parkville, Australia
| | - Anthony J Hannan
- Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Parkville, Australia; Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Australia
| | - Thibault Renoir
- Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Parkville, Australia; Facssulty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia.
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ZAİMOĞLU A, AKYÜZ B, BİLGE SS. Prenatal Sitalopram Maruziyetinin Sıçanların Motor ve Kognitif Fonksiyonları Üzerine Etkisi. ACTA MEDICA ALANYA 2019. [DOI: 10.30565/medalanya.556757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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11
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Nguyen TA, Chow T, Riggs W, Rurak D. Postnatal outcomes in lambs exposed antenatally and acutely postnatally to fluoxetine. Pediatr Res 2019; 85:1032-1040. [PMID: 30739124 DOI: 10.1038/s41390-019-0309-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/31/2018] [Accepted: 01/16/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Approximately 1/3 of newborns exposed antenatally to selective serotonin reuptake inhibitors (SSRIs) exhibit poor neonatal adaptation. Although several potential mechanisms have been proposed, the actual mechanism has not been elucidated. METHODS We investigated outcomes in neonatal lambs exposed prenatally or postnatally to fluoxetine (FX). Daily FX injections (50 mg) were given intravenously (i.v.) to five pregnant ewes via implanted catheters beginning at 131-132 days gestation (term = 147 days) for 2 weeks. In another group, lambs with implanted vascular catheters had sterile water (n = 9) or FX (1 mg/kg, n = 12) injected i.v. on ~postnatal day (PND) 4. RESULTS Prenatal FX-exposed lambs (n = 7) were hyperactive during PND 4 to 14 and their heart rate variability (HRV) was significantly lower than in control lambs (n = 7) on PND 2. In contrast, arterial pressure, heart rate, electrocardiogram, arterial blood gases, pH, glucose, lactate, cortisol, and sleep-activity cycles were not altered following postnatal FX injection. CONCLUSION This abnormal postnatal hyperactivity with antenatal FX exposure may reflect increased maturity in terms of locomotory activity. The results suggest that altered brain development may be involved in the poor neonatal adaptation in human infants exposed to FX in utero.
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Affiliation(s)
- Tuan Anh Nguyen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Timothy Chow
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Riggs
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Dan Rurak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.
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12
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Depresión en el embarazo. ACTA ACUST UNITED AC 2019; 48:58-65. [DOI: 10.1016/j.rcp.2017.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 02/15/2017] [Accepted: 07/10/2017] [Indexed: 11/19/2022]
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13
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Major depressive disorder during pregnancy: Psychiatric medications have minimal effects on the fetus and infant yet development is compromised. Dev Psychopathol 2018; 30:773-785. [PMID: 30068426 DOI: 10.1017/s0954579418000639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Psychotropic medication use and psychiatric symptoms during pregnancy each are associated with adverse neurodevelopmental outcomes in offspring. Commonly, studies considering medication effects do not adequately assess symptoms, nor evaluate children when the effects are believed to occur, the fetal period. This study examined maternal serotonin reuptake inhibitor and polypharmacy use in relation to serial assessments of five indices of fetal neurobehavior and Bayley Scales of Infant Development at 12 months in N = 161 socioeconomically advantaged, non-Hispanic White women with a shared risk phenotype, diagnosed major depressive disorder. On average fetuses showed the expected development over gestation. In contrast, infant average Bayley psychomotor and mental development scores were low (M = 84.10 and M = 89.92, range of normal limits 85-114) with rates of delay more than 2-3 times what would be expected based on this measure's normative data. Controlling for prenatal and postnatal depressive symptoms, prenatal medication effects on neurobehavioral development were largely undetected in the fetus and infant. Mental health care directed primarily at symptoms may not address the additional psychosocial needs of women parenting infants. Speculatively, prenatal serotonin reuptake inhibitor exposure may act as a plasticity rather than risk factor, potentially enhancing receptivity to a nonoptimal postnatal environment in some mother-infant dyads.
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An experimental test of the fetal programming hypothesis: Can we reduce child ontogenetic vulnerability to psychopathology by decreasing maternal depression? Dev Psychopathol 2018; 30:787-806. [PMID: 30068416 DOI: 10.1017/s0954579418000470] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Maternal depression is one of the most common prenatal complications, and prenatal maternal depression predicts many child psychopathologies. Here, we apply the fetal programming hypothesis as an organizational framework to address the possibility that fetal exposure to maternal depressive symptoms during pregnancy affects fetal development of vulnerabilities and risk mechanisms, which enhance risk for subsequent psychopathology. We consider four candidate pathways through which maternal prenatal depression may affect the propensity of offspring to develop later psychopathology across the life span: brain development, physiological stress regulation (hypothalamic-pituitary-adrenocortical axis), negative emotionality, and cognitive (effortful) control. The majority of past research has been correlational, so potential causal conclusions have been limited. We describe an ongoing experimental test of the fetal programming influence of prenatal maternal depressive symptoms using a randomized controlled trial design. In this randomized controlled trial, interpersonal psychotherapy is compared to enhanced usual care among distressed pregnant women to evaluate whether reducing prenatal maternal depressive symptoms has a salutary impact on child ontogenetic vulnerabilities and thereby reduces offspring's risk for emergence of later psychopathology.
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15
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Prenatal stress and models explaining risk for psychopathology revisited: Generic vulnerability and divergent pathways. Dev Psychopathol 2018; 30:1041-1062. [PMID: 30068410 DOI: 10.1017/s0954579418000354] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The present review revisits three hypothesized models that potentially could explain how prenatal maternal stress influences fetal development, birth outcomes, and subsequent developmental psychopathology. These models were mostly based on animal models, and new evidence for these models from human studies is evaluated. Furthermore, divergent trajectories from prenatal exposure to adversities to offspring affected outcomes are reviewed, including the comparison of studies on prenatal maternal stress with research on maternal substance use and maternal malnutrition during pregnancy. Finally, new directions in research on the mechanism underlying prenatal stress effects on human offspring is summarized. While it is concluded that there is abundant evidence for the negative associations between prenatal maternal stress and offspring behavioral, brain, and psychopathological outcomes in humans, there is no consistent evidence for specific mechanisms or specific outcomes in relation to stress exposure in utero. Rather, principles of multifinality and equifinality best describe the consequences for the offspring, suggesting a generic vulnerability and different pathways from prenatal adversities to developmental psychopathology, which complicates the search for underlying mechanisms. New and promising directions for research are provided to get a better understanding of how prenatal stress gets under the skin to affect fetal development.
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Galbally M, Watson SJ, Teti D, Lewis AJ. Perinatal maternal depression, antidepressant use and infant sleep outcomes: Exploring cross-lagged associations in a pregnancy cohort study. J Affect Disord 2018; 238:218-225. [PMID: 29886202 DOI: 10.1016/j.jad.2018.05.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/12/2018] [Accepted: 05/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Both perinatal depression and infant sleep problems are common concerns in many communities, with these problems often coinciding. Findings in this area conflict and much of the research relies on poor measures of sleep and/or depression. Adding to this complexity is the rise in antidepressant treatment for perinatal maternal depression and no previous study has examined the relationship between such exposure and infant sleep. METHODS This study draws on four waves of data (early pregnancy and third trimester, and six and 12 months postpartum) from 264 women in the Mercy Pregnancy and Emotional Wellbeing Study, a prospective pregnancy cohort study of women recruited in early pregnancy in Melbourne, Australia. Cross-lagged regression models were used to examine reciprocity of longitudinal effects between depressive symptoms and infant sleep. RESULTS Maternal antepartum depression and antidepressant use were not significant predictors of infant sleep problems. Likewise, infant sleep problems were not significant predictors of postpartum maternal depression. However, maternal cognitions about infant sleep, characterised by maternal expectations to immediately attend to their crying child, did demonstrate positive reciprocal effects with infant nocturnal waking between six and 12 months postpartum. LIMITATIONS Infant sleep outcomes were reported by the mother and the sample were predominantly Anglophone, restricting generalizability of the models to other cultures. CONCLUSIONS Maternal depression and antidepressant use were not found to be significant factors in infant sleep problems and, likewise, infant sleep problems were not associated with maternal depression. However, postpartum maternal cognitions around six months postpartum regarding limit-setting at night may predict increases in later nocturnal infant signaling.
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Affiliation(s)
- Megan Galbally
- School of Psychology and Exercise Science, Murdoch University, Australia; School of Medicine, University of Notre Dame, Australia; King Edward Memorial Hospital, Australia.
| | - Stuart J Watson
- School of Psychology and Exercise Science, Murdoch University, Australia; School of Medicine, University of Notre Dame, Australia
| | - Doug Teti
- Human Development and Family Studies, The Pennsylvania State University, USA
| | - Andrew J Lewis
- School of Psychology and Exercise Science, Murdoch University, Australia
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Gartstein MA, Skinner MK. Prenatal influences on temperament development: The role of environmental epigenetics. Dev Psychopathol 2018; 30:1269-1303. [PMID: 29229018 PMCID: PMC5997513 DOI: 10.1017/s0954579417001730] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This review summarizes current knowledge and outlines future directions relevant to questions concerning environmental epigenetics and the processes that contribute to temperament development. Links between prenatal adversity, epigenetic programming, and early manifestations of temperament are important in their own right, also informing our understanding of biological foundations for social-emotional development. In addition, infant temperament attributes represent key etiological factors in the onset of developmental psychopathology, and studies elucidating their prenatal foundations expand our understanding of developmental origins of health and disease. Prenatal adversity can take many forms, and this overview is focused on the environmental effects of stress, toxicants, substance use/psychotropic medication, and nutrition. Dysregulation associated with attention-deficit/hyperactivity-disruptive disorders was noted in the context of maternal substance use and toxicant exposures during gestation, as well as stress. Although these links can be made based on the existing literature, currently few studies directly connect environmental influences, epigenetic programming, and changes in brain development/behavior. The chain of events starting with environmental inputs and resulting in alterations to gene expression, physiology, and behavior of the organism is driven by epigenetics. Epigenetics provides the molecular mechanism of how environmental factors impact development and subsequent health and disease, including early brain and temperament development.
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Affiliation(s)
- Maria A. Gartstein
- Department of Psychology, Washington State University, Pullman, WA-99164-4820, USA
| | - Michael K. Skinner
- Center for Reproductive Biology, School of Biological Sciences, Washington State University, Pullman, WA-99164-4236, USA
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18
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Neurobehavioral risks of SSRIs in pregnancy: Comparing human and animal data. Reprod Toxicol 2017; 72:191-200. [DOI: 10.1016/j.reprotox.2017.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/20/2017] [Accepted: 05/04/2017] [Indexed: 12/19/2022]
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Long-term effects of pre-pubertal fluoxetine on behaviour and monoaminergic stress response in stress-sensitive rats. Acta Neuropsychiatr 2017; 29:222-235. [PMID: 27819195 DOI: 10.1017/neu.2016.53] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Although prescription rates of antidepressants for children and adolescents have increased, concerns have been raised regarding effects on neurodevelopment and long-term outcome. Using a genetic animal model of depression, this study investigated the long-term effects of pre-pubertal administration of fluoxetine (FLX) on depressive-like behaviour in early adulthood, as well as on central monoaminergic response to an acute stressor. We postulated that pre-pubertal FLX will have lasting effects on animal behaviour and monoaminergic stress responses in early adulthood. METHODS Flinders sensitive line (FSL) rats received 10 mg/kg/day FLX subcutaneously from postnatal day 21 (PnD21) to PnD34 (pre-pubertal). Thereafter, following normal housing, rats were either subjected to locomotor testing and the forced swim test (FST) on PnD60 (early adulthood), or underwent surgery for microdialysis, followed on PnD60 by exposure to acute swim stress and measurement of stressor-induced changes in plasma corticosterone and pre-frontal cortical monoamine concentrations. RESULTS Pre-pubertal FLX did not induce a late emergent effect on immobility in FSL rats on PnD60, whereas locomotor activity was significantly decreased. Acute swim stress on PnD60 significantly increased plasma corticosterone levels, and increased pre-frontal cortical norepinephrine (NE) and 5-hydroxyindole-3-acetic acid (5-HIAA) concentrations. Pre-pubertal FLX significantly blunted the pre-frontal cortical NE and 5-HIAA response following swim stress on PnD60. Baseline dopamine levels were significantly enhanced by pre-pubertal FLX, but no further changes were induced by swim stress. CONCLUSION Pre-pubertal FLX did not have lasting antidepressant-like behavioural effects in genetically susceptible, stress-sensitive FSL rats. However, such treatment reduced locomotor activity, abrogated noradrenergic and serotonergic stressor responses and elevated dopaminergic baseline levels in adulthood.
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20
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Rotem-Kohavi N, Oberlander TF. Variations in Neurodevelopmental Outcomes in Children with Prenatal SSRI Antidepressant Exposure. Birth Defects Res 2017; 109:909-923. [DOI: 10.1002/bdr2.1076] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/25/2017] [Accepted: 06/01/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Naama Rotem-Kohavi
- Graduate Program in Neuroscience; University of British Columbia; Vancouver BC
- BC Children's Hospital Research Institute; Vancouver BC
| | - Tim F. Oberlander
- BC Children's Hospital Research Institute; Vancouver BC
- Department of Pediatrics; University of British Columbia; Vancouver BC
- School of Population and Public Health; University of British Columbia; Vancouver BC
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21
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Instanes JT, Halmøy A, Engeland A, Haavik J, Furu K, Klungsøyr K. Attention-Deficit/Hyperactivity Disorder in Offspring of Mothers With Inflammatory and Immune System Diseases. Biol Psychiatry 2017; 81:452-459. [PMID: 26809250 DOI: 10.1016/j.biopsych.2015.11.024] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prenatal inflammatory mechanisms may play a role in the pathogenesis of psychiatric disorders and could be relevant for attention-deficit/hyperactivity disorder (ADHD). We investigated maternal chronic somatic diseases with immune components as possible risk factors for ADHD in offspring. METHODS We performed a population-based nested case-control study by linking data from longitudinal Norwegian registers. We included all individuals born during the period 1967-2008 and alive at record linkage (2012). Individuals receiving ADHD medication during the years 2004-2012 were defined as patients with ADHD (N = 47,944), and all remaining individuals (N = 2,274,713) were defined as control subjects. The associations between maternal diseases and ADHD in offspring were analyzed using logistic regression models. RESULTS The following chronic diseases with immune components were related to ADHD in offspring: multiple sclerosis (adjusted odds ratio [OR] = 1.8; 95% confidence interval [CI] = 1.2-2.5), rheumatoid arthritis (adjusted OR = 1.7; 95% CI = 1.5-1.9), type 1 diabetes (adjusted OR = 1.6; 95% CI = 1.3-2.0), asthma (adjusted OR = 1.5; 95% CI = 1.4-1.6), and hypothyroidism (adjusted OR = 1.2; 95% CI = 1.1-1.4). In contrast, chronic hypertension and type 2 diabetes showed no significant associations. Estimates were almost unchanged with additional adjustment for parental ADHD, infant birth weight, and gestational age. Although point estimates for male and female offspring were different for some diseases (e.g., maternal asthma [adjusted OR = 1.7; 95% CI = 1.5-1.8 for female offspring and adjusted OR = 1.5; 95% CI = 1.4-1.6 for male offspring]), none of the associations differed significantly by offspring sex. CONCLUSIONS Several maternal somatic diseases with immune components were found to increase the risk of ADHD in offspring. The associations could involve several causal pathways, including common genetic predisposition and environmental factors, and increased insight into the mechanisms behind these relationships could enhance our understanding of the etiology of ADHD.
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Affiliation(s)
- Johanne T Instanes
- Department of Biomedicine, Bergen; Department of Global Public Health and Primary Care, Bergen; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen;Bergen.
| | - Anne Halmøy
- Department of Biomedicine, Bergen; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen;Bergen; Haukeland University Hospital;Bergen
| | - Anders Engeland
- Department of Global Public Health and Primary Care, Bergen; Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Jan Haavik
- Department of Biomedicine, Bergen; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen;Bergen; Haukeland University Hospital;Bergen
| | - Kari Furu
- Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, Bergen; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen;Bergen; Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen
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Hogue AN, Temple-Cooper ME, Lagzdins M, Worley S, Scwersenski J, Floyd R, Saker F. Effects of in-utero exposure to selective serotonin reuptake inhibitors and venlafaxine on term and preterm infants. J Neonatal Perinatal Med 2017; 10:371-380. [PMID: 29286926 DOI: 10.3233/npm-16133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We hypothesized that in-utero SSRI exposure affects Apgar scores and immediate post-delivery oxygen requirements. STUDY DESIGN SSRI in-utero exposure was assessed retrospectively in preterm neonates ≥ 28 weeks gestation and term neonates. Primary outcome was Apgar <7 at five minutes and delivery room oxygen requirements. Secondary endpoints included one-minute Apgar, length of stay, birth weight, and NICU admission. RESULTS Fifty-one preterm and 117 term neonates were exposed to a SSRI; mostly to sertraline. Pre-term SSRI-exposed neonates had 4.1 times higher delivery room oxygen requirements. One minute Apgar <7 was 3.5 times higher and NICU admission 5 times higher 95% CI (1.3-19) in SSRI-exposed term neonates. Higher doses of sertraline had associated adverse outcomes. CONCLUSION In-utero SSRI exposure was associated with increased neonatal care at birth, differences in Apgar scores compared with controls, and increased NICU admissions. Higher sertraline doses were associated with poorer outcomes.
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Affiliation(s)
- A N Hogue
- Department of Pharmacy Services, Hillcrest - Cleveland Clinic, Mayfield Heights, OH, USA
| | - M E Temple-Cooper
- Department of Pharmacy Services, Hillcrest - Cleveland Clinic, Mayfield Heights, OH, USA
| | - M Lagzdins
- Department of Pharmacy Services, Hillcrest - Cleveland Clinic, Mayfield Heights, OH, USA
| | - S Worley
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - J Scwersenski
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - R Floyd
- Department of Pharmacy Services, Hillcrest - Cleveland Clinic, Mayfield Heights, OH, USA
| | - F Saker
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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Selective serotonin reuptake inhibitors for depression in pregnancy. Am J Obstet Gynecol 2016; 215:722-730. [PMID: 27430585 DOI: 10.1016/j.ajog.2016.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/03/2016] [Accepted: 07/05/2016] [Indexed: 12/31/2022]
Abstract
Perinatal depression is associated with a high risk of morbidity and mortality and may have long-term consequences on child development. The US Preventive Services Task Force has recently recognized the importance of identifying and treating women with depression in the perinatal period. However, screening and accessing appropriate treatment come with logistical challenges. In many areas, there may not be sufficient access to psychiatric care, and, until these resources develop, the burden may inadvertently fall on obstetricians. As a result, understanding the risks of perinatal depression in comparison with the risks of treatment is important. Many studies of selective serotonin reuptake inhibitors in pregnancy fail to control for underlying depressive illness, which can lead to misinterpretation of selective serotonin reuptake inhibitor risk by clinicians. This review discusses the risks and benefits of selective serotonin reuptake inhibitor treatment in pregnancy within the context of perinatal depression. Whereas selective serotonin reuptake inhibitors may be associated with certain risks, the absolute risks are low and may be outweighed by the risks of untreated depression for many women and their offspring.
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24
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Braeken MA, Jones A, Otte RA, Nyklíček I, Van den Bergh BR. Potential benefits of mindfulness during pregnancy on maternal autonomic nervous system function and infant development. Psychophysiology 2016; 54:279-288. [DOI: 10.1111/psyp.12782] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 09/12/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Marijke A.K.A. Braeken
- Faculty of Social and Behavioural Sciences; Tilburg University; Tilburg The Netherlands
- REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University; Hasselt Belgium
- Department of Psychology; KU Leuven Leuven Belgium
| | - Alexander Jones
- Institute of Cardiovascular Science, University College London; London UK
| | - Renée A. Otte
- Faculty of Social and Behavioural Sciences; Tilburg University; Tilburg The Netherlands
| | - Ivan Nyklíček
- Center for Research in Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University; Tilburg The Netherlands
| | - Bea R.H. Van den Bergh
- Faculty of Social and Behavioural Sciences; Tilburg University; Tilburg The Netherlands
- Department of Psychology; KU Leuven Leuven Belgium
- Department of Welfare, Public Health and Family; Flemish Government; Brussels Belgium
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25
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Gentile S, Fusco ML. Placental and fetal effects of antenatal exposure to antidepressants or untreated maternal depression. J Matern Fetal Neonatal Med 2016; 30:1189-1199. [PMID: 27379818 DOI: 10.1080/14767058.2016.1209184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess systematically the effects of antidepressants and untreated maternal depression on human placenta and the developing fetus. METHODS Pertinent medical literature information was identified using MEDLINE/PubMed, SCOPUS and EMBASE. Electronic searches, limited to human studies published in English, provided 21 studies reporting primary data on placental and fetal effects of antidepressant exposure or untreated gestational depression. RESULTS The impact of antidepressants and non-medicated maternal depression on placental functioning and fetal biochemical architecture seems to be demonstrated, although its clinical significance remains unclear. More robust data seem to indicate that exposure to either antidepressants or untreated maternal depression may induce epigenetic changes and interfere with the physiological fetal behavior. Two cases of iatrogenic fetal tachyarrhythmia have also been reported. CONCLUSIONS Future research should clarify the clinical relevance of the impact of antidepressant and untreated maternal depression exposure on placental functioning. Moreover, ultrasound studies investigating fetal responses to antidepressants or maternal depressive symptoms are mandatory. This assessment should be performed during the whole duration of gestational period, when different fetal behavioral patterns become progressively detectable. Analyses of biochemical and epigenetic modifications associated with maternal mood symptoms and antidepressant treatment should also be implemented.
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Affiliation(s)
- Salvatore Gentile
- a ASL Salerno, Department of Mental Health, Mental Health Center Cava de' Tirreni, Vietri sul Mare , Salerno , Italy.,b Department of Neurosciences , Division of Perinatal Psychiatry, Medical School "Federico II", University of Naples , Naples , Italy
| | - Maria Luigia Fusco
- c Mental Health Institute, Torre Annunziata , Naples , Italy , and.,d Department of Developmental Psychology , Post-Graduate School of Psychotherapy (SIPGI), Torre Annunziata, Naples , Italy
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26
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Alwan S, Friedman JM, Chambers C. Safety of Selective Serotonin Reuptake Inhibitors in Pregnancy: A Review of Current Evidence. CNS Drugs 2016; 30:499-515. [PMID: 27138915 DOI: 10.1007/s40263-016-0338-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant medications worldwide. However, over the past decade, their use during pregnancy, a period of extreme vulnerability to the onset of depression, has become highly concerning to patients and their healthcare providers in terms of safety to the developing fetus. Exposure to SSRIs in pregnancy has been associated with miscarriage, premature delivery, neonatal complications, birth defects-specifically cardiac defects-and, more recently, neurodevelopmental disorders in childhood, specifically autism spectrum disorders. Studies addressing the effect of individual SSRIs indicate a small but higher risk for birth defects with maternal fluoxetine and paroxetine use. Though the excess in absolute risk is small, it may still be of concern to some patients. Meanwhile, antenatal depression itself is associated with adverse perinatal outcomes, and discontinuing antidepressant treatment during pregnancy is associated with a high risk of relapse of depression. Whether the observed adverse fetal effects are related to the mother's medication use or her underlying maternal illness remains difficult to determine. It is important that every pregnant woman being treated with an SSRI (or considering such treatment) carefully weighs the risks of treatment against the risk of untreated depression for both herself and her child. The importance of recognizing a higher risk for the development of adverse outcomes lies in the potential for surveillance and possibly a timely intervention. Therefore, we recommend that pregnant women exposed to any SSRI in early pregnancy be offered options for prenatal diagnosis through ultrasound examinations and fetal echocardiography to detect the presence of birth defects. Tapering off or switching to other therapy in early pregnancy, if appropriate for the individual, may also be considered on a case-by-case basis.
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Affiliation(s)
- Sura Alwan
- Department of Medical Genetics, University of British Columbia, BC Women's Hospital and Health Centre, 4500 Oak Street (Box 153), Vancouver, BC, V6H 3N1, Canada.
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, BC Women's Hospital and Health Centre, 4500 Oak Street (Box 153), Vancouver, BC, V6H 3N1, Canada
| | - Christina Chambers
- Department of Pediatrics, School of Medicine, University of California, La Jolla, San Diego, CA, USA
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Vigod S, Hussain-Shamsy N, Grigoriadis S, Howard LM, Metcalfe K, Oberlander TF, Schram C, Stewart DE, Taylor VH, Dennis CL. A patient decision aid for antidepressant use in pregnancy: study protocol for a randomized controlled trial. Trials 2016; 17:110. [PMID: 26923796 PMCID: PMC4770694 DOI: 10.1186/s13063-016-1233-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/16/2016] [Indexed: 12/28/2022] Open
Abstract
Background Many women with depression experience significant difficulty making a decision about whether or not to use antidepressant medication in pregnancy. Patient decision aids (PDAs) are tools that assist patients in making complex health decisions. PDAs can reduce decision-making difficulty and lead to better treatment outcomes. We describe the methods for a pilot randomized controlled trial of an interactive web-based PDA for women who are having difficulty deciding about antidepressant drug use in pregnancy. Methods/Design This is a pilot randomized controlled trial that aims to assess the feasibility of a larger, multi-center efficacy study. The PDA aims to help a woman: (1) understand why an antidepressant is being recommended, (2) be knowledgeable about potential benefits and risks of treatment and non-treatment with antidepressants, and (3) be clear about which benefits and risks are most important to her, with the goal of improving confidence in her decision-making. We include women aged 18 years or older who are: (1) planning a pregnancy or are pregnant (gestational age less than 30 weeks), (2) diagnosed with major depressive disorder, (3) deciding whether or not to use a selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI) antidepressant in pregnancy, and (4) having at least moderate decision-making difficulty as per a Decisional Conflict Scale (DCS) Score ≥25. Participants are randomized to receive the PDA or an informational resource sheet via a secure website, and have access to the stated allocation until their final study follow-up. The primary outcomes of the pilot study are feasibility of recruitment and retention, acceptability of the intervention, and adherence to the trial protocol. The primary efficacy outcome is DCS score at 4 weeks post randomization, with secondary outcomes including depressive and anxiety symptoms. Discussion Our PDA represents a key opportunity to optimize the decision-making process for women around antidepressants in pregnancy, leading to effective decision-making and optimizing improved maternal and child outcomes related to depression in pregnancy. The electronic nature of the PDA will facilitate keeping it up-to-date, and allow for widespread dissemination after efficacy is demonstrated. Trial registration This trial is registered on ClinicalTrials.Gov under the identifier NCT02308592 (first registered: 2 December 2014). Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1233-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simone Vigod
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. .,University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Neesha Hussain-Shamsy
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
| | - Sophie Grigoriadis
- University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. .,Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - Louise M Howard
- King's College London, Institute of Psychiatry, Box P031, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Kelly Metcalfe
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. .,University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Child and Family Research Institute, 4480 Oak St., Vancouver, BC, V6H 3V4, Canada.
| | - Carrie Schram
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. .,University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Donna E Stewart
- University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. .,University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
| | - Valerie H Taylor
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. .,University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Cindy-Lee Dennis
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. .,University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
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Frazer S, Otomo K, Dayer A. Early-life serotonin dysregulation affects the migration and positioning of cortical interneuron subtypes. Transl Psychiatry 2015; 5:e644. [PMID: 26393490 PMCID: PMC5068808 DOI: 10.1038/tp.2015.147] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/22/2015] [Accepted: 08/11/2015] [Indexed: 12/21/2022] Open
Abstract
Early-life deficiency of the serotonin transporter (SERT) gives rise to a wide range of psychiatric-relevant phenotypes; however, the molecular and cellular targets of serotonin dyregulation during neural circuit formation remain to be identified. Interestingly, migrating cortical interneurons (INs) derived from the caudal ganglionic eminence (CGE) have been shown to be more responsive to serotonin-mediated signalling compared with INs derived from the medial ganglionic eminence (MGE). Here we investigated the impact of early-life SERT deficiency on the migration and positioning of CGE-derived cortical INs in SERT-ko mice and in mice exposed to the SERT inhibitor fluoxetine during the late embryonic period. Using confocal time-lapse imaging and microarray-based expression analysis we found that genetic and pharmacological SERT deficiency significantly increased the migratory speed of CGE-derived INs and affected transcriptional programmes regulating neuronal migration. Postnatal studies revealed that SERT deficiency altered the cortical laminar distribution of subtypes of CGE-derived INs but not MGE-derived INs. More specifically, we found that the distribution of vasointestinal peptide (VIP)-expressing INs in layer 2/3 was abnormal in both genetic and pharmacological SERT-deficiency models. Collectively, these data indicate that early-life SERT deficiency has an impact on the migration and molecular programmes of CGE-derived INs, thus leading to specific alterations in the positioning of VIP-expressing INs. These data add to the growing evidence that early-life serotonin dysregulation affects cortical microcircuit formation and contributes to the emergence of psychiatric-relevant phenotypes.
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Affiliation(s)
- S Frazer
- Department of Mental Health and Psychiatry, University of Geneva Medical School, Geneva, Switzerland,Department of Psychiatry and Basic Neurosciences, University of Geneva Medical School, Geneva, Switzerland
| | - K Otomo
- Department of Mental Health and Psychiatry, University of Geneva Medical School, Geneva, Switzerland,Department of Psychiatry and Basic Neurosciences, University of Geneva Medical School, Geneva, Switzerland
| | - A Dayer
- Department of Mental Health and Psychiatry, University of Geneva Medical School, Geneva, Switzerland,Department of Psychiatry and Basic Neurosciences, University of Geneva Medical School, Geneva, Switzerland,Department of Psychiatry and Basic Neurosciences, University of Geneva Medical School (CMU), Rue Michel-Servet 1, 1211 Genève 4, Geneva 1211, Switzerland. E-mail:
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Gentile S. Early pregnancy exposure to selective serotonin reuptake inhibitors, risks of major structural malformations, and hypothesized teratogenic mechanisms. Expert Opin Drug Metab Toxicol 2015; 11:1585-97. [PMID: 26135630 DOI: 10.1517/17425255.2015.1063614] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Selective serotonin reuptake inhibitors (SSRIs) are commonly used to manage antenatal depression. Hence, the aim of this systematic review is to assess the prevalence of birth defects associated with pregnancy exposure to such agents and summarize the hypothesized teratogenic mechanisms. AREAS COVERED Medical literature published in English (1980 - June 2015) was electronically searched to identify all articles reporting an increased prevalence of birth defects associated with prenatal SSRI exposure and hypothesizing teratogenic mechanisms. EXPERT OPINION The only recurrent pattern of congenital anomalies associated with antenatal SSRI exposure is heart defects. SSRIs may alter the function of serotonin and related receptors which are involved in the development of the monoamine-dependent cardiac structures. Nevertheless, the magnitude of this increase and, thus, its clinical significance are unclear. Therefore, a cautious approach of using SSRI during pregnancy only in the case of major depressive episodes should be applied. However, this risk should be balanced against the risks associated with the worsening of depressive symptoms, and take into consideration the large number of studies that found no associations between transplacental SSRI exposure and cardiac anomalies. Prenatal ultrasonography and Doppler sonography to detect early cardiac defects are also advisable. Non-pharmacological approaches are preferred for less severe psychiatric disorders.
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Affiliation(s)
- Salvatore Gentile
- a 1 Mental Health Center Cava de' Tirreni - Vietri sul Marei, Department of Mental Health ASL Salerno , Piazza Galdi, Salerno, Cava de' Tirreni, 841013, Italy +39 089 4455439 ; +39 089 4455440 ; .,b 2 University of Naples (Italy), Medical School "Federico II", Department of Neurosciences, Division of Psychiatry-Perinatal Psychiatry , Via s. Pansini, 5 80131 Naples, Italy
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Use of selective serotonin reuptake inhibitor antidepressants in pregnancy does carry risks, but the risks are small. J Nerv Ment Dis 2015; 203:167-9. [PMID: 25714254 DOI: 10.1097/nmd.0000000000000258] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The paper by Robinson posits that risks from prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants are not different from the risks encountered in the general population and that untoward effects of SSRIs are difficult to distinguish from those of the mood disorder. Indeed, maternal depression and anxiety can have negative consequences for fetal and postnatal development. Fortunately, experimental evidence suggests that mood and anxiety disorder symptoms often respond to psychosocial interventions. If pharmacotherapy becomes necessary, it is, however, important to know that even if SSRI drugs have been shown to be safe overall, research has shown that fetal development can be adversely affected by in utero exposure to SSRIs in a subgroup of neonates. Examples would be the transient neonatal adaptation syndrome, an increased risk of persistent pulmonary hypertension of the newborn, and small, albeit measurable, changes in motor and social adaptability in infancy and childhood.
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Maternal mindfulness during pregnancy and infant socio-emotional development and temperament: the mediating role of maternal anxiety. Early Hum Dev 2015; 91:103-8. [PMID: 25577496 DOI: 10.1016/j.earlhumdev.2014.12.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/09/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Accumulating evidence shows that maternal anxiety during pregnancy adversely affects child outcomes. The positive effects of maternal psychosocial factors during pregnancy on child outcomes are not yet studied. This prospective study addresses the association between maternal mindfulness during pregnancy and socio-emotional development and temperament in 10months-old infants. We also investigated whether this association was mediated by maternal anxiety. METHOD Mothers (N=90) provided information about mindfulness and anxiety at the beginning of the second trimester of pregnancy. Infant socio-emotional development (Ages and Stages Questionnaire: Social Emotional; ASQ:SE) and temperament (Infant Behaviour Questionnaire-Revised; IBQ-R) were assessed at age 10months. RESULTS Higher maternal mindfulness during pregnancy was associated with less infant self-regulation problems and less infant negative affectivity. Mediation analysis showed that maternal anxiety mediated the association between infant self-regulation problems and maternal mindfulness. CONCLUSION These results suggest that maternal mindfulness during pregnancy may have positive effects on infant development. This association may be mediated by reduced anxiety symptoms in pregnant women who score high on mindfulness. Additional replication studies are needed using objective measures of infant behavioural/emotional outcomes and mindfulness of the mother during child development.
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Dayer A. Serotonin-related pathways and developmental plasticity: relevance for psychiatric disorders. DIALOGUES IN CLINICAL NEUROSCIENCE 2014. [PMID: 24733969 PMCID: PMC3984889 DOI: 10.31887/dcns.2014.16.1/adayer] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Risk for adult psychiatric disorders is partially determined by early-life alterations occurring during neural circuit formation and maturation. In this perspective, recent data show that the serotonin system regulates key cellular processes involved in the construction of cortical circuits. Translational data for rodents indicate that early-life serotonin dysregulation leads to a wide range of behavioral alterations, ranging from stress-related phenotypes to social deficits. Studies in humans have revealed that serotonin-related genetic variants interact with early-life stress to regulate stress-induced cortisol responsiveness and activate the neural circuits involved in mood and anxiety disorders. Emerging data demonstrate that early-life adversity induces epigenetic modifications in serotonin-related genes. Finally, recent findings reveal that selective serotonin reuptake inhibitors can reinstate juvenile-like forms of neural plasticity, thus allowing the erasure of long-lasting fear memories. These approaches are providing new insights on the biological mechanisms and clinical application of antidepressants.
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Affiliation(s)
- Alexandre Dayer
- Departments of Mental Health and Psychiatry and Basic Neurosciences, University of Geneva Medical School, Geneva, Switzerland
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Sarkar A, Chachra P, Vaidya VA. Postnatal fluoxetine-evoked anxiety is prevented by concomitant 5-HT2A/C receptor blockade and mimicked by postnatal 5-HT2A/C receptor stimulation. Biol Psychiatry 2014; 76:858-68. [PMID: 24315410 DOI: 10.1016/j.biopsych.2013.11.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postnatal treatment with the selective serotonin reuptake inhibitor fluoxetine, evokes anxiety and depressive behavior in rodent models in adulthood. We examined the role of serotonin 2A (5-HT2A), serotonin 2C (5-HT2C) and serotonin 1A (5-HT1A) receptors, implicated in the development of anxiety, in the behavioral consequences of postnatal fluoxetine (PNFlx). METHODS Control and PNFlx rat pups received concomitant treatment with the 5-HT2A/C receptor antagonist, ketanserin, the 5-HT2A receptor antagonist, MDL100907, the 5-HT2C receptor antagonist, SB242084, or the 5-HT1A receptor antagonist, WAY-100635, and were tested for behavior in adulthood. The effect of postnatal treatment with the 5-HT2A/C receptor agonist, DOI, on anxiety behavior was examined in adulthood. RESULTS Postnatal 5-HT2A/C receptor blockade prevented PNFlx-evoked anxiety, attenuated depressive behavior, and normalized specific gene expression changes in the prefrontal cortex. Postnatal, selective 5-HT2A receptor antagonist treatment blocked PNFlx-evoked anxiety and depressive behavior, whereas 5-HT2C receptor antagonist treatment prevented anxiety but not depressive behavior. Postnatal 5-HT2A/C receptor stimulation was sufficient to evoke anxiety in adulthood. Serotonin 1A receptor blockade did not alter PNFlx-evoked anxiety but resulted in anxiety in control animals, an effect attenuated by concomitant 5-HT2A/C receptor blockade. CONCLUSIONS Postnatal fluoxetine-evoked anxiety and depressive behavior, as well as specific gene expression changes in the prefrontal cortex, were prevented by 5-HT2A/C receptor blockade. Adult anxiety was evoked by either 5-HT2A/C receptor stimulation or 5-HT1A receptor blockade of naive control pups. Our findings implicate serotonin 2 receptors in the development of perturbed emotionality following PNFlx and suggest that an altered balance of signaling through 5-HT1A and 5-HT2A/C receptors in early life influences anxiety behavior.
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Affiliation(s)
- Ambalika Sarkar
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | - Parul Chachra
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | - Vidita A Vaidya
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India.
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Vigod S, Dennis CL, Daskalakis Z, Murphy K, Ray J, Oberlander T, Somerton S, Hussain-Shamsy N, Blumberger D. Transcranial direct current stimulation (tDCS) for treatment of major depression during pregnancy: study protocol for a pilot randomized controlled trial. Trials 2014; 15:366. [PMID: 25234606 PMCID: PMC4177439 DOI: 10.1186/1745-6215-15-366] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/10/2014] [Indexed: 11/15/2022] Open
Abstract
Background Women with depression in pregnancy are faced with difficult treatment decisions. Untreated, antenatal depression has serious negative implications for mothers and children. While antidepressant drug treatment is likely to improve depressive symptoms, it crosses the placenta and may pose risks to the unborn child. Transcranial direct current stimulation is a focal brain stimulation treatment that improves depressive symptoms within 3 weeks of treatment by inducing changes to brain areas involved in depression, without impacting any other brain areas, and without inducing changes to heart rate, blood pressure or core body temperature. The localized nature of transcranial direct current stimulation makes it an ideal therapeutic approach for treating depression during pregnancy, although it has never previously been evaluated in this population. Methods/design We describe a pilot randomized controlled trial of transcranial direct current stimulation among women with depression in pregnancy to assess the feasibility of a larger, multicentre efficacy study. Women over 18 years of age and between 14 and 32 weeks gestation can be enrolled in the study provided they meet diagnostic criteria for a major depressive episode of at least moderate severity and have been offered but refused antidepressant medication. Participants are randomized to receive active transcranial direct current stimulation or a sham condition that is administered in 15 30-minute treatments over three weeks. Women sit upright during treatment and receive obstetrical monitoring prior to, during and after each treatment session. Depressive symptoms, treatment acceptability, and pregnancy outcomes are assessed at baseline (prior to randomization), at the end of each treatment week, every four weeks post-treatment until delivery, and at 4 and 12 weeks postpartum. Discussion Transcranial direct current stimulation is a novel therapeutic option for treating depression during pregnancy. This protocol allows for assessment of the feasibility of, acceptability of and adherence with a clinical trial protocol to administer this treatment to pregnant women with moderate to severe depression. Results from this pilot study will guide the development of a larger multicentre trial to definitively test the efficacy and safety of transcranial direct current stimulation for pregnant women with depression. Trial registration Clinical Trials Gov NCT02116127.
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Affiliation(s)
- Simone Vigod
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON M5S 1B1, Canada.
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DiPietro JA, Davis MF, Costigan KA, Barr DB. Fetal heart rate and motor activity associations with maternal organochlorine levels: results of an exploratory study. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2014; 24:474-481. [PMID: 23591698 PMCID: PMC4513653 DOI: 10.1038/jes.2013.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 02/04/2013] [Accepted: 02/12/2013] [Indexed: 06/02/2023]
Abstract
Contemporaneous associations between circulating maternal organochlorines (OCs) and measures of fetal heart rate and motor activity were evaluated. A panel of 47 OCs, including pesticides and polychlorinated biphenyls (PCBs), was analyzed from serum of 50 pregnant women at 36 weeks gestation. Data were empirically reduced into four factors and six individual compounds. All participants had detectable concentrations of at least one-quarter of the assayed OCs and, in general, higher socioeconomic level was associated with higher OC concentrations. Fetal heart rate measures were not consistently associated with maternal OCs. In contrast, one or more indicators of greater fetal motor activity were significantly associated with higher levels of the DDT and low chlorinated OC factors and five of the six individual compounds (heptachlor epoxide, trans nonachlor, oxychlordane, and PCBs 18 and 52). This preliminary demonstration of associations between fetal motor activity and maternal concentrations of persistent and pervasive environmental contaminants suggests that fetal assessment may be useful in ascertaining the potential early effects of these compounds on development.
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Affiliation(s)
- Janet A. DiPietro
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Meghan F. Davis
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kathleen A Costigan
- Division of Maternal-Fetal Medicine; Johns Hopkins Medical Institutions, Baltimore, MD
| | - Dana Boyd Barr
- Department of Environmental Health, Rollins School of Public Health, Atlanta, GA
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Antenatal depression and antidepressants during pregnancy: unraveling the complex interactions for the offspring. Eur J Pharmacol 2014; 753:257-62. [PMID: 25094036 DOI: 10.1016/j.ejphar.2014.07.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/18/2014] [Accepted: 07/24/2014] [Indexed: 02/01/2023]
Abstract
During pregnancy the risk for a woman to develop a depressive episode is as high as 20%. Antenatal depression is not harmless for the developing child as several changes, including neurodevelopmental alterations, have been reported. Sometimes it is unavoidable to treat a pregnant mother with antidepressants, especially when she is suicidal. Currently, selective serotonin reuptake inhibitors (SSRIs) are the pharmacological choice of antidepressant treatment. SSRIs do not cause gross teratogenic alterations and are generally considered safe for use in pregnancy. However, although SSRIs may relieve the maternal symptoms, they definitively cross the placenta partially influencing the neurodevelopment of the fetus. In this review an overview is given of the effects on the offspring of maternal antenatal depression and the putative neurodevelopmental effects of SSRI treatment during pregnancy. Although we primarily focus on human data, some animal data are discussed to describe possible mechanisms on how SSRIs are affecting underlying biological mechanisms associated with depression. In summary, maternal depression may have long-lasting effects on the offspring, whereas prenatal SSRI exposure also increases the risk for long-lasting effects. It remains to be determined whether the effects found after SSRI treatment in pregnant women are only due to the SSRI exposure or if the underlying depression is also contributing to these effects. The possibility of epigenetic alterations as one of the underlying mechanisms that is altered by SSRI exposure is discussed. However much more research in this area is needed to explain the exact role of epigenetic mechanisms in SSRI exposure during pregnancy.
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Discontinuation of antidepressants during attempts to conceive: a pilot trial of cognitive behavioral therapy for the prevention of recurrent depression. J Clin Psychopharmacol 2014; 34:455-60. [PMID: 24911438 PMCID: PMC4959421 DOI: 10.1097/jcp.0000000000000158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many women discontinue antidepressants (ADs) when trying to conceive, although risk of depressive relapse is high. We examined the feasibility and potential clinical effect of cognitive behavioral therapy for the prevention of recurrence (CBT-PR) for women with a history of recurrent major depressive disorder (MDD) who planned to discontinue maintenance AD treatment for pregnancy. METHODS This was an open preliminary study of CBT-PR in women (N = 12) planning or early in pregnancy with remitted MDD on maintenance ADs with a plan to discontinue ADs for pregnancy. Participants received 12 sessions of CBT-PR during the acute phase and optional monthly booster sessions during follow-up. Participants were assessed monthly during the acute phase and then twice additionally during follow-up by an independent rater using mood scales (depression module of the Mini-International Neuropsychiatric Interview and Montgomery-Åsberg Depression Rating Scale); pregnancy status was also assessed. RESULTS Over the 24 weeks of the trial, 75% (n = 9) of participants did not restart ADs and did not relapse to depression. Of the 3 who reintroduced AD, 2 experienced a depressive relapse, whereas one did not meet full criteria for MDD. Adherence to the intervention was very good with all participants completing all therapy sessions and assessments. CONCLUSIONS Cognitive behavioral therapy for the prevention of recurrence seems feasible and may provide protection for women with recurrent depression on ADs who discontinue their medication while trying to conceive. The extent to which euthymia is sustainable with CBT-PR requires further study; the results of which may broaden treatment choices for women in anticipation of and during pregnancy.
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El Marroun H, White TJH, van der Knaap NJF, Homberg JR, Fernández G, Schoemaker NK, Jaddoe VWV, Hofman A, Verhulst FC, Hudziak JJ, Stricker BHC, Tiemeier H. Prenatal exposure to selective serotonin reuptake inhibitors and social responsiveness symptoms of autism: population-based study of young children. Br J Psychiatry 2014; 205:95-102. [PMID: 25252317 DOI: 10.1192/bjp.bp.113.127746] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are considered safe and are frequently used during pregnancy. However, two case-control studies suggested an association between prenatal SSRI exposure with childhood autism. AIMS To prospectively determine whether intra-uterine SSSRI exposure is associated with childhood autistic symptoms in a population-based study. METHOD A total of 376 children prenatally exposed to maternal depressive symptoms (no SSRI exposure), 69 children prenatally exposed to SSRIs and 5531 unexposed children were included. Child pervasive developmental and affective problems were assessed by parental report with the Child Behavior Checklist at ages 1.5, 3 and 6. At age 6, we assessed autistic traits using the Social Responsiveness Scale (n = 4264). RESULTS Prenatal exposure to maternal depressive symptoms without SSRIs was related to both pervasive developmental (odds ratio (OR) = 1.44, 95% CI 1.07-1.93) and affective problems (OR = 1.44, 95% CI 1.15-1.81). Compared with unexposed children, those prenatally exposed to SSRIs also were at higher risk for developing pervasive developmental problems (OR = 1.91, 95% CI 1.13-3.47), but not for affective problems. Children prenatally exposed to SSRIs also had more autistic traits (B = 0.15, 95% CI 0.08-0.22) compared with those exposed to depressive symptoms only. CONCLUSIONS Our results suggest an association between prenatal SSRI exposure and autistic traits in children. Prenatal depressive symptoms without SSRI use were also associated with autistic traits, albeit this was weaker and less specific. Long-term drug safety trials are needed before evidence-based recommendations are possible.
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Affiliation(s)
- Hanan El Marroun
- Hanan El Marroun, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Tonya J. H. White, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Noortje J. F. van der Knaap, MSc, Judith R. Homberg, PhD, Guillén Fernández, MD, PhD, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Nikita K. Schoemaker, MSc, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Vincent W. V. Jaddoe, MD, PhD, The Generation R Study Group, Department of Epidemiology and Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Albert Hofman, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Frank C. Verhulst, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; James J. Hudziak, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands, and University of Vermont, College of Medicine, Deptartment of Psychiatry, Burlington, Vermont, USA; Bruno H. C. Stricker, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam and Inspectorate of Healthcare, The Hague, The Netherlands; Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Department of Epidemiology and Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Tonya J H White
- Hanan El Marroun, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Tonya J. H. White, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Noortje J. F. van der Knaap, MSc, Judith R. Homberg, PhD, Guillén Fernández, MD, PhD, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Nikita K. Schoemaker, MSc, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Vincent W. V. Jaddoe, MD, PhD, The Generation R Study Group, Department of Epidemiology and Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Albert Hofman, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Frank C. Verhulst, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; James J. Hudziak, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands, and University of Vermont, College of Medicine, Deptartment of Psychiatry, Burlington, Vermont, USA; Bruno H. C. Stricker, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam and Inspectorate of Healthcare, The Hague, The Netherlands; Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Department of Epidemiology and Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Noortje J F van der Knaap
- Hanan El Marroun, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Tonya J. H. White, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Noortje J. F. van der Knaap, MSc, Judith R. Homberg, PhD, Guillén Fernández, MD, PhD, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Nikita K. Schoemaker, MSc, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Vincent W. V. Jaddoe, MD, PhD, The Generation R Study Group, Department of Epidemiology and Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Albert Hofman, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Frank C. Verhulst, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; James J. Hudziak, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands, and University of Vermont, College of Medicine, Deptartment of Psychiatry, Burlington, Vermont, USA; Bruno H. C. Stricker, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam and Inspectorate of Healthcare, The Hague, The Netherlands; Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Department of Epidemiology and Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Judith R Homberg
- Hanan El Marroun, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Tonya J. H. White, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Noortje J. F. van der Knaap, MSc, Judith R. Homberg, PhD, Guillén Fernández, MD, PhD, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Nikita K. Schoemaker, MSc, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Vincent W. V. Jaddoe, MD, PhD, The Generation R Study Group, Department of Epidemiology and Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Albert Hofman, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Frank C. Verhulst, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; James J. Hudziak, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands, and University of Vermont, College of Medicine, Deptartment of Psychiatry, Burlington, Vermont, USA; Bruno H. C. Stricker, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam and Inspectorate of Healthcare, The Hague, The Netherlands; Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Department of Epidemiology and Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Guillén Fernández
- Hanan El Marroun, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Tonya J. H. White, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Noortje J. F. van der Knaap, MSc, Judith R. Homberg, PhD, Guillén Fernández, MD, PhD, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Nikita K. Schoemaker, MSc, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Vincent W. V. Jaddoe, MD, PhD, The Generation R Study Group, Department of Epidemiology and Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Albert Hofman, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Frank C. Verhulst, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; James J. Hudziak, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands, and University of Vermont, College of Medicine, Deptartment of Psychiatry, Burlington, Vermont, USA; Bruno H. C. Stricker, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam and Inspectorate of Healthcare, The Hague, The Netherlands; Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Department of Epidemiology and Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Nikita K Schoemaker
- Hanan El Marroun, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Tonya J. H. White, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Noortje J. F. van der Knaap, MSc, Judith R. Homberg, PhD, Guillén Fernández, MD, PhD, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Nikita K. Schoemaker, MSc, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Vincent W. V. Jaddoe, MD, PhD, The Generation R Study Group, Department of Epidemiology and Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Albert Hofman, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Frank C. Verhulst, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; James J. Hudziak, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands, and University of Vermont, College of Medicine, Deptartment of Psychiatry, Burlington, Vermont, USA; Bruno H. C. Stricker, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam and Inspectorate of Healthcare, The Hague, The Netherlands; Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Department of Epidemiology and Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- Hanan El Marroun, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Tonya J. H. White, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Noortje J. F. van der Knaap, MSc, Judith R. Homberg, PhD, Guillén Fernández, MD, PhD, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Nikita K. Schoemaker, MSc, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Vincent W. V. Jaddoe, MD, PhD, The Generation R Study Group, Department of Epidemiology and Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Albert Hofman, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Frank C. Verhulst, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; James J. Hudziak, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands, and University of Vermont, College of Medicine, Deptartment of Psychiatry, Burlington, Vermont, USA; Bruno H. C. Stricker, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam and Inspectorate of Healthcare, The Hague, The Netherlands; Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Department of Epidemiology and Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Albert Hofman
- Hanan El Marroun, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Tonya J. H. White, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Noortje J. F. van der Knaap, MSc, Judith R. Homberg, PhD, Guillén Fernández, MD, PhD, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Nikita K. Schoemaker, MSc, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Vincent W. V. Jaddoe, MD, PhD, The Generation R Study Group, Department of Epidemiology and Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Albert Hofman, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Frank C. Verhulst, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; James J. Hudziak, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands, and University of Vermont, College of Medicine, Deptartment of Psychiatry, Burlington, Vermont, USA; Bruno H. C. Stricker, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam and Inspectorate of Healthcare, The Hague, The Netherlands; Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Department of Epidemiology and Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Hanan El Marroun, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Tonya J. H. White, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Noortje J. F. van der Knaap, MSc, Judith R. Homberg, PhD, Guillén Fernández, MD, PhD, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Nikita K. Schoemaker, MSc, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Vincent W. V. Jaddoe, MD, PhD, The Generation R Study Group, Department of Epidemiology and Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Albert Hofman, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Frank C. Verhulst, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; James J. Hudziak, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands, and University of Vermont, College of Medicine, Deptartment of Psychiatry, Burlington, Vermont, USA; Bruno H. C. Stricker, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam and Inspectorate of Healthcare, The Hague, The Netherlands; Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Department of Epidemiology and Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - James J Hudziak
- Hanan El Marroun, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Tonya J. H. White, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Noortje J. F. van der Knaap, MSc, Judith R. Homberg, PhD, Guillén Fernández, MD, PhD, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Nikita K. Schoemaker, MSc, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Vincent W. V. Jaddoe, MD, PhD, The Generation R Study Group, Department of Epidemiology and Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Albert Hofman, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Frank C. Verhulst, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; James J. Hudziak, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands, and University of Vermont, College of Medicine, Deptartment of Psychiatry, Burlington, Vermont, USA; Bruno H. C. Stricker, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam and Inspectorate of Healthcare, The Hague, The Netherlands; Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Department of Epidemiology and Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Bruno H C Stricker
- Hanan El Marroun, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Tonya J. H. White, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Noortje J. F. van der Knaap, MSc, Judith R. Homberg, PhD, Guillén Fernández, MD, PhD, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Nikita K. Schoemaker, MSc, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Vincent W. V. Jaddoe, MD, PhD, The Generation R Study Group, Department of Epidemiology and Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Albert Hofman, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Frank C. Verhulst, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; James J. Hudziak, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands, and University of Vermont, College of Medicine, Deptartment of Psychiatry, Burlington, Vermont, USA; Bruno H. C. Stricker, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam and Inspectorate of Healthcare, The Hague, The Netherlands; Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Department of Epidemiology and Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Hanan El Marroun, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Tonya J. H. White, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Noortje J. F. van der Knaap, MSc, Judith R. Homberg, PhD, Guillén Fernández, MD, PhD, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Nikita K. Schoemaker, MSc, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital and The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Vincent W. V. Jaddoe, MD, PhD, The Generation R Study Group, Department of Epidemiology and Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Albert Hofman, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Frank C. Verhulst, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; James J. Hudziak, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands, and University of Vermont, College of Medicine, Deptartment of Psychiatry, Burlington, Vermont, USA; Bruno H. C. Stricker, MD, PhD, Department of Epidemiology, Erasmus Medical Centre, Rotterdam and Inspectorate of Healthcare, The Hague, The Netherlands; Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Department of Epidemiology and Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
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Monteiro Filho WO, de Torres SM, Amorim MJAAL, Andrade AJM, de Morais RN, Tenorio BM, da Silva Junior VA. Fluoxetine induces changes in the testicle and testosterone in adult male rats exposed via placenta and lactation. Syst Biol Reprod Med 2014; 60:274-81. [PMID: 24983959 DOI: 10.3109/19396368.2014.933984] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Fluoxetine is a selective serotonin reuptake inhibitor used to treat depression in pregnant and nursing women. However, recent studies have shown adverse effects in the male reproductive system after fluoxetine treatment. Aiming to analyze the extent of damage caused by fluoxetine in the testicle and safe doses for treatment during the perinatal period, the present study analyzed the effects of in utero exposure and exposure during lactation to fluoxetine in spermatogenesis of male rat offspring in adulthood. Wistar rat dams were orally treated with fluoxetine (5, 10, and 20 mg/kg) from 13 days of gestation to lactation day 21 and their offspring were analyzed at 90 days old. Results showed a reduction in the weight of testes (16%), epididymis (28%), and seminal glands (18%) in animals exposed to fluoxetine 20 mg/kg compared to the control. Seminal gland weight was also reduced 25% and 30% in animals exposed to 5 mg/kg and 10 mg/kg fluoxetine, respectively. Body weight of animals exposed to 20 mg/kg fluoxetine was reduced from post-natal day 9 to 36 compared to controls but from the post-natal day 9 to 36 there was no statistical difference. The volume of seminiferous epithelium reduced 17% and the total volume of Leydig cells reduced 30% in the group exposed to fluoxetine at 20 mg/kg. Furthermore, Leydig cells volume reduced 29% in the 5 mg/kg group. The length of the seminiferous tubules reduced 17% and daily sperm production per testicle also reduced 18% in animals exposed to the highest dose of fluoxetine compared to controls. The individual area of Leydig cells increased 7% and plasma testosterone increased 49% in animals exposed to fluoxetine at 20 mg/kg. In conclusion, exposure to 20 mg/kg fluoxetine via the placenta and during lactation may change testosterone and testicular parameters important for sperm production and male fertility in adulthood.
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Affiliation(s)
- Waldo Oliveira Monteiro Filho
- Department of Animal Morphology and Physiology, Federal Rural University of Pernambuco , Recife, Pernambuco , Brazil and
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van den Heuvel MI, Donkers FCL, Winkler I, Otte RA, Van den Bergh BRH. Maternal mindfulness and anxiety during pregnancy affect infants' neural responses to sounds. Soc Cogn Affect Neurosci 2014; 10:453-60. [PMID: 24925904 DOI: 10.1093/scan/nsu075] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Maternal anxiety during pregnancy has been consistently shown to negatively affect offspring neurodevelopmental outcomes. However, little is known about the impact of positive maternal traits/states during pregnancy on the offspring. The present study was aimed at investigating the effects of the mother's mindfulness and anxiety during pregnancy on the infant's neurocognitive functioning at 9 months of age. Mothers reported mindfulness using the Freiburg Mindfulness Inventory and anxiety using the Symptom Checklist (SCL-90) at ± 20.7 weeks of gestation. Event-related brain potentials (ERPs) were measured from 79 infants in an auditory oddball paradigm designed to measure auditory attention-a key aspect of early neurocognitive functioning. For the ERP responses elicited by standard sounds, higher maternal mindfulness was associated with lower N250 amplitudes (P < 0.01, η(2) = 0.097), whereas higher maternal anxiety was associated with higher N250 amplitudes (P < 0.05, η(2) = 0.057). Maternal mindfulness was also positively associated with the P150 amplitudes (P < 0.01, η(2) = 0.130). These results suggest that infants prenatally exposed to higher levels of maternal mindfulness devote fewer attentional resources to frequently occurring irrelevant sounds. The results show that positive traits and experiences of the mother during pregnancy may also affect the unborn child. Emphasizing the beneficial effects of a positive psychological state during pregnancy may promote healthy behavior in pregnant women.
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Affiliation(s)
- Marion I van den Heuvel
- Department of Psychology, Tilburg University, The Netherlands, Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, MTA, Budapest, Hungary, Institute of Psychology, University of Szeged, Szeged, Hungary, Department of Psychology, Catholic University of Leuven KU Leuven, Belgium, and Flemish Government, Brussels, Belgium
| | - Franc C L Donkers
- Department of Psychology, Tilburg University, The Netherlands, Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, MTA, Budapest, Hungary, Institute of Psychology, University of Szeged, Szeged, Hungary, Department of Psychology, Catholic University of Leuven KU Leuven, Belgium, and Flemish Government, Brussels, Belgium Department of Psychology, Tilburg University, The Netherlands, Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, MTA, Budapest, Hungary, Institute of Psychology, University of Szeged, Szeged, Hungary, Department of Psychology, Catholic University of Leuven KU Leuven, Belgium, and Flemish Government, Brussels, Belgium
| | - István Winkler
- Department of Psychology, Tilburg University, The Netherlands, Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, MTA, Budapest, Hungary, Institute of Psychology, University of Szeged, Szeged, Hungary, Department of Psychology, Catholic University of Leuven KU Leuven, Belgium, and Flemish Government, Brussels, Belgium Department of Psychology, Tilburg University, The Netherlands, Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, MTA, Budapest, Hungary, Institute of Psychology, University of Szeged, Szeged, Hungary, Department of Psychology, Catholic University of Leuven KU Leuven, Belgium, and Flemish Government, Brussels, Belgium
| | - Renée A Otte
- Department of Psychology, Tilburg University, The Netherlands, Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, MTA, Budapest, Hungary, Institute of Psychology, University of Szeged, Szeged, Hungary, Department of Psychology, Catholic University of Leuven KU Leuven, Belgium, and Flemish Government, Brussels, Belgium
| | - Bea R H Van den Bergh
- Department of Psychology, Tilburg University, The Netherlands, Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, MTA, Budapest, Hungary, Institute of Psychology, University of Szeged, Szeged, Hungary, Department of Psychology, Catholic University of Leuven KU Leuven, Belgium, and Flemish Government, Brussels, Belgium Department of Psychology, Tilburg University, The Netherlands, Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, MTA, Budapest, Hungary, Institute of Psychology, University of Szeged, Szeged, Hungary, Department of Psychology, Catholic University of Leuven KU Leuven, Belgium, and Flemish Government, Brussels, Belgium Department of Psychology, Tilburg University, The Netherlands, Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, MTA, Budapest, Hungary, Institute of Psychology, University of Szeged, Szeged, Hungary, Department of Psychology, Catholic University of Leuven KU Leuven, Belgium, and Flemish Government, Brussels, Belgium
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Ornoy A, Koren G. Selective serotonin reuptake inhibitors in human pregnancy: on the way to resolving the controversy. Semin Fetal Neonatal Med 2014; 19:188-94. [PMID: 24321501 DOI: 10.1016/j.siny.2013.11.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There has been an increase in the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. However, in the last 10 years, in spite of a vast literature regarding use in pregnancy there seems to be some confusion as to the possible risk of these drugs, especially related to cardiovascular anomalies. In addition, there are data on developmental follow-up studies that raise the question of possible slight developmental and neurobehavioral problems. The purpose of the present review is therefore to critically summarize the current evidence for the risk/benefit analysis of SSRI use in human pregnancy. Although most studies have not shown an increase in the overall risk of major malformations, several have suggested that the use of SSRIs may be associated with a small increased risk for cardiovascular malformations. However, new compelling evidence shows that this apparent increased risk occurs also in women with untreated depression, highlighting the probable ascertainment bias involved in many of these studies. Persistent pulmonary hypertension of the newborn (PPHN) has also been described with an absolute risk of <1%; however, here too, higher rates were described among offspring of women with untreated depression. Poor neonatal adaptation has been described in up to 30% of neonates exposed to SSRIs late in pregnancy. Of the few postnatal developmental follow-up studies, there are no significant developmental problems. The literature on SSRIs in pregnancy is somewhat confusing but when analysing all prospective cohort data there seems to be no demonstrable increase in the rate of major anomalies or developmental disorders. When evaluating the risk/benefit ratio of SSRI treatment in pregnancy, the risk associated with treatment discontinuation - e.g. higher frequency of relapse, increased risk of preterm delivery and postpartum depression - appear to outweigh the potential, unproven risks of treatment. Moreover, maternal depression may negatively affect the child's development, emphasizing the importance of prevention by appropriate treatment during pregnancy with the least minimal effective dose.
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Affiliation(s)
- Asher Ornoy
- Hebrew University Hadassah Medical School, Jerusalem, Israel; Israeli Teratology Information Service, Israel Ministry of Health, Jerusalem, Israel.
| | - Gideon Koren
- Israeli Teratology Information Service, Israel Ministry of Health, Jerusalem, Israel; Motherisk Program, Division of Clinical Pharmacology/Toxicology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
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Huybrechts KF, Sanghani RS, Avorn J, Urato AC. Preterm birth and antidepressant medication use during pregnancy: a systematic review and meta-analysis. PLoS One 2014; 9:e92778. [PMID: 24671232 PMCID: PMC3966829 DOI: 10.1371/journal.pone.0092778] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/25/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Preterm birth is a major contributor to neonatal morbidity and mortality and its rate has been increasing over the past two decades. Antidepressant medication use during pregnancy has also been rising, with rates up to 7.5% in the US. The objective was to systematically review the literature to determine the strength of the available evidence relating to a possible association between antidepressant use during pregnancy and preterm birth. METHODS We conducted a computerized search in PUBMED, MEDLINE and PsycINFO through September 2012, supplemented with a manual search of reference lists, to identify original published research on preterm birth rates in women taking antidepressants during pregnancy. Data were independently extracted by two reviewers, and absolute and relative risks abstracted or calculated. Our a priori design was to group studies by level of confounding adjustment and by timing of antidepressant use during pregnancy; we used random-effects models to calculate summary measures of effect. RESULTS Forty-one studies met inclusion criteria. Pooled adjusted odds ratios (95% CI) were 1.53 (1.40-1.66) for antidepressant use at any time and 1.96 (1.62-2.38) for 3rd trimester use. Controlling for a diagnosis of depression did not eliminate the effect. There was no increased risk [1.16 (0.92-1.45)] in studies that identified patients based on 1st trimester exposure. Sensitivity analyses demonstrated unmeasured confounding would have to be strong to account for the observed association. DISCUSSION Published evidence is consistent with an increased risk of preterm birth in women taking antidepressants during the 2nd and 3rd trimesters, although the possibility of residual confounding cannot be completely ruled out.
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Affiliation(s)
- Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Reesha Shah Sanghani
- Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jerry Avorn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Adam C. Urato
- MetroWest Medical Center, Tufts University School of Medicine, Framingham, Massachusetts, United States of America
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Bourke CH, Stowe ZN, Owens MJ. Prenatal antidepressant exposure: clinical and preclinical findings. Pharmacol Rev 2014; 66:435-65. [PMID: 24567054 DOI: 10.1124/pr.111.005207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Pharmacological treatment of any maternal illness during pregnancy warrants consideration of the consequences of the illness and/or medication for both the mother and unborn child. In the case of major depressive disorder, which affects up to 10-20% of pregnant women, the deleterious effects of untreated depression on the offspring can be profound and long lasting. Progress has been made in our understanding of the mechanism(s) of action of antidepressants, fetal exposure to these medications, and serotonin's role in development. New technologies and careful study designs have enabled the accurate sampling of maternal serum, breast milk, umbilical cord serum, and infant serum psychotropic medication concentrations to characterize the magnitude of placental transfer and exposure through human breast milk. Despite this progress, the extant clinical literature is largely composed of case series, population-based patient registry data that are reliant on nonobjective means and retrospective recall to determine both medication and maternal depression exposure, and limited inclusion of suitable control groups for maternal depression. Conclusions drawn from such studies often fail to incorporate embryology/neurotransmitter ontogeny, appropriate gestational windows, or a critical discussion of statistically versus clinically significant. Similarly, preclinical studies have predominantly relied on dosing models, leading to exposures that may not be clinically relevant. The elucidation of a defined teratological effect or mechanism, if any, has yet to be conclusively demonstrated. The extant literature indicates that, in many cases, the benefits of antidepressant use during pregnancy for a depressed pregnant woman may outweigh potential risks.
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Greenberg GD, Laman-Maharg A, Campi KL, Voigt H, Orr VN, Schaal L, Trainor BC. Sex differences in stress-induced social withdrawal: role of brain derived neurotrophic factor in the bed nucleus of the stria terminalis. Front Behav Neurosci 2014; 7:223. [PMID: 24409132 PMCID: PMC3885825 DOI: 10.3389/fnbeh.2013.00223] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/22/2013] [Indexed: 12/03/2022] Open
Abstract
Depression and anxiety disorders are more common in women than men, and little is known about the neurobiological mechanisms that contribute to this disparity. Recent data suggest that stress-induced changes in neurotrophins have opposing effects on behavior by acting in different brain networks. Social defeat has been an important approach for understanding neurotrophin action, but low female aggression levels in rats and mice have limited the application of these methods primarily to males. We examined the effects of social defeat in monogamous California mice (Peromyscus californicus), a species in which both males and females defend territories. We demonstrate that defeat stress increases mature brain-derived neurotrophic factor (BDNF) protein but not mRNA in the bed nucleus of the stria terminalis (BNST) in females but not males. Changes in BDNF protein were limited to anterior subregions of the BNST, and there were no changes in the adjacent nucleus accumbens (NAc). The effects of defeat on social withdrawal behavior and BDNF were reversed by chronic, low doses of the antidepressant sertraline. However, higher doses of sertraline restored social withdrawal and elevated BDNF levels. Acute treatment with a low dose of sertraline failed to reverse the effects of defeat. Infusions of the selective tyrosine-related kinase B receptor (TrkB) antagonist ANA-12 into the anterior BNST specifically increased social interaction in stressed females but had no effect on behavior in females naïve to defeat. These results suggest that stress-induced increases in BDNF in the anterior BNST contribute to the exaggerated social withdrawal phenotype observed in females.
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Affiliation(s)
- Gian D Greenberg
- Neuroscience Graduate Group, University of California Davis, CA, USA ; Department of Psychology, University of California Davis, CA, USA ; Center for Neuroscience, University of California Davis, CA, USA
| | - Abigail Laman-Maharg
- Neuroscience Graduate Group, University of California Davis, CA, USA ; Center for Neuroscience, University of California Davis, CA, USA
| | | | - Heather Voigt
- Department of Psychology, University of California Davis, CA, USA
| | - Veronica N Orr
- Department of Psychology, University of California Davis, CA, USA
| | - Leslie Schaal
- Department of Psychology, University of California Davis, CA, USA
| | - Brian C Trainor
- Neuroscience Graduate Group, University of California Davis, CA, USA ; Department of Psychology, University of California Davis, CA, USA ; Center for Neuroscience, University of California Davis, CA, USA
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Ray S, Stowe ZN. The use of antidepressant medication in pregnancy. Best Pract Res Clin Obstet Gynaecol 2013; 28:71-83. [PMID: 24211026 DOI: 10.1016/j.bpobgyn.2013.09.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/06/2013] [Accepted: 09/27/2013] [Indexed: 01/08/2023]
Abstract
The use of antidepressant medications during pregnancy has stimulated much professional and public debate. As a consequence, considerable data on the reproductive safety of antidepressants has been generated that exceeds the available information for most, if not all, other classes of medications that may be used in the perinatal period. Despite progress to date, definitive conclusions are limited by the methodological issues inherent to clinical research involving illness versus treatment effects in pregnancy. A notable shortcoming is the limited discussion of statistically significant (a mathematical determination) versus clinically significant (incorporation of incidence and effect sizes into practical relevance). Research emphasises completing an individualised 'risk-benefit' assessment, which is a laudable goal but falls short in providing succinct practical guidelines that includes the key educational points for patients. In this chapter, we focus on areas in which the preponderance of data are consistent, and there is concordance with the preclinical literature to generate a practical approach for antidepressant use in pregnancy.
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Affiliation(s)
- Shona Ray
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Pediatrics and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street 843, Little Rock, AR 72205-7199, USA.
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46
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Weikum WM, Brain U, Chau CMY, Grunau RE, Boyce WT, Diamond A, Oberlander TF. Prenatal serotonin reuptake inhibitor (SRI) antidepressant exposure and serotonin transporter promoter genotype (SLC6A4) influence executive functions at 6 years of age. Front Cell Neurosci 2013; 7:180. [PMID: 24130516 PMCID: PMC3795328 DOI: 10.3389/fncel.2013.00180] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/24/2013] [Indexed: 11/21/2022] Open
Abstract
Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants and maternal depression may affect prefrontal cognitive skills (executive functions; EFs) including self-control, working memory and cognitive flexibility. We examined long-term effects of prenatal SRI exposure on EFs to determine whether effects are moderated by maternal mood and/or genetic variations in SLC6A4 (a gene that codes for the serotonin transporter [5-HTT] central to the regulation of synaptic serotonin levels and behavior). Children who were exposed to SRIs prenatally (SRI-exposed N = 26) and non-exposed (N = 38) were studied at age 6 years (M = 6.3; SD = 0.5) using the Hearts & Flowers task (H&F) to assess EFs. Maternal mood was measured during pregnancy (3rd trimester) and when the child was age 6 years (Hamilton Depression Scale). Parent reports of child behavior were also obtained (MacArthur Health & Behavior Questionnaire). Parents of prenatally SRI-exposed children reported fewer child externalizing and inattentive (ADHD) behaviors. Generalized estimate equation modeling showed a significant 3-way interaction between prenatal SRI exposure, SLC6A4 variant, and maternal mood at the 6-year time-point on H&F accuracy. For prenatally SRI-exposed children, regardless of maternal mood, the H&F accuracy of children with reduced 5HTT expression (a short [S] allele) remained stable. Even with increasing maternal depressive symptoms (though all below clinical threshold), EFs of children with at least one short allele were comparable to children with the same genotype whose mothers reported few if any depressive symptoms—in this sense they showed resilience. Children with two long (L) alleles were more sensitive to context. When their mothers had few depressive symptoms, LL children showed extremely good EF performance—better than any other group. When their mothers reported more depressive symptoms, LL children's EF performance was worse than that of any other group. In the face of a mother with a more depressed mood, EFs were best preserved in children prenatally exposed to SRIs and with at least one short SLC6A4 allele. Yet, prenatally-exposed LL children hold out promise of possibly superior EF if their mother's mood remains euthymic or improves.
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Affiliation(s)
- Whitney M Weikum
- Pediatrics, Child and Family Research Institute, University of British Columbia Vancouver, BC, Canada
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Vitalis T, Ansorge MS, Dayer AG. Serotonin homeostasis and serotonin receptors as actors of cortical construction: special attention to the 5-HT3A and 5-HT6 receptor subtypes. Front Cell Neurosci 2013; 7:93. [PMID: 23801939 PMCID: PMC3686152 DOI: 10.3389/fncel.2013.00093] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 05/27/2013] [Indexed: 12/15/2022] Open
Abstract
Cortical circuits control higher-order cognitive processes and their function is highly dependent on their structure that emerges during development. The construction of cortical circuits involves the coordinated interplay between different types of cellular processes such as proliferation, migration, and differentiation of neural and glial cell subtypes. Among the multiple factors that regulate the assembly of cortical circuits, 5-HT is an important developmental signal that impacts on a broad diversity of cellular processes. 5-HT is detected at the onset of embryonic telencephalic formation and a variety of serotonergic receptors are dynamically expressed in the embryonic developing cortex in a region and cell-type specific manner. Among these receptors, the ionotropic 5-HT3A receptor and the metabotropic 5-HT6 receptor have recently been identified as novel serotonergic targets regulating different aspects of cortical construction including neuronal migration and dendritic differentiation. In this review, we focus on the developmental impact of serotonergic systems on the construction of cortical circuits and discuss their potential role in programming risk for human psychiatric disorders.
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Affiliation(s)
- Tania Vitalis
- Laboratoire de Neurobiologie, ESPCI ParisTech, Centre National de la Recherche Scientifique-UMR 7637 Paris, France
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Central nervous system effects of prenatal selective serotonin reuptake inhibitors: sensing the signal through the noise. Psychopharmacology (Berl) 2013; 227:567-82. [PMID: 23681158 PMCID: PMC3838633 DOI: 10.1007/s00213-013-3115-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE Women are increasingly prescribed selective serotonin reuptake inhibitors (SSRIs) during pregnancy, with potential implications for neurodevelopment. Whether prenatal SSRI exposure has an effect on neurodevelopment and behavior in the offspring is an important area of investigation. OBJECTIVES The aim of this paper was to review the existing preclinical and clinical literature of prenatal SSRI exposure on serotonin-related behaviors and markers in the offspring. The goal is to determine if there is a signal in the literature that could guide clinical care and/or inform research. RESULTS Preclinical studies (n = 4) showed SSRI exposure during development enhanced depression-like behavior. Half of rodent studies examining anxiety-like behavior (n = 13) noted adverse effects with SSRI exposure. A majority of studies of social behavior (n = 4) noted a decrease in sociability in SSRI exposed offspring. Human studies (n = 4) examining anxiety in the offspring showed no adverse effects of prenatal SSRI exposure. The outcome of one study suggested that children with autism were more likely to have a mother who was prescribed an SSRI during pregnancy. CONCLUSIONS Preclinical findings in rodents exposed to SSRIs during development point to an increase in depression- and anxiety-like behavior and alteration in social behaviors in the offspring, though both the methods used and the findings were not uniform. These data are not robust enough to discourage use of SSRIs during human pregnancy, particularly given the known adverse effects of maternal mental illness on pregnancy outcomes and infant neurodevelopment. Future research should focus on consistent animal models and prospective human studies with larger samples.
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de Vries NKS, van der Veere CN, Reijneveld SA, Bos AF. Early neurological outcome of young infants exposed to selective serotonin reuptake inhibitors during pregnancy: results from the observational SMOK study. PLoS One 2013; 8:e64654. [PMID: 23785389 PMCID: PMC3665535 DOI: 10.1371/journal.pone.0064654] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/17/2013] [Indexed: 12/20/2022] Open
Abstract
Background Use of selective serotonin reuptake inhibitors (SSRI) during pregnancy is common while the effect on the infant’s neurological outcome is unknown. Our objective was to determine the effects of prenatal SSRI-exposure on the infants’ neurological functioning, adjusted for maternal mental health. Methods A prospective observational study from May 2007 to April 2010. The study groups comprised 63 SSRI-exposed infants (SSRI group) and 44 non-exposed infants (non-SSRI group). Maternal depression and anxiety were measured using questionnaires. The main outcome measures during the first week after birth and at three to four months were the quality of the infants’ general movements (GMs) according to Prechtl and a detailed motor optimality score. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for abnormal GM quality in the SSRI and non-SSRI groups, and adjusted for maternal depression, anxiety, and other confounders. The study was registered under 53506435 in the ISRCTN. Findings All infants were born around term. During the first week, abnormal GMs occurred more frequently in the SSRI group than in the non-SSRI group (59% versus 33%) and the median MOS was lower (13 versus 18). The OR for abnormal GMs in the SSRI versus the non-SSRI group was 3·0 (95% CI, 1.3 to 6.9) and increased after adjustment for confounders. At three to four months, more SSRI-exposed infants had monotonous movements (48% versus 20%) with lower median MOSs (26 versus 28). The OR for monotonous movements was 3·5 (95% CI, 1.5 to 8.6) and increased after adjusting for confounders. Interpretation Prenatal exposure to SSRI had an adverse effect on early neurological functioning as reflected by GM quality, irrespective of maternal depression and anxiety, and other confounders. Physicians should take this into account in consultation with parents.
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de Oliveira WM, de Sá IR, de Torres SM, de Morais RN, Andrade AM, Maia FCL, Tenorio BM, da Silva Junior VA. Perinatal exposure to fluoxetine via placenta and lactation inhibits the testicular development in male rat offspring. Syst Biol Reprod Med 2013; 59:244-50. [PMID: 23651434 DOI: 10.3109/19396368.2013.796021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to the widespread use of fluoxetine to treat depression, including pregnant and nursing women, the present study aimed to investigate the effects of in utero and lactational exposure to fluoxetine in rat offspring at post natal day 22. Wistar rat dams were orally treated with fluoxetine (5, 10, and 20 mg/kg) from day 13 gestation to day 21 lactation. Exposure to 10 and 20 mg/kg fluoxetine reduced the body and testis weights. The volume of the seminiferous tubules and epithelium were also reduced following 20 mg/kg fluoxetine exposure. The length of the seminiferous tubules and the population of Sertoli cells changed in offspring exposed to fluoxetine. The amount of seminiferous tubules lacking tubular lumen was higher in rats exposed to 20 mg/kg fluoxetine. Plasma testosterone showed no significant change. In conclusion, fluoxetine exposure via the placenta and lactation may inhibit and delay testicular development, adversely affecting several testicular parameters important for the establishment of sperm production in adulthood.
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Affiliation(s)
- Waldo Monteiro de Oliveira
- Department of Animal Morphology and Physiology , Federal Rural University of Pernambuco , Recife, Pernambuco , Brazil
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