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Phogole CM, Hastie R, Kellermann T. A simple and sensitive LC-MS/MS method for the quantitation of sertraline and N-desmethylsertraline in human plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1228:123827. [PMID: 37490838 DOI: 10.1016/j.jchromb.2023.123827] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
A simple and sensitive LC-MS/MS method for the simultaneous quantification of the second-generation antidepressant sertraline, and its active metabolite, N-desmethylsertraline, in human plasma was developed and validated. The analytes were extracted from 200 µL human plasma using a simple protein precipitation method. A gradient elution mode of water and 0.1% formic acid and acetonitrile was used for chromatographic separation on a Poroshell EC-C18 column (3 × 100 mm, 2.7 µm) at a flow rate of 0.450 mL/min. MS/MS analysis was performed in positive ionization mode using the transitions of m/z 306.1 → 159.1, 309.1 → 275.2, 292.1 → 159.1, and 296.2 → 279.0 for sertraline, sertraline-d3, N-desmethylsertraline, and N-desmethylsertraline-d4, respectively. The calibration curves for sertraline and N-desmethylsertraline in human plasma ranged from 2.50-320 ng/mL and 10.0-1280 ng/mL, respectively, with correlation coefficients (r) of ≥ 0.9992. The intra- and inter-assay precisions for both analytes at four concentrations (LLOQ, QCL, QCM, and QCH) ranged between 2.2% and 12.2%, respectively, while their accuracies ranged between 92.0 and 111.7%, with the exception of LLOQ, which ranged between 84.3 and 106.0%. The mean percentage recovery and process efficiency at three concentrations (QCL, QCM, and QCH) was 94.2 and 87.9% for sertraline, and 95.7 and 95.2% for N-desmethylsertraline, respectively. Both analytes were stable in plasma at room temperature for 2 h, at -80 °C for 28 days and through three freeze/thaw cycles. This method was successfully applied to a clinical study investigating the use of sertraline during pregnancy.
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Affiliation(s)
- Cassius M Phogole
- Division of Clinical Pharmacology, Department of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Australia
| | - Tracy Kellermann
- Division of Clinical Pharmacology, Department of Medicine and Health Sciences, Stellenbosch University, South Africa.
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Benninger KL, McAllister JM, Merhar SL. Neonatal Opioid Withdrawal Syndrome: An Update on Developmental Outcomes. Clin Perinatol 2023; 50:17-29. [PMID: 36868704 DOI: 10.1016/j.clp.2022.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Infants and children with prenatal opioid exposure generally have development within the normal range; however, they seem to be at risk for behavioral problems and for lower scores on cognitive, language, and motor assessments than children without prenatal opioid exposure. It is as of yet unclear whether prenatal opioid exposure itself causes issues with development and behavior, or whether it is simply correlated, due to other confounding factors.
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Affiliation(s)
- Kristen L Benninger
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 575 Children's Crossroad, WB 5203, Columbus, OH 43215, USA.
| | - Jennifer M McAllister
- Cincinnati Children's Hospital Perinatal Institute, University of Cincinnati College of Medicine, 3333 Burnet Ave, ML 7009, Cincinnati, OH 45229, USA
| | - Stephanie L Merhar
- Cincinnati Children's Hospital Perinatal Institute, University of Cincinnati College of Medicine, 3333 Burnet Ave, ML 7009, Cincinnati, OH 45229, USA
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Talarico F, Liu YS, Metes D, Wang M, Wearmouth D, Kiyang L, Wei Y, Gaskin A, Greenshaw A, Janus M, Cao B. Risk factors for developmental vulnerability: Insight from population-level surveillance using the Early Development Instrument. Digit Health 2023; 9:20552076231210705. [PMID: 37928328 PMCID: PMC10624014 DOI: 10.1177/20552076231210705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Objectives Population-level studies may elucidate the most promising intervention targets to prevent negative outcomes of developmental vulnerability in children. This study aims to bridge the current literature gap on identifying population-level developmental vulnerability risk factors using combined social and biological/health information. Methods This study assessed developmental vulnerability among kindergarten children using the 2016 Early Development Instrument (EDI) and identified risk factors of developmental vulnerability using EDI data cross-linked to a population-wide administrative health dataset. A total number of 23,494 children aged 5-6 were included (48% female). Prenatal, neonatal, and early childhood risk factors for developmental vulnerability were investigated, highlighting the most important ones contributing to early development. Results The main risk factors for developmental vulnerability were children with a history of mental health diagnosis (risk ratio = 1.46), biological sex-male (risk ratio = 1.51), and poor socioeconomic status (risk ratio = 1.58). Conclusion Our study encompasses both social and health information in a populational-level representative sample of Alberta, Canada. The results confirm evidence established in other geographic regions and jurisdictions and demonstrate the association between perinatal risk factors and developmental vulnerability. Based on these results, we argue that the health system should adopt a multilevel prevention and intervention strategy, targeting individual, family, and community together.
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Affiliation(s)
| | - Yang S Liu
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Dan Metes
- Ministry of Health, Government of Alberta, Edmonton, Canada
| | - Mengzhe Wang
- Ministry of Health, Government of Alberta, Edmonton, Canada
| | - Dori Wearmouth
- Ministry of Health, Government of Alberta, Edmonton, Canada
| | | | - Yifeng Wei
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Ashley Gaskin
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Andrew Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, Canada
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Lebin LG, Novick AM. Selective Serotonin Reuptake Inhibitors (SSRIs) in Pregnancy: An Updated Review on Risks to Mother, Fetus, and Child. Curr Psychiatry Rep 2022; 24:687-695. [PMID: 36181572 PMCID: PMC10590209 DOI: 10.1007/s11920-022-01372-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW To provide an updated summary and appraisal of work from 2019 to 2022 examining risks of selective serotonin reuptake inhibitor (SSRI) use in pregnancy. RECENT FINDINGS Perinatal SSRI exposure does not increase risk of major malformations or gestational diabetes after accounting for underlying maternal illness. SSRIs are associated with small increase in risk of pre-eclampsia, postpartum hemorrhage, preterm delivery, persistent pulmonary hypertension of the newborn, and neonatal intensive care unit admissions, though absolute risk of these outcomes is low. While data suggests no increased risk of neurodevelopmental disorders in offspring, mixed evidence indicates increased risk of adverse cognitive outcomes and affective disorders. Recent evidence suggest low absolute risk of clinically relevant negative outcomes with perinatal SSRI exposure when compared to untreated perinatal depression. However, study design and ability to control for confounding remains an ongoing research challenge, highlighting need for ongoing rigorous study design and analysis.
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Affiliation(s)
- Lindsay G Lebin
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, 1890 N Revere Court, Suite 5003, Aurora, CO, 80045, USA.
| | - Andrew M Novick
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, 1890 N Revere Court, Suite 5003, Aurora, CO, 80045, USA
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Suarez EA, Bateman BT, Hernández-Díaz S, Straub L, Wisner KL, Gray KJ, Pennell PB, Lester B, McDougle CJ, Zhu Y, Mogun H, Huybrechts KF. Association of Antidepressant Use During Pregnancy With Risk of Neurodevelopmental Disorders in Children. JAMA Intern Med 2022; 182:2797101. [PMID: 36190722 PMCID: PMC9531086 DOI: 10.1001/jamainternmed.2022.4268] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/01/2022] [Indexed: 12/18/2022]
Abstract
Importance Antidepressant use during pregnancy has been associated with neurodevelopmental disorders in children in some studies. However, results may be explained by uncontrolled confounding by parental mental health status, genetics, and environmental factors. Objective To evaluate the association between antidepressant use in pregnancy and neurodevelopmental outcomes in children. Design, Setting, and Participants This cohort study of health care utilization data was separated into cohorts of publicly and privately insured pregnant individuals and their children nested in the Medicaid Analytic eXtract (MAX; 2000-2014) and the IBM MarketScan Research Database (MarketScan; 2003-2015). A total of 1.93 million pregnancies in MAX and 1.25 million pregnancies in MarketScan were recorded. Children were followed from birth until outcome diagnosis, disenrollment, death, or end of study (maximum 14 years). Analyses were conducted between August 2020 and July 2021. Exposures Dispensing of antidepressant medication from gestational week 19 until delivery, the period of synaptogenesis. Main Outcomes and Measures Neurodevelopmental disorders in children defined using validated algorithms. Early pregnancy exposure was considered in sensitivity analyses, and approaches to confounding adjustment included propensity score fine stratification, discontinuers comparison, and sibling analyses. Results Among the individuals included in the analysis, there were 145 702 antidepressant-exposed and 3 032 745 unexposed pregnancies; the mean (SD) age among the antidepressant exposed and unexposed was 26.2 (5.7) and 24.3 (5.8) years in MAX and 32.7 (4.6) and 31.9 (4.6) years in MarketScan, respectively; and in MAX, which collected information on race and ethnicity, 72.4% of the antidepressant-exposed and 37.1% of the unexposed individuals were White. Crude results suggested up to a doubling in risk of neurodevelopmental outcomes associated with antidepressant exposure; however, no association was observed in the most fully adjusted analyses. When comparing antidepressant-exposed and unexposed siblings, hazard ratios were 0.97 (95% CI, 0.88-1.06) for any neurodevelopmental disorder, 0.86 (95% CI, 0.60-1.23) for autism spectrum disorder, 0.94 (95% CI, 0.81-1.08) for attention-deficit/hyperactivity disorder, 0.77 (95% CI, 0.42-1.39) for specific learning disorders, 1.01 (95% CI, 0.88-1.16) for developmental speech/language disorder, 0.79 (95% CI, 0.54-1.17) for developmental coordination disorder, 1.00 (95% CI, 0.45-2.22) for intellectual disability, and 0.95 (95% CI, 0.80-1.12) for behavioral disorders. Results were generally consistent for antidepressant classes and drugs and across exposure windows. Conclusions and Relevance The results of this cohort study suggest that antidepressant use in pregnancy itself does not increase the risk of neurodevelopmental disorders in children. However, given strong crude associations, antidepressant exposure in pregnancy may be an important marker for the need of early screening and intervention.
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Affiliation(s)
- Elizabeth A. Suarez
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Loreen Straub
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Katherine L. Wisner
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kathryn J. Gray
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Page B. Pennell
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Barry Lester
- Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
| | - Christopher J. McDougle
- Lurie Center for Autism, Massachusetts General Hospital, Lexington
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Yanmin Zhu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Reduced Motivation in Perinatal Fluoxetine-Treated Mice: A Hypodopaminergic Phenotype. J Neurosci 2021; 41:2723-2732. [PMID: 33536200 DOI: 10.1523/jneurosci.2608-20.2021] [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: 10/08/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/17/2022] Open
Abstract
Early life is a sensitive period, in which enhanced neural plasticity allows the developing brain to adapt to its environment. This plasticity can also be a risk factor in which maladaptive development can lead to long-lasting behavioral deficits. Here, we test how early-life exposure to the selective-serotonin-reuptake-inhibitor (SSRI), fluoxetine, affects motivation, and dopaminergic signaling in adulthood. We show for the first time that mice exposed to fluoxetine in the early postnatal period exhibit a reduction in effort-related motivation. These mice also show blunted responses to amphetamine and reduced dopaminergic activation in a sucrose reward task. Interestingly, we find that the reduction in motivation can be rescued in the adult by administering bupropion, a dopamine-norepinephrine reuptake inhibitor used as an antidepressant and a smoke cessation aid but not by fluoxetine. Taken together, our studies highlight the effects of early postnatal exposure of fluoxetine on motivation and demonstrate the involvement of the dopaminergic system in this process.SIGNIFICANCE STATEMENT The developmental period is characterized by enhanced plasticity. During this period, environmental factors have the potential to lead to enduring behavioral changes. Here, we show that exposure to the SSRI fluoxetine during a restricted period in early life leads to a reduction in adult motivation. We further show that this reduction is associated with decreased dopaminergic responsivity. Finally, we show that motivational deficits induced by early-life fluoxetine exposure can be rescued by adult administration of bupropion but not by fluoxetine.
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Galbally M, Snellen M. Providing the Evidence for Managing Depression in Pregnancy. Pediatrics 2020; 145:peds.2019-3578. [PMID: 32341181 DOI: 10.1542/peds.2019-3578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Megan Galbally
- College of Science, Health, Education, and Engineering, Murdoch University, Perth, Australia; .,School of Medicine, The University of Notre Dame Australia, Fremantle, Australia.,King Edward Memorial Hospital, Subiaco, Australia.,Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; and
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