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Domingues RR, Teixeira NN, Frizzarini WS, Beard AD, Connelly MK, Vang A, Wiltbank MC, Hernandez LL. The antidepressant fluoxetine (Prozac®) modulates serotonin signaling to alter maternal peripartum calcium homeostasis. Sci Rep 2023; 13:21832. [PMID: 38071334 PMCID: PMC10710465 DOI: 10.1038/s41598-023-49253-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
Antidepressant use is two-fold greater in women compared to men; however, most studies have been performed in male subjects. We aimed to understand the impact of selective serotonin reuptake inhibitors (SSRI, most used antidepressants) on calcium homeostasis and steroid metabolism during the peripartum period. Pregnant sheep (n = 10/group) were treated with vehicle or fluoxetine (most common SSRI) during the last month of gestation. Fluoxetine treatment decreased circulating calcium prior to parturition (8.7 ± 0.1 mg/dL vs 8.2 ± 0.1 mg/dL; P = 0.07). In the control group, total calcium decreased after parturition corresponding to the onset of lactogenesis followed by increase in calcium by day 2 postpartum. Interestingly, this normal transient decrease in circulating calcium was absent in fluoxetine-treated ewes. The steroids cortisol and progesterone were not altered by fluoxetine treatment whereas estradiol was decreased after the onset of treatment (12.4 ± 1.3 vs 9.1 ± 1.2 pg/mL, P = 0.05) and prior to parturition (38.1 ± 8.1 vs 22.3 ± 4.2 pg/mL, P = 0.03). Our hypothesis was supported that fluoxetine treatment alters circulating concentrations of calcium in the peripartum period; however, we surprisingly observed a decrease in estradiol concentrations contrary to reports in in vitro studies.
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Affiliation(s)
- Rafael R Domingues
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA
- Department of Animal Sciences, The Ohio State University, Columbus, OH, USA
| | - Natalia N Teixeira
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
| | - Waneska S Frizzarini
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
| | - Adam D Beard
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Meghan K Connelly
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
| | - Alysia Vang
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Milo C Wiltbank
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura L Hernandez
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA.
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA.
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Fricke HP, Krajco CJ, Perry MJ, Brettingen LJ, Wake LA, Charles JF, Hernandez LL. Fluoxetine treatment during the postpartal period may have short-term impacts on murine maternal skeletal physiology. Front Pharmacol 2023; 14:1244580. [PMID: 38074149 PMCID: PMC10701399 DOI: 10.3389/fphar.2023.1244580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Postpartum depression affects many individuals after parturition, and selective serotonin reuptake inhibitors (SSRIs) are often used as the first-line treatment; however, both SSRIs and lactation are independently associated with bone loss due to the role of serotonin in bone remodeling. Previously, we have established that administration of the SSRI fluoxetine during the peripartal period results in alterations in long-term skeletal characteristics. In the present study, we treated mice with either a low or high dose of fluoxetine during lactation to determine the consequences of the perturbation of serotonin signaling during this time period on the dam skeleton. We found that lactational fluoxetine exposure affected both cortical and trabecular parameters, altered gene expression and circulating markers of bone turnover, and affected mammary gland characteristics, and that these effects were more pronounced in the dams that were exposed to the low dose of fluoxetine in comparison to the high dose. Fluoxetine treatment during the postpartum period in rodents had short term effects on bone that were largely resolved 3 months post-weaning. Despite the overall lack of long-term insult to bone, the alterations in serotonin-driven lactational bone remodeling raises the question of whether fluoxetine is a safe option for the treatment of postpartum depression.
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Affiliation(s)
- Hannah P. Fricke
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, United States
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Chandler J. Krajco
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Molly J. Perry
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Lauren J. Brettingen
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Lella A. Wake
- Departments of Orthopedics and Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Julia F. Charles
- Departments of Orthopedics and Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Laura L. Hernandez
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, United States
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
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Fricke HP, Krajco CJ, Perry MJ, Reisner MA, Brettingen LJ, Wake LA, Charles JF, Hernandez LL. In utero, lactational, or peripartal fluoxetine administration has differential implications on the murine maternal skeleton. Physiol Rep 2023; 11:e15837. [PMID: 37813559 PMCID: PMC10562136 DOI: 10.14814/phy2.15837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/04/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
The peripartal period is marked by alterations in calcium metabolism to accommodate for embryonic skeletal mineralization and support bone development of offspring in early life, and serotonin plays a critical role in modulating peripartal bone remodeling. Selective serotonin reuptake inhibitors (SSRIs) are commonly used as first-line treatment for psychiatric illness during pregnancy and the postpartum period and considered safe for maternal use during this time frame. In order to evaluate the effect of peripartal alterations of the serotonergic system on maternal skeletal physiology, we treated dams with the SSRI fluoxetine during gestation only, lactation only, or during the entire peripartal period. Overall, we found a low dose of fluoxetine during gestation only had minimal impacts on maternal bone at weaning, but there were implications on maternal skeleton at weaning when dams were exposed during lactation only or during the entire peripartal period. We found that these effects were differential between female mice dosed lactationally or peripartally, and there were also impacts on maternal mammary gland at weaning in both of these groups. Though SSRIs are largely considered safe maternally during the peripartal period, this study raises the question whether safety of SSRIs, specifically fluoxetine, during the peripartal period should be reevaluated.
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Affiliation(s)
- Hannah P. Fricke
- Endocrinology and Reproductive Physiology ProgramUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of Dairy ScienceUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Chandler J. Krajco
- Department of Dairy ScienceUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Molly J. Perry
- Department of Dairy ScienceUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Maggie A. Reisner
- Department of Dairy ScienceUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | | | - Lella A. Wake
- Departments of Orthopedics and MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Julia F. Charles
- Departments of Orthopedics and MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Laura L. Hernandez
- Endocrinology and Reproductive Physiology ProgramUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of Dairy ScienceUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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Domingues RR, Wiltbank MC, Hernandez LL. Maternal serotonin: implications for the use of selective serotonin reuptake inhibitors during gestation†. Biol Reprod 2023; 109:17-28. [PMID: 37098165 PMCID: PMC10344603 DOI: 10.1093/biolre/ioad046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 04/27/2023] Open
Abstract
Maternal use of antidepressants has increased throughout the last decades; selective serotonin reuptake inhibitors (SSRI) are the most prescribed antidepressants. Despite the widespread use of SSRI by women during reproductive age and pregnant women, an increasing amount of research warns of possible detrimental effects of maternal use of SSRI during pregnancy including low birthweight/small for gestational age and preterm birth. In this review, we revisited the impact of maternal use of SSRI during pregnancy, its impact on serotonin homeostasis in the maternal and fetal circulation and the placenta, and its impact on pregnancy outcomes-particularly intrauterine growth restriction and preterm birth. Maternal use of SSRI increases maternal and fetal serotonin. The increase in maternal circulating serotonin and serotonin signaling likely promotes vasoconstriction of the uterine and placental vascular beds decreasing blood perfusion to the uterus and consequently to the placenta and fetus with potential impact on placental function and fetal development. Several adverse pregnancy outcomes are similar between women, sheep, and rodents (decreased placental size, decreased birthweight, shorter gestation length/preterm birth, neonatal morbidity, and mortality) highlighting the importance of animal studies to assess the impacts of SSRI. Herein, we address the complex interactions between maternal SSRI use during gestation, circulating serotonin, and the regulation of blood perfusion to the uterus and fetoplacental unit, fetal growth, and pregnancy complications.
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Affiliation(s)
- Rafael R Domingues
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Milo C Wiltbank
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Laura L Hernandez
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
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