Antidepressant use during lactation

A randomized controlled trial on the effect of lifestyle education for Iranian women and their husbands on post-partum anxiety and depression

This randomized controlled trial was conducted on 189 pregnant women to determine the effect of lifestyle-based training for women and their husbands on post-partum anxiety (PPA) and depression (PPD). Follow-ups were continued up for 6 weeks after childbirth. Participants were allocated to three groups using block randomization. In the first intervention group, both the women and their husbands, and in the second intervention group only the women received the lifestyle-based education. In the control group, women received only routine care. Participants completed the Edinburgh Postnatal Depression Scale and Spielberger State-Trait Anxiety Inventory pre-intervention and 6 weeks after childbirth. When compared with the control group, significant reductions in PPD (adjusted difference: -5.5), state anxiety (-13.6) and trait anxiety (-12.6) scores were observed in the lifestyle education-dyad group, and also significant reductions in PPD (-3.2), state anxiety (-5.8) and trait anxiety (-4.9) scores were observed in the lifestyle education-women only group. Also, significant reductions were observed in PPD (-2.2), state anxiety (-7.8) and trait anxiety (-7.7) scores in the lifestyle education-dyad group compared with the lifestyle education-women only group. Results showed the positive effect of lifestyle training on PPD and PPA, especially if the training is given to the parental dyad.

SSRIs in pregnancy and lactation: emphasis on neurodevelopmental outcome

The aim of this review was to assess existing information about the long-term neurocognitive development of children whose mothers took SSRIs during pregnancy and/or breastfeeding. The available literature consists of 11 studies (examining a total of 306 children) that demonstrate no impairment of infant neurodevelopment following prenatal and/or postnatal exposure to SSRIs, and two studies (examining 81 children) that suggest possible unwanted effects of fetal SSRI exposure. These unwanted effects included subtle effects on motor development and motor control. Thus, the available data are not unanimous in excluding possible long-term detrimental neurodevelopmental sequelae of intrauterine exposure to SSRIs. However, it is clear that the research suggesting a lack of adverse events on infants' neurocognitive development is much more numerous and methodologically better conducted than the studies showing possible unwanted effects. Nevertheless, all reviewed studies had procedural inadequacies, and the screening instruments used have limitations, especially in the evaluation of infants. Furthermore, it is not advisable to extend the generalisations emerging from the findings of a few trials to every infant. Some infants may experience difficulties in metabolising the drugs and/or their metabolites, so the benign outcome described for most infants may not occur. Thus, the findings emerging from the reports are inconclusive and are not able to fully clarify the repercussions of maternal SSRI treatment on infants' long-term neurocognitive development. Further large, simple and well designed, randomised, prospective studies will be required for this purpose. These should also be of adequate length and performed using reproducible neurophysiological parameters in order to firmly establish the safety of these medications.

Detection of postpartum depression and anxiety in a large health plan

To determine the prevalence of diagnosed and/or treated postpartum depression and anxiety, records were extracted for 1 year after delivery from databases of outpatient diagnoses and prescriptions, for women in a health maintenance organization who had delivered a child from July 1997 through June 1998. For comparison, telephone interviews were conducted 5 to 9 months after delivery with random samples of women who delivered at 2 facilities from June 1998 through January 1999. Of the women interviewed, 11% met criteria for major depression during the first 4 months postpartum, and an additional 13% met criteria for probable depression at 5 to 9 months postpartum. In contrast 7.0% of the large cohort had a visit or prescription for depression. The 1-year prevalence rate for diagnosed and/or treated anxiety without depression was 3.8%; the rate at time of interview was 14.7%. Overall, less than 33% of women with substantial depression or anxiety symptoms were detected.