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Marr K, Maguet C, Scarlett H, Dray-Spira R, Dubertret C, Gressier F, Sutter-Dallay AL, Melchior M, van der Waerden J. Social determinants in prenatal antidepressant use and continuation: Systematic review and meta-analysis. Acta Psychiatr Scand 2023. [PMID: 38145902 DOI: 10.1111/acps.13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Depression is one of the most common co-morbidities during pregnancy; with severe symptoms, antidepressants are sometimes recommended. Social determinants are often linked with antidepressant use in the general population, and it is not known if this is the case for pregnant populations. Our objective was to determine if social determinants are associated with prenatal antidepressant intake via a systematic review and meta-analysis. METHODS A systematic search of five databases was conducted to identify publications from inception to October 2022 that reported associations with prenatal antidepressant intake (use/continuation) and one or more social determinants: education, race, immigration status, relationship, income, or employment. Eligible studies were included in random effects meta-analyses. RESULTS A total of 23 articles describing 22 studies were included. Education was significantly and positively associated with prenatal antidepressant continuation and heterogeneity was moderate. (Odds ratio = 0.83; 95% CI, 0.78 to 0.89; p < 0.00001; I2 = 53%). Meta-analyses of antidepressant use and education, race, and relationship status, and antidepressant continuation and income were not significant with high levels of heterogeneity. DISCUSSION While most social determinants in this review were not linked with prenatal antidepressant intake, lower maternal education level does seem to be associated with lower rates of prenatal antidepressant continuation. CONCLUSIONS Education appears to be linked with prenatal antidepressant intake. The low number of included studies precludes conclusive evidence for other social determinants.
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Affiliation(s)
- Ketevan Marr
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Charlotte Maguet
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Honor Scarlett
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Rosemary Dray-Spira
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Caroline Dubertret
- AP-HP, Groupe Hospital-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
- Faculté de Médecine, Université de Paris, Paris, France
| | - Florence Gressier
- CESP, Inserm UMR1178, Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Anne-Laure Sutter-Dallay
- Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux University, Bordeaux, France
- University Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, Bordeaux, France
| | - Maria Melchior
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Judith van der Waerden
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
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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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Bravo K, González-Ortiz M, Beltrán-Castillo S, Cáceres D, Eugenín J. Development of the Placenta and Brain Are Affected by Selective Serotonin Reuptake Inhibitor Exposure During Critical Periods. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1428:179-198. [PMID: 37466774 DOI: 10.1007/978-3-031-32554-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are usually prescribed to treat major depression and anxiety disorders. Fetal brain development exhibits dependency on serotonin (5-hydroxytryptamine, 5-HT) from maternal, placental, and fetal brain sources. At very early fetal stages, fetal serotonin is provided by maternal and placental sources. However, in later fetal stages, brain sources are indispensable for the appropriate development of neural circuitry and the rise of emergent functions implied in behavior acquisition. Thus, susceptible serotonin-related critical periods are recognized, involving the early maternal and placental 5-HT synthesis and the later endogenous 5-HT synthesis in the fetal brain. Acute and chronic exposure to SSRIs during these critical periods may result in short- and long-term placental and brain dysfunctions affecting intrauterine and postnatal life. Maternal and fetal cells express serotonin receptors which make them susceptible to changes in serotonin levels influenced by SSRIs. SSRIs block the serotonin transporter (SERT), which is required for 5-HT reuptake from the synaptic cleft into the presynaptic neuron. Chronic SSRI administration leads to pre- and postsynaptic 5-HT receptor rearrangement. In this review, we focus on the effects of SSRIs administered during critical periods upon placentation and brain development to be considered in evaluating the risk-safety balance in the clinical use of SSRIs.
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Affiliation(s)
- Karina Bravo
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile USACH, Santiago, Chile.
- Facultad de Ingeniería, Universidad Autónoma de Chile, Santiago, Chile.
| | - Marcelo González-Ortiz
- Laboratorio de Investigación Materno-Fetal (LIMaF), Departamento de Obstetricia y Ginecología, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Sebastian Beltrán-Castillo
- Centro integrativo de Biología y Química Aplicada (CIBQA), Universidad Bernardo O'Higgins, Santiago, Chile
| | - Daniela Cáceres
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile USACH, Santiago, Chile
| | - Jaime Eugenín
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile USACH, Santiago, Chile
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Wahba NS, Seliem AO, Abd Allah EG, Mohammed MZ. Electron microscopic study on the effect of chronic fluoxetine treatment on pituitary gland and the possible therapeutic effect of adipose-derived mesenchymal stem cells in adult male albino rats. Ultrastruct Pathol 2022; 46:334-347. [PMID: 35695512 DOI: 10.1080/01913123.2022.2083279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adipose-derived mesenchymal stem cells (ADSCs) have therapeutic potential for the treatment of a variety of disorders due to their self-renewal and multipotential differentiation capabilities. AIM OF THE WORK This study was planned to demonstrate the electron microscopic structure of the pituitary gland after chronic fluoxetine treatment and the possible therapeutic effect of ADSCs. MATERIALS AND METHODS Thirty healthy male adult albino rats were classified into Control group (Group I). Fluoxetine treated (Group II) received 24 mg/kg/day of fluoxetine dissolved in 1.0 mL of tap water once a day. Fluoxetine group treated with ADSCs (Group III) received fluoxetine as group (II) for 30 days and then was injected once by ADSCs at a dose of 1 × 106 cells/rat in the tail vein suspended in 0.5 ml of phosphate-buffered saline (PBS). Recovery group (Group IV) received fluoxetine for 30 days and then received no treatment till the end of the experiment. RESULTS The ultrastructural observations of the fluoxetine-treated group revealed major histological changes in both the pars distalis and nervosa. Pars distalis revealed cells with different shapes, sizes, nuclei, and variable profiles of the cytoplasm. Pars nervosa, on the other hand, revealed pituicytes with electron-lucent cytoplasm and small apoptotic nuclei. Administration of ADSCs greatly improved the microscopic appearance of cells, while the recovery group showed similar histological changes as the fluoxetine group. CONCLUSION Fluoxetine caused various deleterious changes in the pituitary gland of albino rats, as evidenced by electron microscopy. These changes were almost corrected by the ADSCs treatment. .
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Affiliation(s)
- Nashwa S Wahba
- Department of Medical Histology and Cell Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Assmaa O Seliem
- Department of Medical Histology and Cell Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Enas G Abd Allah
- Department of Medical Histology and Cell Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Maha Z Mohammed
- Department of Medical Histology and Cell Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Wahba NS, Saliem AO, Abd Allah EG, Mohammed MZ. Therapeutic efficacy of adipose-derived mesenchymal stem cells after chronic fluoxetine treatment on pars distalis in adult male albino rats. Tissue Cell 2022; 76:101770. [DOI: 10.1016/j.tice.2022.101770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 10/19/2022]
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Chauhan M, Parry R, Bobo WV. Vilazodone for Major Depression in Adults: Pharmacological Profile and an Updated Review for Clinical Practice. Neuropsychiatr Dis Treat 2022; 18:1175-1193. [PMID: 35726313 PMCID: PMC9206504 DOI: 10.2147/ndt.s279342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/08/2022] [Indexed: 12/16/2022] Open
Abstract
This article provides an updated review of the pharmacological profile and available efficacy and tolerability/safety data for vilazodone, one of the most recent antidepressant drugs to be approved in the USA for the treatment of major depressive disorder (MDD) in adults. The efficacy of vilazodone for MDD in adults is supported by four positive short-term (8-10 weeks), randomized, placebo-controlled trials. Beyond these pivotal trials, we review updated research findings pertaining to the clinical effects of vilazodone for MDD including the results of switch studies, small comparative efficacy trials, key pooled and secondary data analyses focused on important depressive subtypes (anxious depression) and predictors of treatment outcome, and safety studies including direct studies of sexual side-effects. Despite these additional research efforts and use for over a decade, important gaps in the clinical evidence base remain with vilazodone. Hypothesized differences in efficacy and adverse effects between other antidepressants and vilazodone based on its multimodal mechanism of action (combining serotonin reuptake inhibition with serotonin 5-HT1A partial agonist effects) have not been comprehensively demonstrated in clinical studies and its effectiveness as a continuation- or maintenance-phase therapeutic is not yet established. Questions remain regarding its reproductive and lactational safety profiles and its efficacy as a potential next-step therapeutic for patients with MDD who do not respond to first-line antidepressants such as selective serotonin reuptake inhibitors. Suggestions for clinical use of vilazodone and discussion of its place among the broad range of pharmacotherapies for adults with MDD are provided.
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Affiliation(s)
- Mohit Chauhan
- Department of Psychiatry & Psychology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Rebecca Parry
- Department of Psychiatry & Psychology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - William V Bobo
- Department of Psychiatry & Psychology, Mayo Clinic Florida, Jacksonville, FL, USA.,Center for Individualized Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
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Meurer YDSR, Linhares SSG, Lima ADC, de Aquino ACQ, Brandão LEM, Nôga DA, Campelo CLDC, Lima RH, Cavalcante JDS, Engelberth RCGJ, Ribeiro AM, Silva RH. Postnatal exposure to fluoxetine led to cognitive-emotional alterations and decreased parvalbumin positive neurons in the hippocampus of juvenile Wistar rats. Int J Dev Neurosci 2021; 81:616-632. [PMID: 34196404 DOI: 10.1002/jdn.10139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/29/2021] [Accepted: 06/24/2021] [Indexed: 12/31/2022] Open
Abstract
The exposure to selective serotonin reuptake inhibitors (SSRIs) during development results in behavioural impairment in adulthood in humans and animal models. Indeed, serotonergic overexpression in early life leads to structural and functional changes in brain circuits that control cognition and emotion. However, the effects of developmental exposure to these substances on the behaviour of adolescent rats are conflicting and remain poorly characterised. We performed a behavioural screening to investigate the effects of postnatal exposure to fluoxetine on memory and behaviours related to anxiety, anhedonia, and depression, as well we evaluate the parvalbumin expression in hippocampus of juvenile (~PND45) female and male rats. Fluoxetine (daily 20 mg/kg s.c. injections from PND7-PND21)- or vehicle-treated adolescent rats went through several behavioural tasks (from PND 38 to PND52) and were subject to transcardial perfusion and brain removal for immunohistochemical analysis (PND53). We found that postnatal exposure to fluoxetine increased anxiety- and depression-like behaviours in the open field and sucrose preference and forced swimming tests, respectively. In addition, this treatment induced working memory and short-term (but not long-term) recognition memory impairments, and reduced parvalbumin-positive interneurons in the hippocampus. In addition, the results revealed developmental sex-dependent effects of fluoxetine postnatal treatment on adolescent rats' behaviour. These outcomes indicate that affective disorders and mnemonic alterations caused by SSRIs perinatal exposure can be present at adolescence.
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Affiliation(s)
- Ywlliane da Silva Rodrigues Meurer
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Federal University of São Paulo, São Paulo, Brazil.,Memory and Cognition Studies Laboratory, Post-graduate Program of Cognitive Neuroscience and Behavior, Department of Psychology, Federal University of Paraíba, João Pessoa, Brazil.,Laboratory of Neurochemical Studies, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Sara Sophia Guedes Linhares
- Laboratory of Neurochemical Studies, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Alvaro da Costa Lima
- Memory and Cognition Studies Laboratory, Post-graduate Program of Cognitive Neuroscience and Behavior, Department of Psychology, Federal University of Paraíba, João Pessoa, Brazil
| | - Antonio Carlos Queiroz de Aquino
- Laboratory of Neurochemical Studies, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | | | - Ramon Hypólito Lima
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
| | - Jeferson de Souza Cavalcante
- Laboratory of Neurochemical Studies, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Alessandra Mussi Ribeiro
- Laboratory of Neuroscience and Bioprospecting of Natural Products, Department of Biosciences, Federal University of São Paulo, Santos, Brazil
| | - Regina Helena Silva
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Federal University of São Paulo, São Paulo, Brazil
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Chen LF, Lin CE, Chung CH, Lai CH, Chien WC. Association between the use of antidepressants and the risk of preterm birth among pregnant women with depression: a retrospective cohort study in Taiwan. J Investig Med 2021; 69:999-1007. [PMID: 33648982 DOI: 10.1136/jim-2020-001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/04/2022]
Abstract
Our study was aimed to investigate the association between the use of antidepressants and the risk of preterm birth in pregnant women who have had perinatal depression. We extracted data from the Taiwanese National Health Insurance Research Database (NHIRD) and analyzed them using multivariate Cox proportional hazard regression models. Identified from the NHIRD, we matched 1789 women aged 18-55 years who were using antidepressants during pregnancy and 1789 women who were experiencing depression but who were not using antidepressants during pregnancy for age, index date, and medical comorbidities. We enrolled the women in our study, which we conducted using 12 years' worth of data between 2000 and 2012, and then followed up individually with them for up to 1 year to identify any occurrence of preterm birth. Results highlighted that, compared with the women with perinatal depression who were not using antidepressants during pregnancy, the women taking antidepressants had a 1.762-fold risk of preterm birth (adjusted HR=1.762, 95% CI 1.351 to 2.294, p<0.001). The use of antidepressants in women with perinatal depression may increase the risk of preterm birth. However, the decision to start, stop, or change the use of antidepressants during pregnancy requires evaluating the risks of treatment versus untreated depression for both mother and child.
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Affiliation(s)
- Li-Fen Chen
- Department of Psychiatry, Hualien Armed Forces General Hospital, Hualien, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Ching-Huang Lai
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan .,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
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Li HJ, Martinez PE, Li X, Schenkel LA, Nieman LK, Rubinow DR, Schmidt PJ. Transdermal estradiol for postpartum depression: results from a pilot randomized, double-blind, placebo-controlled study. Arch Womens Ment Health 2020; 23:401-412. [PMID: 31372757 PMCID: PMC10105981 DOI: 10.1007/s00737-019-00991-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Abstract
Postpartum depression (PPD) is a common complication following delivery, though evidence-based treatment options are limited. This study explores the feasibility and efficacy of outpatient PPD treatment with transdermal estradiol (TE). In a pilot, double-blind, placebo-controlled trial, women with PPD were randomized to receive transdermal 17β-estradiol (100 mcg/day) or placebo patch. Over 6 weeks, women completed weekly ratings on the Beck Depression Inventory (BDI), Edinburgh Postnatal Depression Scale (EPDS), and Hamilton Depression Scale (HAM-D). Primary outcome measures were treatment response (> 50% decrease from baseline BDI) and remission (BDI < 10) at 6 weeks, and secondary outcome measures included severity on all scales at weeks 3 and 6. Of 12 recruited women, 6 received TE and 6 received placebo. By week 6, 5 women receiving TE responded to treatment and 4 showed symptom remission, compared to 2 responders and 1 remitter in the placebo group. This difference was not significant (p = 0.24). In a mixed-model of BDI ratings, TE was associated with a 9.2 point decrease at 3 weeks (95%CI - 19.5 to + 1.0, p = 0.074) and a 10.5 point decrease at 6 weeks (95%CI - 21.0-0.0, p = 0.049) compared to placebo, though these differences did not survive multiple comparisons correction. Analogous effects were found for HAM-D but not EPDS scores. Interestingly, no significant difference in plasma estradiol levels existed between groups. We were unable to demonstrate a significant therapeutic benefit of TE compared with placebo in PPD. Although limited by under-recruitment and loss to follow-up, our results suggest TE is a feasible option for outpatient PPD management, with preliminary evidence (based on secondary outcomes) for efficacy. Therapeutic effects may be seen as early as 3 weeks and may not directly depend on peripheral measures of estradiol.
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Affiliation(s)
- Howard J Li
- Harvard Medical School, Boston, MA, USA
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Pedro E Martinez
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Xiaobai Li
- Biostatistics and Epidemiology, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Linda A Schenkel
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lynnette K Nieman
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Peter J Schmidt
- Section on Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
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Weisskopf E, Guidi M, Fischer CJ, Bickle Graz M, Beaufils E, Nguyen KA, Morisod Harari M, Rouiller S, Rothenburger S, Gaucherand P, Kassai-Koupai B, Borradori Tolsa C, Epiney M, Tolsa JF, Vial Y, Hascoët JM, Claris O, Eap CB, Panchaud A, Csajka C. A population pharmacokinetic model for escitalopram and its major metabolite in depressive patients during the perinatal period: Prediction of infant drug exposure through breast milk. Br J Clin Pharmacol 2020; 86:1642-1653. [PMID: 32162723 DOI: 10.1111/bcp.14278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Escitalopram (SCIT) is frequently prescribed to breastfeeding women. Available information on SCIT excretion into breast milk is based on heterogeneous and incomplete data. A population pharmacokinetic model that aimed to better characterize maternal and infant exposure to SCIT and its metabolite was developed. METHODS The study population was composed of women treated by SCIT or racemic citalopram and enrolled in the multicenter prospective cohort study SSRI-Breast Milk study (ClinicalTrial.gov NCT01796132). A joint structural model was first built for SCIT and S-desmethylcitalopram (SDCIT) in plasma using NONMEM and the milk-to-plasma ratio (MPR) was estimated by adding the drug breast milk concentrations. The effect of different influential covariates was tested and the average drug exposure with variability through breastfeeding was predicted under various conditions by simulation. RESULTS The study enrolled 33 patients treated with SCIT or racemic citalopram who provided 80 blood and 104 milk samples. Mean MPR for both parent drug and metabolite was 1.9. Increased milk fat content was significantly associated with an increased drug transfer into breast milk (+28% for SCIT and +18% for SDCIT when fat amount doubles from 3.1 to 6.2 g/100 mL). Simulations suggested that an exclusively breastfed infant would ingest daily through breast milk 3.3% of the weight-adjusted maternal SCIT dose on average. CONCLUSION The moderate between-subject variability in milk concentration of SCIT and the limited exposure to escitalopram through breast milk observed provide reassurance for treated mothers of breastfed healthy infants.
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Affiliation(s)
- Etienne Weisskopf
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, Lausanne University Hospital and University of Lausanne, University of Geneva, Switzerland
| | - Monia Guidi
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, Lausanne University Hospital and University of Lausanne, University of Geneva, Switzerland.,Service of Clinical Pharmacology, Lausanne University Hospital, Lausanne, Switzerland
| | - Céline J Fischer
- Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Myriam Bickle Graz
- Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Kim An Nguyen
- Department of Neonatology, Hospices Civils de Lyon, Lyon, France.,Department of Pharmacotoxicology, CHU Lyon, Lyon, France
| | - Mathilde Morisod Harari
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Sylvie Rouiller
- Service of Gynecology and Obstetrics, Ensemble hospitalier de la Côte, Morges, Switzerland
| | - Sophie Rothenburger
- Department of Obstetrics and Gynecology, Maternité, CHRU Nancy, Nancy, France
| | | | | | | | - Manuella Epiney
- Department of Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | | | - Yvan Vial
- Department of Gynecology, Obstetrics and Genetics, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Michel Hascoët
- Department of Neonatology, Maternité Régionale, Université de Lorraine, Nancy, France
| | - Olivier Claris
- Department of Neonatology, Hospices Civils de Lyon, Lyon, France.,Claude Bernard University, P2S 4129, Lyon, France
| | - Chin B Eap
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, Lausanne University Hospital and University of Lausanne, University of Geneva, Switzerland.,Unit of Pharmacogenetics and Clinical Psychopharmacology, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Alice Panchaud
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, Lausanne University Hospital and University of Lausanne, University of Geneva, Switzerland.,Pharmacy Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, Lausanne University Hospital and University of Lausanne, University of Geneva, Switzerland
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Costa CB, Xandre PE, Mathis KJ. Treating Individuals With Eating Disorders: Part 2. J Psychosoc Nurs Ment Health Serv 2020; 58:9-15. [DOI: 10.3928/02793695-20200310-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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12
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Coşgunarslan A, Aşantoğrol F, Soydan Çabuk D, Canger EM. The effect of selective serotonin reuptake inhibitors on the human mandible. Oral Radiol 2020; 37:20-28. [PMID: 31897966 DOI: 10.1007/s11282-019-00419-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Selective serotonin reuptake inhibitors (SSRI) are a group of drugs that selectively and strongly block the serotonin transporter. Aim of this study was to evaluate the mandibular bone structure of patients who are using SSRIs with fractal analysis and panoramic morphometric indices [mandibular cortical width (MCW), panoramic mandibular index (PMI) and Klemetti index (KI)] and to compare with control group. METHODS Patients who declared using SSRIs for more than six months had been included in the study group. In total, 212 dental panoramic radiographs (DPR) were assessed. For fractal analysis; three regions of interest (ROIs) were determined: ROI1 and ROI2 were chosen within trabecular bone, ROI3 was selected from cortical bone. MCW, PMI, and KI were obtained from DPRs. The study group was categorized into five subgroups of various SSRIs. The fractal dimension (FD) values and panoramic morphometric indices of these subgroups were also compared. RESULTS There was no significant difference between the groups for age and gender (p = 0.57, p = 0.5). There were significant differences in the mean FD values between the study and control groups both for the ROI1 and ROI2 (p < 0.01, p < 0.01). There was no significant difference between the groups for the mean FD value of ROI3, MCW, PMI and KI (p = 0.93, p = 0.98, p = 0.74, p = 0.06). There were no significant differences for all the values between the SSRI subgroups (p = 0.52, p = 0.7, p = 0.76, p = 0.24, p = 0.31, p = 0.08) CONCLUSIONS: Trabecular rich sites of the mandible were found to be affected by SSRI usage.
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Affiliation(s)
- Aykağan Coşgunarslan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey.
| | - Firdevs Aşantoğrol
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
| | - Damla Soydan Çabuk
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
| | - Emin Murat Canger
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
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13
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Bond C, Johnson J, Chaudhary V, McCarthy E, McWhorter M, Woehrle N. Perinatal fluoxetine exposure results in social deficits and reduced monoamine oxidase gene expression in mice. Brain Res 2020; 1727:146282. [DOI: 10.1016/j.brainres.2019.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/28/2019] [Accepted: 06/01/2019] [Indexed: 12/27/2022]
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14
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Use of Prescribed Psychotropics during Pregnancy: A Systematic Review of Pregnancy, Neonatal, and Childhood Outcomes. Brain Sci 2019; 9:brainsci9090235. [PMID: 31540060 PMCID: PMC6770670 DOI: 10.3390/brainsci9090235] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022] Open
Abstract
This paper reviews the findings from preclinical animal and human clinical research investigating maternal/fetal, neonatal, and child neurodevelopmental outcomes following prenatal exposure to psychotropic drugs. Evidence for the risks associated with prenatal exposure was examined, including teratogenicity, neurodevelopmental effects, neonatal toxicity, and long-term neurobehavioral consequences (i.e., behavioral teratogenicity). We conducted a comprehensive review of the recent results and conclusions of original research and reviews, respectively, which have investigated the short- and long-term impact of drugs commonly prescribed to pregnant women for psychological disorders, including mood, anxiety, and sleep disorders. Because mental illness in the mother is not a benign event, and may itself pose significant risks to both mother and child, simply discontinuing or avoiding medication use during pregnancy may not be possible. Therefore, prenatal exposure to psychotropic drugs is a major public health concern. Decisions regarding drug choice, dose, and duration should be made carefully, by balancing severity, chronicity, and co-morbidity of the mental illness, disorder, or condition against the potential risk for adverse outcomes due to drug exposure. Globally, maternal mental health problems are considered as a major public health challenge, which requires a stronger focus on mental health services that will benefit both mother and child. More preclinical and clinical research is needed in order to make well-informed decisions, understanding the risks associated with the use of psychotropic medications during pregnancy.
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15
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Fischer Fumeaux CJ, Morisod Harari M, Weisskopf E, Eap CB, Epiney M, Vial Y, Csajka C, Bickle Graz M, Panchaud A. Risk-benefit balance assessment of SSRI antidepressant use during pregnancy and lactation based on best available evidence - an update. Expert Opin Drug Saf 2019; 18:949-963. [PMID: 31430189 DOI: 10.1080/14740338.2019.1658740] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Introduction: Depression affects 300 million individuals worldwide. While selective serotonin reuptake inhibitors (SSRI) are one of the first-line pharmacological treatments of major depression in the general population, there is still uncertainty regarding their potential benefits and risks during pregnancy. Areas covered: Outcomes requisite for a proper risk/benefit assessment of SSRI in pregnancy and lactation were considered: (a) potential risks associated with untreated depression, (b) effectiveness of different treatment options of depression, (c) potential risks associated with SSRI. Expert opinion: Despite the growing amount of literature on SSRI use during pregnancy, no new trials assessing the benefits of SSRIs on maternal depression were found. In the light of new data regarding the potential risks, depressed SSRI-treated pregnant women and their children seem at increased risk for several complications (mostly of small absolute risk). The interpretation of these findings remains quite similar to our previous review as the available methodology does not allow to disentangle the potential effect of SSRIs from those of the disease itself or/and of its unmeasured associated risk factors. Thus, in pregnant or lactating women who require a pharmacological treatment, SSRIs can still be considered as appropriate when effective as the abundant data support their relative safety.
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Affiliation(s)
- Céline J Fischer Fumeaux
- Clinic of Neonatology, Mother and Child department, Lausanne University Hospital , Lausanne , Switzerland
| | - Mathilde Morisod Harari
- Service of Child and Adolescent Psychiatry, Lausanne University Hospital , Lausanne , Switzerland
| | - Etienne Weisskopf
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne , Geneva , Switzerland
| | - Chin B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Department of Psychiatry, Lausanne University Hospital , Lausanne , Switzerland
| | - Manuella Epiney
- Department of Gynecology and Obstetrics, Geneva University Hospital , Geneva , Switzerland
| | - Yvan Vial
- Service of Obstetrics, Mother and Child department, Lausanne University Hospital , Lausanne , Switzerland
| | - Chantal Csajka
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne , Geneva , Switzerland
| | - Myriam Bickle Graz
- Clinic of Neonatology, Mother and Child department, Lausanne University Hospital , Lausanne , Switzerland
| | - Alice Panchaud
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne , Geneva , Switzerland.,Pharmacy Service, Department of interdisciplinary centers, Lausanne University Hospital , Lausanne , Switzerland
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16
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Lonstein JS. The dynamic serotonin system of the maternal brain. Arch Womens Ment Health 2019; 22:237-243. [PMID: 30032323 PMCID: PMC7001094 DOI: 10.1007/s00737-018-0887-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022]
Abstract
Many pregnant and postpartum women worldwide suffer from high anxiety and/or depression, which can have detrimental effects on maternal and infant well-being. The first-line pharmacotherapies for prepartum and postpartum affective disorders continue to be the selective serotonin reuptake inhibitors (SSRIs), despite the lack of large well-controlled studies demonstrating their efficacy in reproducing women and the potential for fetal/neonatal exposure to the drugs. Prepartum or postpartum use of SSRIs or other drugs that modulate the brain's serotonin system is also troubling because very little is known about the typical, let alone the atypical, changes that occur in the female central serotonin system across reproduction. We do know from a handful of studies of women and female laboratory rodents that numerous aspects of the central serotonin system are naturally dynamic across reproduction and are also affected by pregnancy stress (a major predisposing factor for maternal psychopathology). Thus, it should not be assumed that the maternal central serotonin system being targeted by SSRIs is identical to non-parous females or males. More information about the normative and stress-derailed changes in the maternal central serotonin system is essential for understanding how serotonin is involved in the etiology of, and the best use of SSRIs for potentially treating, affective disorders in the pregnant and postpartum populations.
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Affiliation(s)
- Joseph S. Lonstein
- Department of Psychology & Neuroscience Program, Michigan State University, 108 Giltner Hall, East Lansing, MI 48824, USA
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17
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Giardinelli L, Lelli L, Ugolini V, Lazzeretti L, Burian I, Lino G, Lunardi C, Castellini G, Ricca V. Comparison of two different treatments in depressed pregnant women: fetal growth characteristics and neonatal outcomes. J Perinat Med 2018; 47:134-137. [PMID: 30024856 DOI: 10.1515/jpm-2017-0367] [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] [Received: 11/21/2017] [Accepted: 06/25/2018] [Indexed: 11/15/2022]
Abstract
Background In this pilot study, the effects of selective serotonin reuptake inhibitors (SSRIs) and psychological intervention on fetal growth characteristics and neonatal outcomes were evaluated in two different groups of women affected by prenatal depression. Methods Forty-seven pregnant women diagnosed with major depression were divided into two different treatment groups according to the severity of their depression. The first group was treated with a combination of pharmacotherapy and psychological support. The second group (milder depression) was treated with psychological support only. The control group (CG) was made up of 26 healthy pregnant women. All of the patients and controls were assessed by means of a structured clinical interview and different self-reported questionnaires. Fetal ultrasonography assessments were performed in the second and third trimesters. Neonatal outcomes were evaluated at delivery. Results The infants of both treatment groups showed significant alterations in fetal biometry and a higher rate of low birth weight (LBW) with respect to controls. The infants of the patients treated with psychological support showed only a significantly higher rate of head circumference, <10th percentile with respect to controls. No significant difference was found between the two patient groups when fetal growth characteristics and neonatal outcomes were taken into account. Conclusion The data obtained from this study shed light on the effects of pharmacological and psychological treatment of prenatal depression on fetal growth.
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Affiliation(s)
- Lisa Giardinelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lorenzo Lelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valentina Ugolini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lisa Lazzeretti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Iuliia Burian
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giuliana Lino
- Department of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Clara Lunardi
- Department of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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18
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Kimmel MC, Cox E, Schiller C, Gettes E, Meltzer-Brody S. Pharmacologic Treatment of Perinatal Depression. Obstet Gynecol Clin North Am 2018; 45:419-440. [DOI: 10.1016/j.ogc.2018.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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19
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Memantine rescues prenatal citalopram exposure-induced striatal and social abnormalities in mice. Exp Neurol 2018; 307:145-154. [PMID: 29913137 DOI: 10.1016/j.expneurol.2018.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/02/2018] [Accepted: 06/04/2018] [Indexed: 01/21/2023]
Abstract
Prenatal exposure to citalopram (CTM), an antidepressant drug, has been associated with altered behavior, including autism-like symptoms in both human and rodent offspring. However, the neurological basis underlying these abnormal behaviors is not well understood. Here, we examined behavioral, morphological, and biochemical alterations in the male and female offspring of C57BL/6 mouse mothers that had been exposed to CTM during the last trimester of gestation. We observed abnormal behavior such as anxiety, altered locomotion and disordered social interactions in 2-5 months old offspring with prenatal CTM exposure. Using Golgi-Cox staining, we found that CTM caused significantly reduced dendritic length and number of dendritic branches in striatal neurons, as well as altered subunit levels of N-methyl-d-aspartate receptors (NMDARs) and calcium/calmodulin-dependent protein kinase II (CaMKII). Memantine, a selective NMDAR antagonist, improved prenatal CTM-induced abnormal protein levels and social interaction deficits. These results highlight potential mechanisms underlying the abnormal behavior observed in children who are prenatally exposed to CTM.
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20
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Bénard-Laribière A, Pambrun E, Sutter-Dallay AL, Gautier S, Hurault-Delarue C, Damase-Michel C, Lacroix I, Bégaud B, Pariente A. Patterns of antidepressant use during pregnancy: a nationwide population-based cohort study. Br J Clin Pharmacol 2018; 84:1764-1775. [PMID: 29665098 DOI: 10.1111/bcp.13608] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 12/24/2022] Open
Abstract
AIMS We explored the patterns of antidepressant use during pregnancy. METHODS A cohort of women who started a pregnancy in 2014 was identified using data from the French reimbursement healthcare system (covering approximately 99% of the population). Antidepressant usage (initiated before or during pregnancy) was assessed. Explored changes in antidepressant treatment were: associations, switches, discontinuation and resumption of antidepressants during pregnancy. RESULTS The cohort included 766 508 pregnancies (755 519 women). Antidepressant use during pregnancy was 25.7 per 1000 [95% CI: 25.3-26.0]. New use concerned 3.9 per 1000 [95% CI: 3.7-4.0]; the most initiated class during pregnancy was selective serotonin reuptake inhibitors (SSRIs), while the most prescribed individual drug in second and third trimesters was amitriptyline, a tricyclic. Most changes were observed before pregnancy and during the first trimester: 63% of ongoing treatments in the year before pregnancy were discontinued before conception; 68% of treatments maintained after conception were discontinued during the first trimester; switches or antidepressant associations mostly occurred during the periconceptional period or during the first trimester. Regardless of initial antidepressant, switches to sertraline were the most frequent. Associations mainly consisted of a prescription of tri-/tetracyclic or mirtazapine/mianserin in addition to an SSRI. Discontinuation during pregnancy led to treatment resumption in 22% of pregnancies. CONCLUSIONS These results suggest that pregnancy was planned or the treatment especially adapted in accordance with existing recommendations in a large proportion of women under antidepressants or in whom such treatments have been initiated after starting a pregnancy.
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Affiliation(s)
- Anne Bénard-Laribière
- team PHARMACOEPIDEMIOLOGY, Univ. Bordeaux, Inserm UMR 1219, Bordeaux Population Health Research Center, F-33000, Bordeaux, France
| | - Elodie Pambrun
- team PHARMACOEPIDEMIOLOGY, Univ. Bordeaux, Inserm UMR 1219, Bordeaux Population Health Research Center, F-33000, Bordeaux, France
| | - Anne-Laure Sutter-Dallay
- team PHARMACOEPIDEMIOLOGY, Univ. Bordeaux, Inserm UMR 1219, Bordeaux Population Health Research Center, F-33000, Bordeaux, France.,Charles Perrens Hospital, F-33000, Bordeaux, France
| | - Sophie Gautier
- Clinical Pharmacology Department, U 1171 University Hospital of Lille, University of Lille, F-59000, Lille, France
| | - Caroline Hurault-Delarue
- Clinical Pharmacology Department, Inserm UMR 1027, CIC Inserm 1436, Faculty of Medicine, University Hospital of Toulouse, F-31000, Toulouse, France
| | - Christine Damase-Michel
- Clinical Pharmacology Department, Inserm UMR 1027, CIC Inserm 1436, Faculty of Medicine, University Hospital of Toulouse, F-31000, Toulouse, France
| | - Isabelle Lacroix
- Clinical Pharmacology Department, Inserm UMR 1027, CIC Inserm 1436, Faculty of Medicine, University Hospital of Toulouse, F-31000, Toulouse, France
| | - Bernard Bégaud
- team PHARMACOEPIDEMIOLOGY, Univ. Bordeaux, Inserm UMR 1219, Bordeaux Population Health Research Center, F-33000, Bordeaux, France.,Clinical Pharmacology, University Hospital of Bordeaux, F-33000, Bordeaux, France
| | - Antoine Pariente
- team PHARMACOEPIDEMIOLOGY, Univ. Bordeaux, Inserm UMR 1219, Bordeaux Population Health Research Center, F-33000, Bordeaux, France.,Clinical Pharmacology, University Hospital of Bordeaux, F-33000, Bordeaux, France
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21
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Pogliani L, Baldelli S, Cattaneo D, Pileri P, Clementi E, Cetin I, Zuccotti G. Selective serotonin reuptake inhibitors’ passage into human milk of lactating women. J Matern Fetal Neonatal Med 2018; 32:3020-3025. [DOI: 10.1080/14767058.2018.1455180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Laura Pogliani
- Department of Pediatrics, ASST FBF-Sacco, L. Sacco University Hospital, Milan, Italy
| | - Sara Baldelli
- Unit of Clinical Pharmacology, ASST FBF-Sacco, L. Sacco University Hospital, Milan, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, ASST FBF-Sacco, L. Sacco University Hospital, Milan, Italy
| | - Paola Pileri
- Department of Gynecology and Obstetrics Fatebenefratelli-Sacco, L. Sacco hospital, University Hospital, Milan, Italy
| | - Emilio Clementi
- Department of Biomedical and Clinical Sciences L, Clinical Pharmacology Unit, Consiglio Nazionale delle Ricerche Institute of Neuroscience, Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
- E. Medea Scientific Institute, Bosisio Parini, Italy
| | - Irene Cetin
- Department of Gynecology and Obstetrics Fatebenefratelli-Sacco, L. Sacco hospital, University Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, ASST FBF-Sacco, L. Sacco University Hospital, Milan, Italy
- Department of Pediatrics, ASST Fatebenefratelli-Sacco, Ospedale dei Bambini V, Buzzi, Milan, Italy
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22
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Zucker I. Psychoactive drug exposure during breastfeeding: a critical need for preclinical behavioral testing. Psychopharmacology (Berl) 2018; 235:1335-1346. [PMID: 29549392 DOI: 10.1007/s00213-018-4873-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/26/2018] [Indexed: 12/11/2022]
Abstract
Breastfeeding women are excluded from clinical trials of psychoactive drugs because of ethical concerns. Animal testing, which often is predictive of adverse effects in humans, represents the only avenue available for assessing drug safety for human offspring exposed to drugs during lactation. I determined whether behavioral outcomes for children exposed during breastfeeding to antidepressants, anxiolytics, antipsychotics, anti-seizure medications, analgesics, sedatives, and marijuana can be predicted by rodent studies of offspring exposed to drugs during lactation. Animal data were available for only 10 of 80 CNS-active drugs canvassed. Behavioral deficits in adolescence or adulthood in rats and mice after various drug exposures during lactation included reductions in sexual behavior, increased anxiety, hyperactivity, and impaired learning and memory. Whether similar adverse effects will emerge in adulthood in children exposed to drugs during breastfeeding is unknown. Rodent research has the potential to forecast impairments in breastfed children long before information emerges from post-marketing reports and should be prioritized during preclinical drug evaluation by the FDA for new drugs and for drugs currently prescribed off-label for lactating women.
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Affiliation(s)
- Irving Zucker
- Departments of Psychology and Integrative Biology, University of California, Berkeley, CA, 94720, USA. .,Psychology Department, University of California, Berkeley, CA, 94720, USA.
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23
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Nezvalová-Henriksen K, Spigset O, Brandlistuen RE, Ystrom E, Koren G, Nordeng H. Effect of prenatal selective serotonin reuptake inhibitor (SSRI) exposure on birthweight and gestational age: a sibling-controlled cohort study. Int J Epidemiol 2018; 45:2018-2029. [PMID: 27188860 DOI: 10.1093/ije/dyw049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 11/14/2022] Open
Abstract
Background Up to 10% of women are exposed to selective serotonin reuptake inhibitors (SSRIs) during pregnancy. Information on their effect on birthweight and gestational age remains conflicting. The aim of this sibling-controlled prospective cohort study is to address shared geneticand family-level confounding to investigate the effects of prenatal SSRI exposure and maternal depression on birthweight and gestational age. Methods We used the Norwegian Mother and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN). Our study population consisted of 27 756 siblings; 194 were prenatally exposed to SSRIs and 27 500 were unexposed to any antidepressant medication. Random and fixed effects analysis with propensity score adjustment was used to evaluate the effectson birthweight and gestational age. Results SSRI exposure during two or more trimesters was associated with a decrease in birthweight of 205 g [95% confidence interval (CI) -372 to - 38] and a decrease in gestational length of 4.9 days (95% CI - 9.1 to - 1.4). Neither maternal SSRI use in one trimester, lifetime history of major depression nor depressive symptoms during pregnancy were associated with these pregnancy outcomes (for non-pharmacologically treated depression in two periods in pregnancy, +5 g (95% CI - 56 to + 67) and +4.9 days (95% CI - 4.7 to + 14.7), respectively). Conclusions Prenatal exposure to SSRIs during two or more trimesters may decrease birthweight and gestational length. Our results indicate that neither maternal depression nor shared genetics and family environment fully explain this association.
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Affiliation(s)
| | - Olav Spigset
- Department of Clinical Pharmacology, St Olav's University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ragnhild Eek Brandlistuen
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway.,Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eivind Ystrom
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Gideon Koren
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway.,Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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24
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Simultaneous determination of selective serotonin reuptake inhibitors and their main metabolites in human breast milk by liquid chromatography-electrospray mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1057:101-109. [DOI: 10.1016/j.jchromb.2017.04.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/07/2017] [Accepted: 04/23/2017] [Indexed: 11/19/2022]
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25
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Latendresse G, Elmore C, Deneris A. Selective Serotonin Reuptake Inhibitors as First-Line Antidepressant Therapy for Perinatal Depression. J Midwifery Womens Health 2017; 62:317-328. [PMID: 28485526 DOI: 10.1111/jmwh.12607] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/22/2016] [Accepted: 01/06/2017] [Indexed: 01/22/2023]
Abstract
One in 7 women experience depression during the prenatal and/or postpartum period. Nonpharmacologic approaches are known to be as effective as pharmacologic therapies for mild to moderate depression. However, for women who suffer from moderate to severe depression, antidepressant therapy may be the best option, in combination with nonpharmacologic approaches. Considering the substantial negative impact of untreated perinatal depression, providers of prenatal care need to be prepared to diagnose depression, prescribe first-line antidepressants, and refer to other professionals. The purpose of this article is to assist providers to select the safest, most effective selective serotonin reuptake inhibitor (SSRI) as the first-line antidepressant during pregnancy and lactation. Information about side effects, adverse effects, contraindications, and clinical considerations associated with the use of SSRIs is provided. A brief discussion of nonpharmacologic therapies is provided but is not the focus of this article.
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26
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Regueira LS, Marcelos PGCLD, Santiago-Jaegger IM, Perez DEDC, Evêncio J, Baratella-Evêncio L. Fluoxetine effects on periodontogenesis: histomorphometrical and immunohistochemical analyses in rats. J Appl Oral Sci 2017; 25:159-167. [PMID: 28403356 PMCID: PMC5393536 DOI: 10.1590/1678-77572015-0564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/31/2016] [Indexed: 11/21/2022] Open
Abstract
Reports have indicated that serotonin plays an important role in cell migration and differentiation during the organogenesis of several tissues, including the oral types. Administration of selective serotonin reuptake inhibitor (SSRI) drugs during pregnancy could affect the delivery of serotonin to embryonic tissues altering its development.
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Affiliation(s)
| | | | | | - Danyel Elias da Cruz Perez
- Universidade Federal de Pernambuco, Faculdade de Odontologia, Departamento de Clínica e Odontologia Preventiva, Seção de Patologia Oral Recife, PE, Brasil
| | - Joaquim Evêncio
- Universidade Federal de Pernambuco, Faculdade de Odontologia, Departamento de Morfologia e Fisiologia Animal, Recife, PE
| | - Liriane Baratella-Evêncio
- Universidade Federal de Pernambuco, Faculdade de Odontologia, Departamento de Histologia e Embriologia, Recife, PE, Brasil
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27
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Bø K, Artal R, Barakat R, Brown W, Davies GAL, Dooley M, Evenson KR, Haakstad LAH, Henriksson-Larsen K, Kayser B, Kinnunen TI, Mottola MF, Nygaard I, van Poppel M, Stuge B, Khan KM. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1-exercise in women planning pregnancy and those who are pregnant. Br J Sports Med 2017; 50:571-89. [PMID: 27127296 DOI: 10.1136/bjsports-2016-096218] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Kari Bø
- Norwegian School of Sport Sciences, Oslo, Norway
| | - Raul Artal
- Department of Obstetrics/Gynecology and Women's Health, Saint Louis University, St Louis, Missouri, USA
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Wendy Brown
- Centre for Research on Exercise, School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Gregory A L Davies
- Department of Maternal-Fetal Medicine, Queens University, Kingston, Ontario, Canada
| | - Michael Dooley
- The Poundbury Clinic Dorchester-The Poundbury Suite, King Edward VII Hospital London, London, UK
| | - Kelly R Evenson
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Lene A H Haakstad
- Department of Sport Sciences, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Bengt Kayser
- Faculty of Biology and Medicine, Institute of Sports Science, University of Lausanne, Lausanne, Switzerland
| | - Tarja I Kinnunen
- University Lecturer, School of Health Sciences, University of Tampere, Tampere, Finland Department of Children, Young People and Families, The National Institute for Health and Welfare, Helsinki, Finland
| | - Michelle F Mottola
- R Samuel McLaughlin Foundation-Exercise and Pregnancy Lab, The University of Western Ontario London, London, Ontario, Canada
| | - Ingrid Nygaard
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
| | | | - Britt Stuge
- Oslo University Hospital, Ullevål, Oslo, Norway
| | - Karim M Khan
- Department of Family Practice & Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
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Singal D, Brownell M, Chateau D, Ruth C, Katz LY. Neonatal and childhood neurodevelopmental, health and educational outcomes of children exposed to antidepressants and maternal depression during pregnancy: protocol for a retrospective population-based cohort study using linked administrative data. BMJ Open 2016; 6:e013293. [PMID: 27899401 PMCID: PMC5168512 DOI: 10.1136/bmjopen-2016-013293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Antidepressants are commonly prescribed during pregnancy; however, there are inconsistent data on the safety of these medications during the prenatal period. To address this gap, this study will investigate short-term and long-term neurodevelopmental, physical and mental health, and educational outcomes of children who have been exposed to selective serotonin reuptake inhibitors (SSRIs) or selective serotonin norepinephrine reuptake inhibitors (SNRIs) and/or maternal depression during pregnancy. METHODS AND ANALYSIS Administrative data will be linked to generate 4 population-based exposed groups from all children born in Manitoba between 1996 and 2014 whose mother had at least 2 prescriptions for either an SSRI or SNRI: (1) throughout the prenatal period (beginning of pregnancy until birth); (2) in the first trimester (≤14 weeks gestation); (3) in the second trimester (15-26 weeks gestation); (4) in the third trimester (≥27 weeks gestation) and 1 population-based unexposed group consisting of children whose mothers had a diagnosis of mood or anxiety disorder during pregnancy but did not use antidepressants. Propensity scores and inverse probability treatment weights will be used to adjust for confounding. Multivariate regression modelling will determine whether, compared with untreated mood/anxiety disorder, prenatal exposure to antidepressant medications is associated with: (1) adverse birth and neonatal outcomes, including: preterm birth, low birth weight, low Apgar scores, respiratory distress, congenital malformations and persistent pulmonary hypertension; (2) adverse early childhood outcomes, including: early childhood education challenges, diagnosis of neurodevelopmental disorders and diagnosis of mental disorders. We will determine if exposure effects differ between SSRIs and SRNIs, and determine if exposure effects differ between gestation timing of exposure to antidepressants. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Manitoba Health Research Ethics Board. Dissemination of results will include engagement of stakeholders and patients, writing of reports for policymakers and patients, and publication of scientific papers.
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Affiliation(s)
- Deepa Singal
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea Ruth
- Department of Paediatrics and Child Health, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laurence Y Katz
- Department of Psychiatry, Child and Adolescent Mental Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Weisskopf E, Panchaud A, Nguyen KA, Grosjean D, Hascoët JM, Csajka C, Eap CB, Ansermot N. Stereoselective determination of citalopram and desmethylcitalopram in human plasma and breast milk by liquid chromatography tandem mass spectrometry. J Pharm Biomed Anal 2016; 131:233-245. [PMID: 27606925 DOI: 10.1016/j.jpba.2016.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/16/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Abstract
A high performance liquid chromatography (HPLC) tandem mass spectrometry (MS/MS) method was developed for the simultaneous, stereoselective quantification of the antidepressant citalopram and its active metabolite desmethylcitalopram in human plasma and breast milk. Sample preparation was performed by a two-step approach, including generic protein precipitation with acetonitrile followed by solid phase extraction. Enantiospecific separation of analytes was achieved on a Phenomenex® Lux Cellulose-2 column (4.6mm×150mm; 5μm), using reversed phase chromatography conditions characterized by a gradient elution of ammonium acetate buffer (pH 9.0; 20mM) and acetonitrile at a flow rate of 0.6ml/min. The compounds were detected by a tandem quadrupole mass spectrometer equipped with an electrospray ionization source and operating in multiple reaction monitoring mode. The method was fully validated in both biological fluids over a large concentration range of 0.1-100ng/ml for S-(+)- and R-(-)-citalopram, and 0.3-100ng/ml for S-(+)- and R-(-)-desmethylcitalopram. Trueness (90.0-113.3% and 97.1-103.6%), repeatability (0.9-15.9% and 0.9-8.4%) and intermediate precision (1.3-17.8% and 0.9-9.6%) in plasma and breast milk, respectively, meet international guidelines for method validation. Internal standard-normalized matrix effects ranged between 99 and 101% and 98-105%, respectively. The accuracy profiles (total error of trueness and precision) were mostly within the acceptance limits for biological samples defined as ±30%. The method was successfully applied to patient samples in a clinical trial setting.
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Affiliation(s)
- Etienne Weisskopf
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland
| | - Alice Panchaud
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland; Division of Clinical Pharmacology, Lausanne University Hospital, Lausanne, Switzerland
| | - Kim An Nguyen
- Department of Neonatology, Hospices Civils de Lyon, Lyon, France
| | - Delphine Grosjean
- EPICIME-CIC 1407, Inserm, Service of Clinical Pharmacology, CHU-Lyon, Bron, France
| | - Jean-Michel Hascoët
- Department of Neonatology, Maternité Régionale, Université de Lorraine, Nancy, France
| | - Chantal Csajka
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland; Division of Clinical Pharmacology, Lausanne University Hospital, Lausanne, Switzerland
| | - Chin B Eap
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland; Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Nicolas Ansermot
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland.
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Gils C, Pottegård A, Ennis ZN, Damkier P. Perception of drug teratogenicity among general practitioners and specialists in obstetrics/gynecology: a regional and national questionnaire-based survey. BMC Pregnancy Childbirth 2016; 16:226. [PMID: 27531162 PMCID: PMC4988043 DOI: 10.1186/s12884-016-1025-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Estimating the true risk of fetal malformations attributable to the use of medications is difficult and perception of risk by health professionals will impact their counseling and treatment of patients who need medication during pregnancy. The objective of this study was to assess the perception of the teratogenic risk of 9 commonly and 3 rarely prescribed drugs among general practitioners and specialists in obstetrics/gynecology. METHODS All 811 general practitioners in the Region of Southern Denmark and all 502 specialist obstetricians/gynecologists in Denmark as a whole were invited to participate in the study based on an online questionnaire. Medians and interpercentile ranges of the perceived background risk and perceived risks for each of the drugs were included in the questionnaire. RESULTS One hundred forty three (18 %) general practitioners and 138 (27 %) obstetricians/gynecologists participated. Estimates provided by the participants were generally in accordance with current knowledge of drugs with established safety during pregnancy. Perceptions of risks associated with warfarin and retinoid exposure were severely underestimated. CONCLUSIONS Understanding of teratogenic background risk and specific risks associated with in utero exposure to 12 different drugs generally approached the established knowledge. The risk associated with warfarin and retinoid exposure was severely underestimated by both groups of health care professionals, while general practitioners specifically overestimated the risk of sertraline and citalopram to some extent. In Denmark, general practitioners can prescribe antidepressants, and even minor misconceptions of the teratogenic potential of citalopram and sertraline may be of clinical relevance. In Denmark, systemic retinoids can only be prescribed by a dermatologist, and warfarin treatment is only rarely initiated in women of the fertile age without involvement of specialists in internal medicine. Hence, the active knowledge on the teratogenic potential of these drugs is likely to be less accurate among general practitioners and obstetricians/gynecologists; although still of clinical importance since these specialists are largely involved in the counselling of pregnant women.
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Affiliation(s)
- Charlotte Gils
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark
| | - Anton Pottegård
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark.,Clinical Pharmacology and Pharmaceutics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Zandra Nymand Ennis
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark.,Clinical Pharmacology and Pharmaceutics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Per Damkier
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark. .,Clinical Pharmacology and Pharmaceutics, Department of Public Health, University of Southern Denmark, Odense, Denmark.
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Affiliation(s)
- Philip O Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California , San Diego, La Jolla, California
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The Effect of Orange Peel Essential Oil on Postpartum Depression and Anxiety: A Randomized Controlled Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.30298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Evaluate the rationale for screening women for postpartum depression• Assess tools for screening for postpartum depression OBJECTIVE To perform a qualitative literature review on screening for postpartum depression (PPD), as applicable to the general psychiatrist. Results are classified by instrument, timing, and clinical setting of the screen. DATA SOURCES A literature search was conducted using the PubMed database for English-language articles published since January 1987. Of the 2406 citations initially identified, 61 articles remained after application of inclusion and exclusion criteria. RESULTS Among numerous screening tools for PPD, the Edinburgh Postnatal Depression Scale is the most widely used. Data suggest that screening for PPD should commence soon after delivery, with subsequent screens at multiple time-points in the postpartum period. Primary care, pediatric, and obstetric settings are all viable locations for screening, but are ineffective without follow-up mental health evaluations. Less data are available to define optimal patterns either for screening in psychiatric settings or for the psychiatrist's role in managing perinatal depression. CONCLUSIONS The American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics, and most authors firmly recommend screening for PPD. The Edinburgh Postnatal Depression Scale can be administered in various clinical settings. Screening should occur at multiple time-points throughout the first postpartum year. The psychiatrist's role in early detection and prevention of PPD requires further exploration.
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Ormsby SM, Smith CA, Dahlen HG, Hay PJ, Lind JM. Evaluation of an antenatal acupuncture intervention as an adjunct therapy for antenatal depression (AcuAnteDep): study protocol for a pragmatic randomised controlled trial. Trials 2016; 17:93. [PMID: 26887958 PMCID: PMC4758005 DOI: 10.1186/s13063-016-1204-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 01/28/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Depressed pregnant women face difficulty navigating a course between the potentially serious consequences of leaving depression untreated and significant limitations associated with conventional therapies, such as foetal toxicity and teratogenicity. Preliminary evidence is suggestive that acupuncture may provide a safe and effective alternative treatment option for antenatal depression; however, additional research is required. The purpose of this study is to further investigate this treatment possibility, with an additional examination of a potential biomechanistic acupuncture effect. METHODS/DESIGN In this pragmatic randomised controlled trial, we will compare individually tailored, flexible antenatal depression-oriented acupuncture with equivalent attention progressive muscle relaxation and routine antenatal depression hospital care. Eligible women at 24 weeks of gestation with Edinburgh Postnatal Depression Scale scores of 13 or more will be recruited from 2 antenatal clinics in South Western Sydney, Australia. The recruitment goal of 96 is powered to demonstrate a significant difference in Edinburgh Postnatal Depression Scale score severity between acupuncture and usual care, with intervention groups receiving weekly 1-h treatments for 8 weeks from 24 to 31 weeks of gestation. Mental health and quality-of-life assessments will occur at study commencement, intervention weeks 4 and 8 and 6 weeks post-natally via the collection of completed Edinburgh Postnatal Depression Scale scores, Depression, Stress and Anxiety Scale scores and World Health Organisation Quality of Life Scale scores. Adjustment to mothering will also be evaluated at 6 weeks post-natally using the Being a Mother Scale. A putative biomechanistic effect of acupuncture on the oxytocinergic system will additionally be examined by comparing baseline salivary hormone levels with those measured at intervention weeks 4 and 8, as well as leucocyte oxytocin receptor expression at baseline and intervention week 8. DISCUSSION Ethical approval was received in February 2015, and recruitment is underway and expected to be completed in July 2016. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12615000250538, Registered on 19 March 2015.
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Affiliation(s)
- Simone M Ormsby
- PhD Candidate, National Institute of Complementary Medicine, Western Sydney University, Building 5, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Caroline A Smith
- Professor of Complementary Medicine, National Institute of Complementary Medicine, Western Sydney University, Building 5, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Hannah G Dahlen
- Professor of Midwifery, Western Sydney University, Building EB, Parramatta Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Phillipa J Hay
- Chair of Mental Health, Western Sydney University, Building 30, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Joanne M Lind
- Associate Professor, Molecular Biology and Genetics, Western Sydney University, Building 30, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Zohar I, Shoham S, Weinstock M. Perinatal citalopram does not prevent the effect of prenatal stress on anxiety, depressive-like behaviour and serotonergic transmission in adult rat offspring. Eur J Neurosci 2016; 43:590-600. [PMID: 26669896 DOI: 10.1111/ejn.13150] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/26/2015] [Accepted: 12/07/2015] [Indexed: 12/17/2022]
Abstract
It is still not clear whether the selective serotonin reuptake inhibitors frequently prescribed to depressed pregnant women improve the behavioural outcome in their children. The current study investigated whether administration of citalopram to pregnant rats could prevent anxiety and depressive-like behaviour induced by gestational stress in their offspring, and restore the expression of serotonin 1A autoreceptors in GABAergic interneurons in the medial prefrontal cortex and dorsal raphe nuclei in males, and of corticotropin-releasing factor type 2 receptors in GABAergic interneurons in the dorsal raphe nuclei in females. Activation of these receptors modulates serotonergic transmission to target areas and is reduced in a sex-dependent manner by prenatal stress. Citalopram (10 mg/kg/day), administered orally from day 7 of gestation until 21 days postpartum, prevented the increase in anxiety in stressed mothers but did not reduce anxiety and depressive-like behaviour in their offspring and even induced depressive-like behaviour in the offspring of control mothers. Citalopram failed to restore the reduction in the expression of serotonin 1A autoreceptors in the prefrontal cortex of males and in corticotropin-releasing factor type 2 receptors in the dorsal raphe nuclei of females induced by prenatal stress. Prenatal citalopram did not prevent the behavioural changes or reduction in serotonergic transmission to target areas induced by prenatal stress. It had adverse behavioural effects in the offspring of control rats, which, together with the lack of any change in prenatally-stressed rats, may be due to inhibition of the foetal serotonin transporter thereby preventing normal development of the serotonin system.
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Affiliation(s)
- Inbar Zohar
- Department of Pharmacology, Institute of Drug Research, Hebrew University Medical Centre, Ein Kerem, Jerusalem, Israel
| | - Shai Shoham
- Department of Pharmacology, Institute of Drug Research, Hebrew University Medical Centre, Ein Kerem, Jerusalem, Israel
| | - Marta Weinstock
- Department of Pharmacology, Institute of Drug Research, Hebrew University Medical Centre, Ein Kerem, Jerusalem, Israel
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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. Managing antidepressant treatment in pregnancy and puerperium. Careful with that axe, Eugene. Expert Opin Drug Saf 2015; 14:1011-4. [DOI: 10.1517/14740338.2015.1037273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Marasco LA. Unsolved Mysteries of the Human Mammary Gland: Defining and Redefining the Critical Questions from the Lactation Consultant's Perspective. J Mammary Gland Biol Neoplasia 2014; 19:271-88. [PMID: 26084427 DOI: 10.1007/s10911-015-9330-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/08/2015] [Indexed: 02/07/2023] Open
Abstract
Despite advances in knowledge about human lactation, clinicians face many problems when advising mothers who are experiencing breastfeeding difficulties that do not respond to normal management strategies. Primary insufficient milk production is now being acknowledged, but incidence rates have not been well studied. Many women have known histories of infertility, polycystic ovary syndrome, obesity, hypertension, insulin resistance, thyroid dysfunction, hyperandrogenism or other hormonal imbalances, while others have no obvious risk factors. Some present with obviously abnormal breasts that are pubescent, tuberous/tubular or asymmetric in shape, raising the question of insufficient mammary gland tissue. Other women have breasts that appear within normal limits yet do not lactate normally. Endocrine disruptors may underlie some of these cases but their impact on human milk production has not been well explored. Similarly, any problem with prolactin such as a deficiency in serum prolactin or receptor number, receptor resistance, or poor bioavailability or bioactivity could underlie some cases of insufficient lactation, yet these possibilities are rarely investigated. A weak or suppressed milk ejection reflex, often assumed to be psychosomatic, could be related to thyroid dysfunction or caused by downstream post-receptor pathway problems. In the absence of sufficient data regarding these situations, desperate mothers may turn to non-evidence-based remedies, sometimes at considerable cost and unknown risk. Research targeted to these clinical dilemmas is critical in order to develop evidence-based strategies and increase breastfeeding duration and success rates.
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