1
|
Marazziti D, Foresi Crowther L, Arone A. An overview of the differences in the pharmacological management of post-traumatic stress disorder between women and men. Expert Rev Neurother 2024; 24:575-584. [PMID: 38771657 DOI: 10.1080/14737175.2024.2355259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/10/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a disabling psychiatric condition with a worldwide prevalence between 6% and 9%, and more common in the female than in the male sex. The aim of this paper is to review and comment on the different factors that might explain the discrepancies in the pharmacological management of women and men. AREAS COVERED The available literature shows that there exists a vulnerability of women to develop PTSD that may depend on neurobiological as well as environmental/cultural factors. These variables might influence the clinical picture, the outcome and the response to specific treatments, given their consequences on the pharmacokinetics of commonly prescribed drugs. Women suffering from PTSD are more prone to consult and receive more prescriptions of psychotropic drugs than men. However, it is evident that the particular stages of a women's life such as pregnancy or breastfeeding might require a specific evaluation and care. EXPERT OPINION It is necessary to explore the pharmacokinetics of compounds highlighting sex-related differences, and their safety during pregnancy and lactation. Taking care of differences between women and men should represent a main focus of research, while being a primary target towards a really tailored pharmacological treatment of PTSD.
Collapse
Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Lara Foresi Crowther
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Alessandro Arone
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| |
Collapse
|
2
|
Den Besten-Bertholee D, Touw DJ, Damer EA, Mian P, Ter Horst PGJ. Sertraline, citalopram and paroxetine in lactation: passage into breastmilk and infant exposure. Front Pharmacol 2024; 15:1414677. [PMID: 38841362 PMCID: PMC11150716 DOI: 10.3389/fphar.2024.1414677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
Objectives This study aimed to investigate the plasma and breastmilk concentrations for sertraline, citalopram and paroxetine for assessment of the Milk/Plasma (M/P) ratio and Absolute Infant Dose (AID), and to determine actual infant drug exposure through breastfeeding. Subsequently, informed recommendations will be formulated regarding the advisability of breastfeeding in women undergoing treatment with the three most widely used antidepressants. Methods A pharmacokinetic study in lactating women and their infants using sertraline, citalopram or paroxetine was performed. Paired breastmilk and plasma samples and single point infant plasma samples were collected to determine antidepressant concentrations. An Area Under the Curve (AUC) based approach with the trapezoidal rule was used to calculate M/P ratios and AID for all three antidepressants by combining all measured concentrations for the same dose. Results Thirty-seven lactating women and their infants participated in this study. 111 paired breastmilk and plasma samples and 37 single point infant plasma samples were collected. Detectable concentrations of sertraline, citalopram and paroxetine were present in all breastmilk samples. For sertraline and citalopram M/P ratio is above one, indicating higher breastmilk than plasma concentrations, however, drug exposure by breastmilk did not lead to detectable plasma drug levels in any of the 15 infants for sertraline, for nine (out of 13) infants for citalopram and for eight (out of nine) infants for paroxetine. Conclusion Given the well-known benefits of breastfeeding, our findings support breastfeeding of infants by mothers who are taking sertraline, citalopram or paroxetine is safe. Sertraline and paroxetine are the preferred antidepressants during breastfeeding, reaching mostly undetectable infant drug levels.
Collapse
Affiliation(s)
| | - Daan J. Touw
- Groningen Research Institute of Pharmacy, Section Pharmaceutical Analysis, University of Groningen, Groningen, Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | | | - Paola Mian
- Groningen Research Institute of Pharmacy, Section Pharmaceutical Analysis, University of Groningen, Groningen, Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | | |
Collapse
|
3
|
Deligiannidis KM, Bullock A, Nandy I, Dunbar J, Lasser R, Witte M, Leclair B, Wald J. Zuranolone Concentrations in the Breast Milk of Healthy, Lactating Individuals: Results From a Phase 1 Open-Label Study. J Clin Psychopharmacol 2024:00004714-990000000-00252. [PMID: 38739007 DOI: 10.1097/jcp.0000000000001873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
PURPOSE/BACKGROUND Zuranolone is a positive allosteric modulator of both synaptic and extrasynaptic γ-aminobutyric acid type A receptors and a neuroactive steroid approved as an oral, once-daily, 14-day treatment course for adults with postpartum depression in the United States. This study assessed zuranolone transfer into breast milk. METHODS/PROCEDURES Healthy, nonpregnant, lactating adult female participants received once-daily 30 mg zuranolone from day (D)1 through D5 in this phase 1 open-label study. The relative infant dose (RID; weight-adjusted proportion of the maternal dose in breast milk over 24 hours) for 30 mg zuranolone was assessed at D5. An RID for 50 mg zuranolone was estimated using a simulation approach across a range of infant ages and weights. FINDINGS/RESULTS Of 15 enrolled participants (mean age, 30.1 years), 14 completed the study. The mean RID for 30 mg zuranolone at D5 was 0.357%; the mean steady-state milk volume over D3 to D5 decreased from baseline by 8.3%. Overall unbound zuranolone in plasma was low (≤0.49%). Plasma concentrations peaked at D5 before decreasing in a biexponential manner. There was strong concordance between the temporal evolution of zuranolone concentrations in plasma and breast milk. The estimated mean RID for 50 mg zuranolone based on a milk intake of 200 mL/kg per day was 0.984%. All treatment-emergent adverse events reported by participants were mild, the most common being dizziness (n = 3). IMPLICATIONS/CONCLUSIONS Zuranolone transfer into the breast milk of healthy, nonpregnant, lactating adult female participants was low; the estimated RID for 50 mg zuranolone was <1%, well below the <10% threshold generally considered compatible with breastfeeding.
Collapse
|
4
|
Abdelhafez M, Ahmed K, Ahmed N, Ismail M, Mohd Daud MNB, Ping NPT, Eldiasty A, Amri MFB, Jeffree MS, Kadir F, pg Baharuddin DM, Bolong MFB, Hayati F, BtAzizan N, Sumpat D, Syed Abdul Rahim SS, Abdel Malek EH. Psychiatric illness and pregnancy: A literature review. Heliyon 2023; 9:e20958. [PMID: 37954333 PMCID: PMC10632674 DOI: 10.1016/j.heliyon.2023.e20958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Background Women of reproductive age frequently suffer from psychiatric disorders. The risk of developing anxiety, bipolar, and depressive disorders is especially significant during the perinatal period. Objectives This article aims to identify and discuss the different psychiatric conditions that might affect pregnant women and update the mother's carers about the recent and updated bidirectional relationship between psychiatric disease and adverse pregnancy outcomes, As well as the most updates in diagnostic and management strategies. Methods A thorough analysis of the literature was conducted using database searches in EMBASE, Science Direct, Google Scholar, Scopus, and PubMed to obtain the objectives and aim of the study. Results The presence of maternal mental illness during pregnancy has been linked to preterm delivery, newborn hypoglycemia, poor neurodevelopmental outcomes, and disturbed attachment. Placental anomalies, small-for-gestational-age foetuses, foetal discomfort, and stillbirth are among more undesirable perinatal outcomes. Conclusions Pregnancy-related psychiatric disorders are frequent. The outcomes for pregnant women, infants, and women's health are all improved by proper diagnosis and treatment of psychiatric problems.
Collapse
Affiliation(s)
- MohsenM.A. Abdelhafez
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - KarimA.M. Ahmed
- Department of Dermatology, Helios Saint Johannes Klinikum, Duisburg, Germany
| | - NashwaA.M. Ahmed
- Department of Orthodontics, Faculty of Dental and Oral Surgery, Ahram Canadian University, Egypt
| | - MohdHamdy Ismail
- Owner and Leading Clinician, Ulti Care Dental Clinics, Cairo, Egypt
| | - Mohd Nazri Bin Mohd Daud
- Family Medicine Unit, Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Nicholas Pang Tze Ping
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - AyaM. Eldiasty
- Department of Dermatology, Helios Saint Johannes Klinikum, Duisburg, Germany
| | - Mohd Fariz Bin Amri
- Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Mohammad Saffree Jeffree
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Fairrul Kadir
- Department of Emergency Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Dg Marshitah pg Baharuddin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Mohammed Firdaus Bin Bolong
- Department of Emergency Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Nornazirah BtAzizan
- Department of Clinical Pathology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Doreen Sumpat
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | | | - Ehab Helmy Abdel Malek
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| |
Collapse
|
5
|
Altieri MA, da Silva AS, da Silva Moreira S, Zapaterini JR, Arena AC, Barbisan LF. Safety of lactational exposure to venlafaxine on the rat mammary gland development and carcinogenesis in F1 female offspring. Reprod Toxicol 2023; 120:108451. [PMID: 37532207 DOI: 10.1016/j.reprotox.2023.108451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023]
Abstract
The chronic use of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors (SNRIs) may result in human gynecomastia, mammoplasia, galactorrhea, and elevated breast cancer risk. As antidepressants are frequently used for postpartum depression (PPD) treatment, this study investigated the adverse effects of lactational exposure to venlafaxine (VENL, a selective SNRI) on mammary gland development and carcinogenesis in F1 female offspring. Thus, lactating Wistar rats (F0) received VENL by oral gavage at daily doses of 3.85, 7.7, or 15.4 mg/kg (N = 9, each group) from lactational day (LD 1) until the weaning of the offspring (LD 21). F1 female offspring were euthanized for mammary gland, and ovary histological analyses on the post-natal day (PND) 22 and 30 (1 pup/litter/period, N = 9, each group). At PND 22, other females (2 pups/litter, N = 18, each group) received a single dose of carcinogen N-methyl-N-nitrosourea (MNU, 50 mg/kg) intraperitoneally (i.p.) for tumor susceptibility assay until PND 250. Tumor incidence and latency were recorded and representative tumor samples were collected for histopathology. The results indicate that lactational exposure to VENL did not alter the development of the mammary gland (epithelial ductal tree or the mean number of terminal end buds), or the ovary (weight and primary, secondary, tertiary, and Graafian follicles) in prepubertal F1 female offspring. In addition, VENL exposure did not influence tumor incidence or tumor latency in adult female offspring that received MNU. Thus, the findings of this animal study indicated that lactational VENL exposure, a period similar to human PPD, did not exert an adverse effect on the mammary gland development at the prepubertal phase or on chemically induced mammary tumorigenesis in adult F1 female rats.
Collapse
Affiliation(s)
- Marcelo Augusto Altieri
- São Paulo State University (UNESP), Institute of Biosciences, Department of Structural and Functional Biology, Botucatu, SP, Brazil
| | - Anielly Sarana da Silva
- São Paulo State University (UNESP), Institute of Biosciences, Department of Structural and Functional Biology, Botucatu, SP, Brazil
| | - Suyane da Silva Moreira
- São Paulo State University (UNESP), Institute of Biosciences, Department of Structural and Functional Biology, Botucatu, SP, Brazil
| | - Joyce Regina Zapaterini
- São Paulo State University (UNESP), Institute of Biosciences, Department of Structural and Functional Biology, Botucatu, SP, Brazil; São Paulo State University (UNESP), Faculty of Medicine, Department of Pathology, Botucatu, SP, Brazil
| | - Arielle Cristina Arena
- São Paulo State University (UNESP), Institute of Biosciences, Department of Structural and Functional Biology, Botucatu, SP, Brazil
| | - Luís Fernando Barbisan
- São Paulo State University (UNESP), Institute of Biosciences, Department of Structural and Functional Biology, Botucatu, SP, Brazil.
| |
Collapse
|
6
|
Liu C, Ystrom E, McAdams TA. Long-Term Maternal and Child Outcomes Following Postnatal SSRI Treatment. JAMA Netw Open 2023; 6:e2331270. [PMID: 37642961 PMCID: PMC10466165 DOI: 10.1001/jamanetworkopen.2023.31270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/22/2023] [Indexed: 08/31/2023] Open
Abstract
Importance Although selective serotonin reuptake inhibitors (SSRIs) are recommended for postnatal depression treatment, there is a lack of evidence regarding long-term maternal and child outcomes following postnatal SSRI treatment. Objective To examine whether postnatal SSRI treatment moderated postnatal depression-associated maternal and child outcomes across early childhood years. Design, Setting, and Participants This cohort study used longitudinal data from the Norwegian Mother, Father and Child Cohort Study. Participating women were recruited in weeks 17 to 18 of pregnancy from 1999 to 2008 and were prospectively followed up after childbirth. Data analysis was performed between December 2021 to October 2022. Exposure Postnatal depression diagnosis (a binary indicator of eligibility for treatment) was defined as a score of 7 or greater on the 6-item version of the Edinburgh Postnatal Depression Scale. The Hopkins Symptom Checklist was used as a continuous indicator of and postnatal depressive symptomology at postpartum month 6. Postnatal SSRI treatment was identified using self-reported data at postpartum month 6. Main Outcomes and Measures Maternal outcomes included self-reported depression symptomology and relationship satisfaction from childbirth to postpartum year 5. Child outcomes included maternal-report internalizing and externalizing problems, attention-deficit/hyperactivity disorder symptoms, and motor and language development at ages 1.5, 3, and 5 years. A propensity score adjustment method was used to control for prenatal factors associated with postnatal SSRI exposure probability. Results Among a total of 61 081 mother-child dyads, 8671 (14.2%) (mean [SD] age, 29.93 [4.76] years) met the criteria for postnatal depression diagnosis, 177 (2.0%) (mean [SD] age, 30.20 [5.01] years) of whom received postnatal SSRI treatment. More severe postnatal depression symptomology was associated with a range of adverse maternal and child outcomes. Focusing analyses only on the postnatal depression dyads indicated that postnatal SSRI treatment attenuated negative associations between postnatal depression and maternal relationship satisfaction at postpartum month 6 (moderation β, 0.13; 95% CI, 0.07-0.19), years 1.5 (moderation β, 0.11; 95% CI, 0.05-0.18) and 3 (moderation β, 0.12; 95% CI, 0.04-0.19), and for child ADHD at age 5 years (moderation β, -0.15; 95% CI, -0.24 to -0.05). Postnatal SSRI treatment mitigated the negative associations between postnatal depression and maternal depression, partner relationship satisfaction, child externalizing problems, and attention-deficit/hyperactivity disorder up to 5 years after childbirth. Conclusions and Relevance The results of this large prospective cohort study suggest that postnatal SSRI treatment was associated with a reduced risk of postnatal depression-associated maternal mental health problems and child externalizing behaviors across early childhood years. These findings suggest that postnatal SSRI treatment may bring benefits in the long term to women with postnatal depression and their offspring. This study potentially provides valuable information for clinicians and women with postnatal depression to make informed treatment decisions.
Collapse
Affiliation(s)
- Chaoyu Liu
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, England
| | - Eivind Ystrom
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
- Department Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Pharmaco-Epidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Tom A McAdams
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, England
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| |
Collapse
|
7
|
Saharoy R, Potdukhe A, Wanjari M, Taksande AB. Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants. Cureus 2023; 15:e41381. [PMID: 37546054 PMCID: PMC10400812 DOI: 10.7759/cureus.41381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Postpartum depression (PPD) is a common and debilitating mental health condition affecting many mothers worldwide. This review article aims to explore the complex effects of PPD on mothers and infants, focusing on maternal care. The transition to motherhood is a critical period characterized by numerous physical, psychological, and social changes, making women vulnerable to the onset of PPD. Consequently, PPD can significantly impact a mother's ability to provide optimal care for her infant, leading to potential adverse consequences for both parties. The article synthesizes existing research literature on the topic, encompassing studies from various disciplines, including psychology, psychiatry, obstetrics, and pediatrics. It begins by providing an overview of the prevalence and risk factors associated with PPD, emphasizing the importance of early detection and intervention. The impact of PPD on maternal caregiving behaviors, such as bonding, sensitivity, and responsiveness, is then examined, highlighting the potential disruptions in the mother-infant relationship. Furthermore, the article delves into the potential consequences of impaired maternal care on infant development, including emotional, cognitive, and social domains. Several factors contributing to the complex interplay between PPD and maternal care are discussed, including hormonal changes, psychosocial stressors, and the influence of social support networks. The review also addresses the bidirectional nature of the mother-infant relationship, whereby infant characteristics and behaviors can exacerbate or mitigate the effects of PPD on maternal care. Moreover, the article explores the role of healthcare providers and the importance of implementing effective screening, assessment, and treatment strategies for PPD to promote optimal maternal-infant outcomes. By consolidating current knowledge on the topic, this review article provides valuable insights into the multifaceted effects of PPD on both mothers and infants. Recognizing the significance of maternal care and understanding the mechanisms through which PPD disrupts it can inform the development of targeted interventions to promote early detection, effective treatment, and supportive interventions for mothers experiencing PPD. Ultimately, improving maternal mental health and enhancing maternal-infant relationships can yield long-term positive effects on mothers' and infants' well-being and development.
Collapse
Affiliation(s)
- Rishika Saharoy
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashwini Potdukhe
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Avinash B Taksande
- Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
8
|
Is lactational sertraline exposure safe for maternal health and the reproductive/neurobehavioral development of the descendants? A study in rats. Reprod Toxicol 2023; 117:108356. [PMID: 36828160 DOI: 10.1016/j.reprotox.2023.108356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/12/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023]
Abstract
Although sertraline is considered one of the safest antidepressants in the lactation period, there are still few studies that assess its impact on child development. Therefore, this experimental study aimed to clarify the effect of sertraline on the neurobehavioral and reproductive development of male rats. Thus, 30 lactating rats were divided into 3 experimental groups (n = 10/group): CO- received filtered water, S10 and S20 groups that received, respectively, 10 and 20 mg/kg/day of sertraline. Treatment was performed by gavage, from postnatal days (PND) 1-20. During this period, the reflex and somatic development of rats were observed, as well as maternal behavior. On PND 21, mothers were euthanized and the organs were weighed. On PND 21, 45, and 100, one male from each litter was euthanized for histological and immunohistochemical (PCNA and WT1) analysis of the reproductive organs. The growth of body weight, the anogenital distance (AGD), the time to puberty, sperm quality, sexual behavior, neurobehavior, and natural fertility were also verified. Statistical analysis: One-way ANOVA or Kruskal-Wallis test (p ≤ 0.05). The results showed that mothers in the S20 group had an increase in thyroid weight. The male offspring exposed to sertraline had lower body weight (PND 7), lower AGD (PND 7 and 14), and delay in reflex development, in addition to histological alterations in the testis (PND 21). In adulthood, sperm quality was altered, without compromising natural fertility. Therefore, the present study found important alterations in the reflex and reproductive development of male rats exposed to sertraline during lactation.
Collapse
|
9
|
Association between breastfeeding and postpartum depression: A meta-analysis. J Affect Disord 2022; 308:512-519. [PMID: 35460745 DOI: 10.1016/j.jad.2022.04.091] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 03/17/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The association of breastfeeding (BF) for postpartum depression (PPD) remains controversial. Currently there are no specific guidelines on the role of BF in the management of PPD. OBJECTIVES To determine the association between BF and PPD. METHODS We searched PubMed, Cochrane Library, and EMBASE up to December 2021 for relevant articles associated between PPD and BF. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with a random-effects model. RESULTS A total of 8 studies with 18,570 participants were included. BF was associated with a 14% lower risk of PPD (OR 0.86, 95% CI 0.77-0.94, I2 = 51.78%). For a single BF episode, BF duration of >1 month was associated a 37% lower risk (OR 0.63, 95% CI 0.47-0.79, I2 = 34.98%, P = 0.19), and BF for <1 month was associated with a 6% lower risk (OR 0.94, 95% CI 0.89-0.99, I2 = 0.00%, P = 0.61). Exclusive breastfeeding (EBF) compared with never breastfeeding (NBF) was associated with a 53% lower risk for PPD (OR 0.47, 95% CI 0.27-0.66, I2 = 0.00%, P = 0.98). And EBF compared with partial breastfeeding (PBF) was associated with an 8% lower risk for PPD (OR 0.92, 95% CI 0.86-0.98, I2 = 13.86%, P = 0.31). The subgroups we studied may be a source of heterogeneity. CONCLUSIONS Our results show an association between PPD and risk for BF. To confirm the conclusion, more studies with large sample sizes are required.
Collapse
|
10
|
Wegler C, Saleh A, Lindqvist A, Nordeng H, Smeraglia J, Baranczewski P. Simple and rapid quantification of cetirizine, venlafaxine, and O-desmethylvenlafaxine in human breast milk, and metformin in human milk and plasma with UHPLC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1205:123340. [PMID: 35732105 DOI: 10.1016/j.jchromb.2022.123340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022]
Abstract
The majority of women have health problems that require medication after giving birth. Complications such as allergies, postpartum depression, and diabetes are often treated with drugs such as cetirizine, venlafaxine, and metformin, respectively. These treatments are considered safe during lactation, but information of the transfer of drugs to breast milk and possible effects on the infant is scarce. Therefore, this needs to be systematically investigated in larger populations. To enable the determination of drug transfer, we here describe the validation of two rapid, sensitive, and high-throughput analysis methods for 1) simultaneous quantification of cetirizine, venlafaxine, and O-desmethylvenlafaxine in human breast milk, and 2) metformin in human breast milk and plasma. In both methods, a simple protein precipitation protocol with acetonitrile and benchtop-centrifugation was used prior to compound analysis with liquid-chromatography tandem mass spectrometry. The methods had linear ranges between 0.39 - 194.5 ng/mL for cetirizine, 0.28 - 138.7 ng/mL for venlafaxine, 0.26 - 131.7 ng/mL for O-desmethylvenlafaxine, in milk, and 0.65 - 193.7 ng/mL for metformin in both milk and plasma. Intra-run and inter-run precision and accuracy were ≤ 9% for cetirizine, venlafaxine, and O-desmethylvenlafaxine in milk, and ≤ 7% for metformin in milk and plasma. Cetirizine was measured to median milk concentrations of 13 ng/mL (range: 0.65 - 65 ng/mL) in 228 donor samples from breast-feeding women.
Collapse
Affiliation(s)
- Christine Wegler
- Department of Pharmacy, Uppsala Drug Optimization and Pharmaceutical Profiling (UDOPP), Uppsala University, SE-75123 Uppsala, Sweden
| | - Aljona Saleh
- Department of Pharmacy, Uppsala Drug Optimization and Pharmaceutical Profiling (UDOPP), Uppsala University, SE-75123 Uppsala, Sweden; Department of Pharmacy, SciLifeLab Drug Discovery and Development Platform, Uppsala University, SE-75123 Uppsala, Sweden
| | - Annika Lindqvist
- Department of Pharmacy, Uppsala Drug Optimization and Pharmaceutical Profiling (UDOPP), Uppsala University, SE-75123 Uppsala, Sweden; Department of Pharmacy, SciLifeLab Drug Discovery and Development Platform, Uppsala University, SE-75123 Uppsala, Sweden
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - John Smeraglia
- Development Sciences, Translational Biomarkers and Bioanalysis, UCB BioPharma SPRL, B-1420 Braine-l'Alleud, Belgium
| | - Pawel Baranczewski
- Department of Pharmacy, Uppsala Drug Optimization and Pharmaceutical Profiling (UDOPP), Uppsala University, SE-75123 Uppsala, Sweden; Department of Pharmacy, SciLifeLab Drug Discovery and Development Platform, Uppsala University, SE-75123 Uppsala, Sweden.
| |
Collapse
|
11
|
Brown JVE, Wilson CA, Ayre K, Robertson L, South E, Molyneaux E, Trevillion K, Howard LM, Khalifeh H. Antidepressant treatment for postnatal depression. Cochrane Database Syst Rev 2021; 2:CD013560. [PMID: 33580709 PMCID: PMC8094614 DOI: 10.1002/14651858.cd013560.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Depression is one of the most common morbidities of the postnatal period. It has been associated with adverse outcomes for women, children, the wider family and society as a whole. Treatment is with psychosocial interventions or antidepressant medication, or both. The aim of this review is to evaluate the effectiveness of different antidepressants and to compare their effectiveness with placebo, treatment as usual or other forms of treatment. This is an update of a review last published in 2014. OBJECTIVES To assess the effectiveness and safety of antidepressant drugs in comparison with any other treatment (psychological, psychosocial, or pharmacological), placebo, or treatment as usual for postnatal depression. SEARCH METHODS We searched Cochrane Common Mental Disorders's Specialized Register, CENTRAL, MEDLINE, Embase and PsycINFO in May 2020. We also searched international trials registries and contacted experts in the field. SELECTION CRITERIA We included randomised controlled trials (RCTs) of women with depression during the first 12 months postpartum that compared antidepressant treatment (alone or in combination with another treatment) with any other treatment, placebo or treatment as usual. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the study reports. We requested missing information from study authors wherever possible. We sought data to allow an intention-to-treat analysis. Where we identified sufficient comparable studies we pooled data and conducted random-effects meta-analyses. MAIN RESULTS We identified 11 RCTs (1016 women), the majority of which were from English-speaking, high-income countries; two were from middle-income countries. Women were recruited from a mix of community-based, primary care, maternity and outpatient settings. Most studies used selective serotonin reuptake inhibitors (SSRIs), with treatment duration ranging from 4 to 12 weeks. Meta-analysis showed that there may be a benefit of SSRIs over placebo in response (55% versus 43%; pooled risk ratio (RR) 1.27, 95% confidence interval (CI) 0.97 to 1.66); remission (42% versus 27%; RR 1.54, 95% CI 0.99 to 2.41); and reduced depressive symptoms (standardised mean difference (SMD) -0.30, 95% CI -0.55 to -0.05; 4 studies, 251 women), at 5 to 12 weeks' follow-up. We were unable to conduct meta-analysis for adverse events due to variation in the reporting of this between studies. There was no evidence of a difference between acceptability of SSRI and placebo (27% versus 27%; RR 1.10, 95% CI 0.74 to 1.64; 4 studies; 233 women). The certainty of all the evidence for SSRIs was low or very low due to the small number of included studies and a number of potential sources of bias, including high rates of attrition. There was insufficient evidence to assess the efficacy of SSRIs compared with other classes of antidepressants and of antidepressants compared with other pharmacological interventions, complementary medicines, psychological and psychosocial interventions or treatment as usual. A substantial proportion of women experienced adverse effects but there was no evidence of differences in the number of adverse effects between treatment groups in any of the studies. Data on effects on children, including breastfed infants, parenting, and the wider family were limited, although no adverse effects were noted. AUTHORS' CONCLUSIONS There remains limited evidence regarding the effectiveness and safety of antidepressants in the management of postnatal depression, particularly for those with more severe depression. We found low-certainty evidence that SSRI antidepressants may be more effective in treating postnatal depression than placebo as measured by response and remission rates. However, the low certainty of the evidence suggests that further research is very likely to have an important impact on our effect estimate. There is a continued imperative to better understand whether, and for whom, antidepressants or other treatments are more effective for postnatal depression, and whether some antidepressants are more effective or better tolerated than others. In clinical practice, the findings of this review need to be contextualised by the extensive broader literature on antidepressants in the general population and perinatal clinical guidance, to inform an individualised risk-benefit clinical decision. Future RCTs should focus on larger samples, longer follow-up, comparisons with alternative treatment modalities and inclusion of child and parenting outcomes.
Collapse
Affiliation(s)
- Jennifer Valeska Elli Brown
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Claire A Wilson
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Karyn Ayre
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lindsay Robertson
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Emily South
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Emma Molyneaux
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kylee Trevillion
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hind Khalifeh
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
12
|
Lee HJ, Kim SM, Kwon JY. Repetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis. BMC Pregnancy Childbirth 2021; 21:118. [PMID: 33563220 PMCID: PMC7874443 DOI: 10.1186/s12884-021-03600-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/28/2021] [Indexed: 12/29/2022] Open
Abstract
Background Peripartum depression is a common disorder with very high potential hazards for both the patients and their babies. The typical treatment options include antidepressants and electroconvulsive therapy. However, these treatments do not ensure the safety of the fetus. Recently, repetitive transcranial magnetic stimulation has emerged as a promising treatment for neuropathies as well as depression. Nevertheless, many studies excluded pregnant women. This systematic review was conducted to confirm whether repetitive transcranial magnetic stimulation was a suitable treatment option for peripartum depression. Methods We performed a systematic review that followed the PRISMA guidelines. We searched for studies in the MEDLINE, PsycINFO, EMBASE, and Cochrane library databases published until the end of September 2020. Eleven studies were selected for the systematic review, and five studies were selected for quantitative synthesis. Data analysis was conducted using Comprehensive Meta-Analysis 3 software. The effect size was analyzed using the standardized mean difference, and the 95% confidence interval (CI) was determined by the generic inverse variance estimation method. Results The therapeutic effect size of repetitive transcranial magnetic stimulation for peripartum depression was 1.394 (95% CI: 0.944–1.843), and the sensitivity analysis effect size was 1.074 (95% CI: 0.689–1.459), indicating a significant effect. The side effect size of repetitive transcranial magnetic stimulation for peripartum depression was 0.346 (95% CI: 0.214–0.506), a meaningful result. There were no severe side effects to the mothers or fetuses. Conclusions From various perspectives, repetitive transcranial magnetic stimulation can be considered an alternative treatment to treat peripartum depression to avoid exposure of fetuses to drugs and the severe side effects of electroconvulsive therapy. Further research is required to increase confidence in the results. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03600-3.
Collapse
Affiliation(s)
- Hyune June Lee
- Department of Medical Devices Industry, Dongguk University, Seoul, South Korea
| | - Sung Min Kim
- Department of Medical Devices Industry, Dongguk University, Seoul, South Korea
| | - Ji Yean Kwon
- Department of Medical Devices Industry, Dongguk University, Seoul, South Korea.
| |
Collapse
|
13
|
Schoretsanitis G, Westin AA, Stingl JC, Deligiannidis KM, Paulzen M, Spigset O. Antidepressant transfer into amniotic fluid, umbilical cord blood & breast milk: A systematic review & combined analysis. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110228. [PMID: 33358964 PMCID: PMC7882033 DOI: 10.1016/j.pnpbp.2020.110228] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/22/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Data regarding the ability of antidepressants to enter fetal, newborn and infant fluids have become gradually available, but mechanisms of antidepressant transfer remain poorly understood. Here we calculated penetration ratios in an array of matrices from combined samples of pregnant/breastfeeding women taking antidepressants. METHOD We performed a systematic literature search of PubMed and EMBASE to identify studies with concentrations of antidepressants from maternal blood, amniotic fluid, umbilical cord blood and/or breast milk. Penetration ratios were calculated by dividing the concentrations in amniotic fluid, umbilical cord plasma or breast milk by the maternal plasma concentration. When data from multiple studies were available, we calculated combined penetration ratios, weighting the study mean by study size. RESULTS Eighty-five eligible studies were identified. For amniotic fluid, the highest penetration ratios were estimated for venlafaxine (mean 2.77, range 0.43-4.70 for the active moiety) and citalopram (mean 2.03, range 0.35-6.97), while the lowest ratios were for fluvoxamine (mean 0.10) and fluoxetine (mean 0.11, range 0.02-0.20 for the active moiety). For umbilical cord plasma, nortriptyline had the highest ratio (mean 2.97, range 0.25-26.43) followed by bupropion (mean 1.14, range 0.3-5.08). For breast milk, the highest ratios were observed for venlafaxine (mean 2.59, range 0.85-4.85), mianserin (mean 2.22, range 0.80-3.64) and escitalopram (mean 2.19, range 1.68-3.00). CONCLUSION We observed considerable variability across antidepressants regarding their ability to enter fetal, newborn and infant fluids. Measuring antidepressant concentrations in a maternal blood sample can provide a reliable estimate of fetal/infant exposure, although further evidence for concentration-dependent effects is required.
Collapse
Affiliation(s)
- Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.
| | - Andreas A. Westin
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
| | - Julia C. Stingl
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Kristina M. Deligiannidis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA,Zucker School of Medicine, Hempstead, New York and The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany and Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany,JARA - Translational Brain Medicine, Aachen, Germany
| | - Olav Spigset
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
14
|
Dickinson L, Walimbwa S, Singh Y, Kaboggoza J, Kintu K, Sihlangu M, Coombs JA, Malaba TR, Byamugisha J, Pertinez H, Amara A, Gini J, Else L, Heiberg C, Hodel EM, Reynolds H, Myer L, Waitt C, Khoo S, Lamorde M, Orrell C. Infant exposure to dolutegravir through placental and breastmilk transfer: a population pharmacokinetic analysis of DolPHIN-1. Clin Infect Dis 2020; 73:e1200-e1207. [PMID: 33346335 PMCID: PMC8423479 DOI: 10.1093/cid/ciaa1861] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Rapid reduction of HIV viral load is paramount to prevent peripartum transmission in women diagnosed late in pregnancy. We investigated dolutegravir population pharmacokinetics in maternal plasma, cord, breastmilk and infant plasma of DolPHIN-1 participants (NCT02245022) presenting with untreated HIV late in pregnancy (28-36 weeks gestation). METHODS Pregnant women from Uganda and South Africa were randomised (1:1) to daily dolutegravir (50 mg) or efavirenz-based therapy. Dolutegravir pharmacokinetic sampling (0-24 hours) was undertaken 14 days after treatment initiation and within 1-3 weeks of delivery, with matched maternal and cord samples at delivery. Mothers switched to efavirenz and maternal and infant plasma and breastmilk samples taken 24, 48 or 72 hours post-switch. Nonlinear mixed effects (NONMEM v. 7.4) was used to describe dolutegravir in all matrices and to evaluate covariates. RESULTS Twenty-eight women and 22 infants were included. Maternal dolutegravir was described by a two-compartment model linked to a fetal and breastmilk compartment. Cord and breastmilk to maternal plasma ratios were 1.279 (1.209-1.281) and 0.033 (0.021-0.050), respectively. Infant dolutegravir was described by breastmilk-to-infant and infant elimination rate constants. No covariate effects were observed. Predicted infant dolutegravir half-life and time to protein adjusted-IC90 (0.064 mg/L) for those above this threshold were 37.9 hours (22.1-63.5) and 108.9 hours [(18.6-129.6); 4.5 days (0.8-5.4); n=13]. CONCLUSIONS Breastfeeding contributed relatively little to infant plasma exposures but a median of 4.5 days additional prophylaxis to some of the breastfed infants was observed following maternal dolutegravir cessation (3-15 days postpartum), which waned with time postpartum as transplacental dolutegravir cleared.
Collapse
Affiliation(s)
- Laura Dickinson
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Stephen Walimbwa
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Yashna Singh
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Julian Kaboggoza
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Kenneth Kintu
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mary Sihlangu
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Julie-Anne Coombs
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Thokozile R Malaba
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Josaphat Byamugisha
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Henry Pertinez
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Alieu Amara
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Joshua Gini
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Laura Else
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Christie Heiberg
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Eva Maria Hodel
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Helen Reynolds
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catriona Waitt
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Saye Khoo
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Catherine Orrell
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
15
|
Teychenne M, Abbott G, Stephens LD, Opie RS, Olander EK, Brennan L, van der Pligt P, Apostolopoulos M, Ball K. Mums on the Move: A pilot randomised controlled trial of a home-based physical activity intervention for mothers at risk of postnatal depression. Midwifery 2020; 93:102898. [PMID: 33290891 DOI: 10.1016/j.midw.2020.102898] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postnatal women are commonly physically inactive, and, when coupled with depressive symptoms, barriers to physical activity can be heightened. This study aimed to 1) examine the feasibility and acceptability of a multi-component home-based physical activity intervention delivered to mothers at risk of postnatal depression, and 2) examine changes in health behaviours (physical activity, sedentary behaviour, sleep, diet) and indicators of mental health. METHODS Sixty-two mothers (3 - 9 months postpartum) who at baseline were insufficiently active and experiencing heightened depressive symptoms were recruited into a 12-week randomised controlled trial in 2018. Participants were randomised into either a) Intervention group (receiving a theoretically underpinned multi-component program including free exercise equipment at home, access to smartphone web-app, and an online forum); or b) Control group (usual routine). Primary outcomes were program feasibility and acceptability. Secondary outcomes included self-reported and accelerometer-assessed physical activity and sedentary behavior, sleep, diet, determinants of physical activity, and mental health (depressive and anxiety symptoms), measured at baseline and follow-up (12-weeks), with self-reported physical activity, sedentary behaviour and depressive symptoms also measured at weeks 4 and 8. Qualitative data was analysed following inductive content analysis, and quantitative data using linear mixed models. RESULTS Exercise equipment use in the home was shown to be a feasible strategy to re-engage postnatal women in physical activity. Other components of the program (e.g. web-app, online forum) had low compliance. The program had high acceptability, predominately due to its accessibility, flexibility and ability to overcome key barriers to physical activity. The program resulted in improvements in short-term self-reported physical activity (increased 162min/week at 4 weeks, 95% CI: 37.7, 286.2), behavioural skills (B=0.4, 95% CI: 0.0, 0.8) and perceived barriers to physical activity. However, accelerometer measured physical activity decreased in the intervention group, compared to control group at week 12 (B=-1.3, 95% CI:-2.5, -0.1). There were no changes in other outcomes. CONCLUSIONS A home-based physical activity program involving free exercise equipment is acceptable and feasible amongst women experiencing heightened postnatal depressive symptoms. Such programs may be effective in increasing engagement in physical activity, yet additional strategies may be needed to enhance maintenance of physical activity and improvements in mental health.
Collapse
Affiliation(s)
- Megan Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Lena D Stephens
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Rachelle S Opie
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Wodonga, Victoria, Australia
| | - Paige van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Maria Apostolopoulos
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| |
Collapse
|
16
|
Long-term effects of pre-gestational stress and perinatal venlafaxine treatment on neurobehavioral development of female offspring. Behav Brain Res 2020; 398:112944. [PMID: 33017639 DOI: 10.1016/j.bbr.2020.112944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 02/08/2023]
Abstract
Preclinical studies suggest that stress-related disorders even prior gestation can cause long-term changes at the level of neurobehavioral adaptations. Therefore, it is critical to consider undergoing antidepressant therapy which could reverse the negative consequences in the offspring. Venlafaxine is widely used in clinical practice; however insufficient amount of well-controlled studies verified the safety of venlafaxine therapy during gestation and lactation. The aim of this work was to investigate the effects of perinatal venlafaxine therapy on selected neurobehavioral variables in mothers and their female offspring using a model of maternal adversity. Pre-gestational stressed and non-stressed Wistar rat dams were treated with either venlafaxine (10 mg/kg/day) or vehicle during pregnancy and lactation. We have shown that pre-gestational stress decreased the number of pups with a significant reduction in the number of males but not females. Furthermore, we found that offspring of stressed and treated mothers exhibited anxiogenic behavior in juvenile and adolescent age. However, during adulthood pre-gestational stress significantly increased anxiety-like behavior of female, with venlafaxine treatment normalizing the state to control levels. Additionally, we found that even maternal stress prior gestation can have long-term impact on adult number of hippocampal immature neurons of the female offspring. A number of questions related to the best treatment options for maternal depression still remains, however present data may provide greater insight into the possible outcomes associated with perinatal venlafaxine therapy.
Collapse
|
17
|
Uguz F. Pharmacological prevention of mood episodes in women with bipolar disorder during the perinatal period: A systematic review of current literature. Asian J Psychiatr 2020; 52:102145. [PMID: 32516746 DOI: 10.1016/j.ajp.2020.102145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This review examined the efficacy of mood stabilizers and antipsychotics in patients with bipolar disorder during pregnancy and the postpartum period. METHODS PubMed was searched for reports between 01 January 1996 and 31 December 2019 by using combinations of key words bipolar disorder, pregnancy, postpartum period, puerperium, prophylaxis, mood stabilizers, antipsychotics, lithium, lamotrigine, valproate, carbamazepine, oxcarbazepine, olanzapine, risperidone, quetiapine, aripiprazole, haloperidol, and chlorpromazine. RESULTS The present reports included a total of 256 patients using lithium (n = 143), lamotrigine (n = 73), valproate (n = 17), olanzapine (n = 17), quetiapine (n = 4) and haloperidol (n = 1) during pregnancy or the postpartum period. Recurrence rates in pregnant patients using lithium (n = 79) and lamotrigine (n = 17) were 22.7 % and 41.2 %, respectively. According to very limited data, none of the patients using valproate (n = 2), quetiapine (n = 3) or olanzapine (n = 6) experienced a new episode during pregnancy. A recurrence was reported in 12 (70.6 %) of 17 patients using valproate during the postpartum period. The same recurrence rates in patients using lithium (n = 123), lamotrigine (n = 63), olanzapine (n = 17) and quetiapine (n = 3) were 20.3 %, 7.9 %, 11.7 %, and 33.3 %, respectively. CONCLUSIONS This review suggests that lithium, lamotrigine and olanzapine seem to be effective in preventing new mood episodes in patients with bipolar disorder during the perinatal period.
Collapse
Affiliation(s)
- Faruk Uguz
- Department of Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Brown JVE, Wilson CA, Ayre K, South E, Molyneaux E, Trevillion K, Howard LM, Khalifeh H. Antidepressant treatment for postnatal depression. Hippokratia 2020. [DOI: 10.1002/14651858.cd013560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jennifer Valeska Elli Brown
- University of York; Mental Health and Addiction Research Group, Department of Health Sciences; York UK
- University of York; Cochrane Common Mental Disorders; York UK
| | - Claire A Wilson
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Karyn Ayre
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Emily South
- University of York; Centre for Reviews and Dissemination; York UK
| | - Emma Molyneaux
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Kylee Trevillion
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Louise M Howard
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Hind Khalifeh
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| |
Collapse
|
20
|
Betcher HK, Wisner KL. Psychotropic Treatment During Pregnancy: Research Synthesis and Clinical Care Principles. J Womens Health (Larchmt) 2019; 29:310-318. [PMID: 31800350 DOI: 10.1089/jwh.2019.7781] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Psychiatric illnesses are common in women of childbearing age. The perinatal period is a particularly high-risk time for depression, bipolar, and anxiety disorders. Methods: The scope of the public health problem of perinatal mental disorders is discussed followed by an examination of the specific research methods utilized for the study of birth and developmental outcomes associated with maternal mental illness and its treatment. The evidence on exposure to common psychotropics during pregnancy and breastfeeding is reviewed. Results: Selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitor medications are not associated with higher rates of birth defects or long-term changes in mental development after adjustment for confounding factors associated with underlying psychiatric illness. Lithium exposure is associated with an increased risk for fetal cardiac malformations, but this risk is lower than previously thought (absolute risk of Ebstein's anomaly 6/1,000). Antipsychotics, other than risperidone and potentially paliperidone, have not been associated with an increase in birth defects; olanzapine and quetiapine have been linked with an elevated risk of gestational diabetes. Due to the dramatic physiological changes of pregnancy and enhanced hepatic metabolism, drug doses may need to be adjusted during pregnancy to sustain efficacy. Untreated maternal psychiatric illness also carries substantial risks for the mother, fetus, infant, and family. Conclusions: The goal of perinatal mental health treatment is to optimally provide pharmacotherapy to mitigate the somatic and psychosocial burdens of maternal psychiatric disorders. Regular symptom monitoring during pregnancy and postpartum and medication dose adjustments to sustain efficacy constitutes good practice.
Collapse
Affiliation(s)
- Hannah K Betcher
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Katherine L Wisner
- 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
| |
Collapse
|
21
|
Tunali-Akbay T, Kahraman MV, Oktay B, İpekci H, Kayaman-Apohan N. Development of nanofiber based immunosorbent surface for the removal of fluoxetine from breast milk. INT J POLYM MATER PO 2019. [DOI: 10.1080/00914037.2018.1525539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Tuğba Tunali-Akbay
- Faculty of Dentistry, Department of Basic Medical Sciences, Marmara University, Istanbul, Turkey
| | - Memet Vezir Kahraman
- Faculty of Art and Science, Department of Chemistry, Marmara University, Istanbul, Turkey
| | - Burcu Oktay
- Faculty of Art and Science, Department of Chemistry, Marmara University, Istanbul, Turkey
| | - Hazal İpekci
- Faculty of Dentistry, Department of Basic Medical Sciences, Marmara University, Istanbul, Turkey
| | - Nilhan Kayaman-Apohan
- Faculty of Art and Science, Department of Chemistry, Marmara University, Istanbul, Turkey
| |
Collapse
|
22
|
Wyska E. Pharmacokinetic considerations for current state-of-the-art antidepressants. Expert Opin Drug Metab Toxicol 2019; 15:831-847. [DOI: 10.1080/17425255.2019.1669560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Elżbieta Wyska
- Department of Pharmacokinetics and Physical Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
23
|
Antidepressants in breast milk; comparative analysis of excretion ratios. Arch Womens Ment Health 2019; 22:383-390. [PMID: 30116895 DOI: 10.1007/s00737-018-0905-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/10/2018] [Indexed: 01/16/2023]
Abstract
Despite increasing prescription rates of antidepressants in pregnant and breastfeeding women over the past decades, evidence of drug exposure for neonates through lactation is very sparse. Concentrations of three antidepressants citalopram, sertraline, and venlafaxine were measured in maternal blood and breast milk in 17 women receiving antidepressant therapy during breastfeeding period. We also computed concentration-by-dose-ratios (C/D) and milk to serum (plasma) penetration ratios (M/P). Non-parametric tests were applied. Serum concentration of citalopram and daily dosage correlated positively while daily dosage and mother milk concentration did not (rho = 0.939, p = 0.005, and rho = 0.772, p > 0.05 respectively). A significant correlation was also found between serum and milk concentrations (rho = 0.812, p = 0.05). Venlafaxine daily dosage correlated positively with the active moiety milk concentration (rho = 0.949, p = 0.014). No significant correlations were reported for sertraline. The amount of antidepressant concentrations to which neonates may be exposed, assessed as absolute infant dose (AID), was particularly low with the highest median AID being 0.16 mg/kg/day for venlafaxine. No significant difference was detected for the M/P ratios between different drugs (p > 0.05), whereas the comparison of C/D ratios revealed lower values in the sertraline group, with the highest values reported for citalopram group (p = 0.007 for serum concentrations and p = 0.008 for mother milk). Findings suggest that breastfeeding under antidepressant treatment constantly exposes children with measurable drug concentrations. As daily dosage and serum concentration of the antidepressants did not predict drug concentrations in mother milk, measuring of drug concentrations in milk helps to quantify drug exposure during breastfeeding. More data-even data of drug concentrations in breastfed children-are needed to better assess the effects of drug exposure on children's development.
Collapse
|
24
|
|
25
|
Trifu S, Vladuti A, Popescu A. THE NEUROENDOCRINOLOGICAL ASPECTS OF PREGNANCY AND POSTPARTUM DEPRESSION. ACTA ENDOCRINOLOGICA-BUCHAREST 2019; 15:410-415. [PMID: 32010366 DOI: 10.4183/aeb.2019.410] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Ties between the endocrine system and mental health are undeniably a consistent point of interest in modern day medicine. Furthermore, mental disturbances due to hormonal changes following childbirth have been mentioned in medical literature since Hippocrates. Considering the dramatic endocrine, paracrine and autocrine changes that occur during gestation, labour and postnatal phase, hormonal theories are not to be ignored in the treatment of postpartum disorders. Results Reproductive hormones are known to modulate behavioural, emotional and cognitive response, therefore rapid changes in estradiol and progesterone plasma concentrations during pregnancy and labour create a vulnerable terrain leading towards postpartum disorders. New research shows that women suffering from postpartum disorders have abnormal neural responses, suggesting a neuroendocrine explanation for postpartum syndromes. Conclusion To facilitate further research in this area, we present new information on several hormonal interactions and the psychiatric response involved in pregnancy and labour, offering an interdisciplinary outlook on pregnancy and postpartum disorders. There is enough evidence to suggest that estradiol, progesterone, oxytocin, cortisol and thyroid hormones are some of many hormones involved in postpartum syndromes and tackling their perinatal imbalance with pharmacological substituents or antagonists could be useful as an adjuvant form of treatment in future patients.
Collapse
Affiliation(s)
- S Trifu
- "Carol Davila" University of Medicine and Pharmacy - Dept. of Neurosciences, Bucharest, Romania
| | - A Vladuti
- University of Bucharest Faculty of Psychology and Educational Sciences - Dept. of Psychology, Bucharest, Romania
| | - A Popescu
- "Alex. Obregia" Clinical Hospital for Psychiatry - Dept. of Psychiatry, Bucharest, Romania
| |
Collapse
|
26
|
Pocivalnik M, Danda M, Urlesberger B, Raith W. Severe Brief Resolved Unexplained Event in a Newborn Infant in Association with Maternal Sertralin Treatment during Pregnancy. MEDICINES 2018; 5:medicines5040113. [PMID: 30360382 PMCID: PMC6313667 DOI: 10.3390/medicines5040113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/13/2018] [Accepted: 10/17/2018] [Indexed: 11/18/2022]
Abstract
Background: Selective serotonin reuptake inhibitors are a very common choice of antidepressive drug-therapy during pregnancy. In up to 30% of cases, they have been found to cause neonatal abstinence syndrome in newborn infants. Although often both time-limiting and self-limiting, severe symptoms of neonatal abstinence syndrome (NAS) can occur. Methods/Results: We report a term male infant suffering from a severe brief resolved unexplained event caused by his mother’s sertraline intake during pregnancy. Conclusions: Newborn infants exposed to selective serotonine reuptake inhibitors (SSRIs) during pregnancy should be evaluated very carefully concerning NAS and monitored for NAS symptoms for a minimum of 72–96 h, or until symptoms have fully recovered using standardized protocols. There is a risk of severe NAS symptoms which might occur, and this circumstance should be discussed with the parents and taken into account before administering the drug.
Collapse
Affiliation(s)
- Mirjam Pocivalnik
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria.
| | - Manfred Danda
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria.
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria.
| | - Wolfgang Raith
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria.
| |
Collapse
|
27
|
da L.D. Barros M, Manhães-de-Castro R, Alves DT, Quevedo OG, Toscano AE, Bonnin A, Galindo L. Long term effects of neonatal exposure to fluoxetine on energy balance: A systematic review of experimental studies. Eur J Pharmacol 2018; 833:298-306. [DOI: 10.1016/j.ejphar.2018.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 02/01/2023]
|
28
|
Cuomo A, Maina G, Neal SM, De Montis G, Rosso G, Scheggi S, Beccarini Crescenzi B, Bolognesi S, Goracci A, Coluccia A, Ferretti F, Fagiolini A. Using sertraline in postpartum and breastfeeding: balancing risks and benefits. Expert Opin Drug Saf 2018; 17:719-725. [PMID: 29927667 DOI: 10.1080/14740338.2018.1491546] [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] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The World Health Organization recommends newborns to be breastfed but this may be challenging if the mother needs to be treated for depression, since strong evidence to inform treatment choice is missing. AREAS COVERED We provide a critical review of the literature to guide clinicians who are considering sertraline for the management of depression during postpartum. EXPERT OPINION Sertraline is one of the safest antidepressants during breastfeeding. In most cases, women already taking sertraline should be advised to breastfeed and continue the medication. We recommend to begin with low doses and to slowly increase the dose up, with careful monitoring of the newborn for adverse effects (irritability, poor feeding, or uneasy sleep, especially if the child was born premature or had low weight at birth). The target dose should be the lowest effective. When feasible, child exposure to the medication may be reduced by avoiding breastfeeding at the time when the antidepressant milk concentration is at its peak. A decision to switch to sertraline from ongoing and effective treatment should be taken only after a scrupulous evaluation of the potential risks and benefits of switching versus continuing the ongoing medication while monitoring the infant carefully.
Collapse
Affiliation(s)
- Alessandro Cuomo
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| | - Giuseppe Maina
- b University of Torino , Department of Neuroscience (GM , GR )
| | - Stephen M Neal
- c The Department of Psychiatry , West Virginia School of Osteopathic Medicine (SMN)
| | - Graziella De Montis
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| | - Gianluca Rosso
- b University of Torino , Department of Neuroscience (GM , GR )
| | - Simona Scheggi
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| | - Bruno Beccarini Crescenzi
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| | - Simone Bolognesi
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| | - Arianna Goracci
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| | - Anna Coluccia
- d University of Siena Department of Medical , Sugical and Neurological Sciences (AC2, FF)
| | - Fabio Ferretti
- d University of Siena Department of Medical , Sugical and Neurological Sciences (AC2, FF)
| | - Andrea Fagiolini
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| |
Collapse
|
29
|
Holman L, McKeever R. The Andrea Yates Effect: Priming Mental Illness Stereotypes Through Exemplification of Postpartum Disorders. HEALTH COMMUNICATION 2017; 32:1284-1296. [PMID: 27690626 DOI: 10.1080/10410236.2016.1219929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In a randomized between-subjects design, participants (N = 80) were assigned to one of four conditions, 2 (pregnant, not pregnant) × 2 (extreme prime, moderate prime). It was hypothesized that primes involving moderate mental illness would be positively associated with increased perceived risk of developing postpartum depression. Hayes and Preacher's bootstrapping procedure was used to test the direct, indirect, and conditional indirect effects related to the hypothesized model. In addition, further analyses evaluated whether implicitly activated goals (to be healthy or to be a good mother) were positively associated with increased perceptions of risk and engagement of downstream avoidance behavioral intentions. Findings show that for pregnant participants, the effect of the prime condition on perceived personal risk of developing postpartum depression was mediated by perceptions about the target character's sanity. However, activated "healthy" and "good mother" goals are not influencing behavioral intentions.
Collapse
Affiliation(s)
- Lynette Holman
- a Department of Communication , Appalachian State University
| | - Robert McKeever
- b School of Journalism and Mass Communications University of South Carolina
| |
Collapse
|
30
|
McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, Gregoire A, Howard LM, Jones I, Khalifeh H, Lingford-Hughes A, McDonald E, Micali N, Pariante CM, Peters L, Roberts A, Smith NC, Taylor D, Wieck A, Yates LM, Young AH. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 2017; 31:519-552. [PMID: 28440103 DOI: 10.1177/0269881117699361] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.
Collapse
Affiliation(s)
- R Hamish McAllister-Williams
- 1 Institute of Neuroscience, Newcastle University, Newcastle, UK.,2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David S Baldwin
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,4 University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Abby Easter
- 6 Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eilish Gilvarry
- 2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,7 Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Vivette Glover
- 8 Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lucian Green
- 9 Ealing, Hounslow, Hammersmith & Fulham Perinatal Mental Health Service, West London Mental Health Trust, London, UK
| | - Alain Gregoire
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,10 Hampshire Perinatal Mental Health Service, Winchester, UK
| | - Louise M Howard
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | - Ian Jones
- 13 National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Hind Khalifeh
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Elizabeth McDonald
- 15 Royal College of Psychiatrists, London, UK.,16 East London Foundation Trust, London, UK.,17 Tavistock and Portman NHS Foundation Trust, London, UK
| | - Nadia Micali
- 18 Behavioural and Brain Sciences Unit, GOSH Institute of Child Health, University College London, London, UK
| | - Carmine M Pariante
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Ann Roberts
- 20 St Martin's Healthcare Services CIC, Leeds, UK.,21 Hertfordshire Partnership University NHS Foundation Trust, Hatfield, Hertfordshire, UK.,22 Postgraduate School of Medicine, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Natalie C Smith
- 23 Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, County Durham, UK
| | - David Taylor
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,24 Institute of Pharmaceutical Science, King's College London, London, UK
| | - Angelika Wieck
- 25 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,26 University of Manchester, Manchester, UK
| | - Laura M Yates
- 27 UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,28 Institute of Genetic Medicine, Newcastle University, Newcastle, UK
| | - Allan H Young
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | |
Collapse
|
31
|
Uguz F, Arpaci N. Short-Term Safety of Paroxetine and Sertraline in Breastfed Infants: A Retrospective Cohort Study from a University Hospital. Breastfeed Med 2016; 11:487-489. [PMID: 27575664 DOI: 10.1089/bfm.2016.0095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Primary pharmacological agents for depression and anxiety disorders are antidepressants, especially selective serotonine reuptake inhibitors. The aim of this study was to examine the features and prevalence of adverse effects of paroxetine and sertraline in breastfed infants. METHODS The study had a retrospective cohort design. Five-year clinical data of 72 patients were included in the study. Psychiatric diagnoses were ascertained by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. RESULTS The prevalence rate of adverse events in the infants was 12.5%. Insomnia (88.9%), restlessness (55.6%), and constant crying (22.2%) were the most frequent adverse events. A switch between paroxetine and sertraline performed in five patients, who reported an adverse event in their breastfed infants, resulted in cessation of the adverse events. CONCLUSION The results suggest that the prevalence rate of adverse events in the infants exposed to sertraline or paroxetine is relatively low and mostly mild.
Collapse
Affiliation(s)
- Faruk Uguz
- Department of Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University , Konya, Turkey
| | - Nazile Arpaci
- Department of Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University , Konya, Turkey
| |
Collapse
|
32
|
Salazar FR, D’Avila FB, de Oliveira MH, Ferreira PL, Bergold AM. Development and validation of a bioanalytical method for five antidepressants in human milk by LC–MS. J Pharm Biomed Anal 2016; 129:502-508. [DOI: 10.1016/j.jpba.2016.07.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
|
33
|
Uguz F, Sharma V. Mood stabilizers during breastfeeding: a systematic review of the recent literature. Bipolar Disord 2016; 18:325-33. [PMID: 27297617 DOI: 10.1111/bdi.12398] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/11/2016] [Accepted: 04/22/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVE This review examined the safety of mood stabilizers in exposed breastfed infants. METHODS PubMed was searched for English language reports between 1 January 1995 and 30 August 2015 by using combinations of key words breastfeeding, lactation, postpartum period, puerperium, mood stabilizers, lithium, lamotrigine, valproate, carbamazepine, and oxcarbazepine. Case reports, case series, and prospective or cross-sectional studies including relevant data such as relative infant dose, milk-to-plasma ratio, infant drug plasma levels, and adverse events were identified. RESULTS A total of 26 of 604 relevant reports in PubMed were included in the study. These reports included lamotrigine (122 cases in 12 reports), lithium (26 cases in five reports), carbamazepine (64 cases in five reports), valproate (nine cases in three reports), and oxcarbazepine (two cases in two reports). Of 26 reports, one report included both carbamazepine and valproate. The reports suggest that a considerable amount of lithium and lamotrigine are excreted into breast milk. There is a paucity of data on valproate and oxcarbazepine; however, the infant/maternal ratio of serum drug concentration seems to be lower in valproate exposure compared to other mood stabilizers. The incidence of adverse events in infants exposed to mood stabilizers is reported to be very low. CONCLUSIONS The current data suggest that mood stabilizers can be prescribed without any adverse events in most infants in lactating women. The available reports also suggest a low prevalence rate of laboratory abnormalities including hepatic, kidney, and thyroid functions in the infants. Additional studies examining short-term and especially long-term effects of mood stabilizers on breastfed infants are required.
Collapse
Affiliation(s)
- Faruk Uguz
- Department of Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Verinder Sharma
- Department of Psychiatry and Obstetrics and Gynecology, Western University, Parkwood Institute, London, ON, Canada
| |
Collapse
|
34
|
Second-Generation Antipsychotics During the Lactation Period: A Comparative Systematic Review on Infant Safety. J Clin Psychopharmacol 2016; 36:244-52. [PMID: 27028982 DOI: 10.1097/jcp.0000000000000491] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This review examined the safety of second-generation antipsychotics (SGAs) in exposed breastfed infants. METHODS PubMed was searched for English language reports between January 1, 1990, to June 30, 2015, by using combinations of the key words breastfeeding, lactation, postpartum period, puerperium, antipsychotics, second-generation antipsychotics, olanzapine, quetiapine, risperidone, ziprasidone, aripiprazole, amisulpride, clozapine, asenapine, lurasidone, and iloperidone. Case reports, case series, and prospective or cross-sectional studies including relevant data such as relative infant dose (RID), milk-to-plasma ratio (M/P ratio), infant drug plasma levels, and adverse events were identified. RESULTS A total of 37 relevant reports were examined. These reports included a total of 206 infants exposed to olanzapine (n = 170), quetiapine (n = 14), risperidone/paliperidone (n = 8), clozapine (n = 6), aripiprazole (n = 4), ziprasidone (n = 2), and amisulpride (n = 2). Approximately half of the available data on the M/P ratio, RID, and infant drug plasma levels included olanzapine. Relatively adequate reports suggest that olanzapine has low RID values. Limited reports suggest low RID values for quetiapine and ziprasidone, moderate RID values for risperidone/paliperidone and aripiprazole, and high RID values for amisulpride. Antipsychotic levels were undetectable in the plasma of most of the exposed infants. Other than clozapine, adverse events were rarely reported in infants exposed to SGAs. CONCLUSIONS The current data suggest that SGAs seem to be relatively safe in the exposed breastfed infants for short-term usage. However, additional studies, in particular for antipsychotics other than olanzapine, examining short-term and especially long-term effects of SGAs on the breastfed infants are required.
Collapse
|
35
|
Abstract
Depression is a common complication of pregnancy and the postpartum period. There are multiple risk factors for peripartum mood disorders, most important of which is a prior history of depression. Both depression and antidepressant medications confer risk upon the infant. Maternal depression has been associated with preterm birth, low birth weight, fetal growth restriction, and postnatal cognitive and emotional complications. Antidepressant exposure has been associated with preterm birth, reductions in birth weight, persistent pulmonary hypertension, and postnatal adaptation syndrome (PNAS) as well as a possible connection with autism spectrum disorder. Paroxetine has been associated with cardiac malformations. Most antidepressant medications are excreted in low levels in breast milk and are generally compatible with breastfeeding. The use of antidepressants during pregnancy and postpartum must be weighed against the risk of untreated depression in the mother.
Collapse
Affiliation(s)
- Madeleine Becker
- Department of Psychiatry and Human Behavior, Thomas Jefferson University Hospital, 1020 Sansom Street, Thompson Bldg, Suite 1652, Philadelphia, PA, 19107, USA.
| | - Tal Weinberger
- Department of Psychiatry and Human Behavior, Thomas Jefferson University Hospital, 833 Chestnut St. 2nd floor, Suite 210, Philadelphia, PA, 19107, USA
| | - Ann Chandy
- Department of Psychiatry and Human Behavior, Thomas Jefferson University Hospital, 1020 Sansom Street, Thompson Bldg, Suite 1652, Philadelphia, PA, 19107, USA
| | - Sarah Schmukler
- Department of Psychiatry and Human Behavior, Thomas Jefferson University Hospital, 1020 Sansom Street, Thompson Bldg, Suite 1652, Philadelphia, PA, 19107, USA
| |
Collapse
|
36
|
Schjøtt J. Challenges in psychopharmacology: a drug information centre perspective. J Clin Pharm Ther 2016; 41:4-6. [DOI: 10.1111/jcpt.12354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Affiliation(s)
- J. Schjøtt
- Section of Clinical Pharmacology; Laboratory of Clinical Biochemistry; Haukeland University Hospital; Bergen Norway
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest); Haukeland University Hospital; Bergen Norway
- Department of Clinical Science; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
| |
Collapse
|
37
|
Haim A, Albin-Brooks C, Sherer M, Mills E, Leuner B. The effects of gestational stress and Selective Serotonin reuptake inhibitor antidepressant treatment on structural plasticity in the postpartum brain--A translational model for postpartum depression. Horm Behav 2016; 77:124-31. [PMID: 25997412 PMCID: PMC4651861 DOI: 10.1016/j.yhbeh.2015.05.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/30/2015] [Accepted: 05/11/2015] [Indexed: 12/12/2022]
Abstract
This article is part of a Special Issue "Parental Care". Postpartum depression (PPD) is a common complication following childbirth experienced by one in every five new mothers. Although the neural basis of PPD remains unknown, previous research in rats has shown that gestational stress, a risk factor for PPD, induces depressive-like behavior during the postpartum period. Moreover, the effect of gestational stress on postpartum mood is accompanied by structural modifications within the nucleus accumbens (NAc) and the medial prefrontal cortex (mPFC)-limbic regions that have been linked to PPD. Mothers diagnosed with PPD are often prescribed selective serotonin reuptake inhibitor (SSRI) antidepressant medications and yet little is known about their effects in models of PPD. Thus, here we investigated whether postpartum administration of Citalopram, an SSRI commonly used to treat PPD, would ameliorate the behavioral and morphological consequences of gestational stress. In addition, we examined the effects of gestational stress and postpartum administration of Citalopram on structural plasticity within the basolateral amygdala (BLA) which together with the mPFC and NAc forms a circuit that is sensitive to stress and is involved in mood regulation. Our results show that postpartum rats treated with Citalopram do not exhibit gestational stress-induced depressive-like behavior in the forced swim test. In addition, Citalopram was effective in reversing gestational stress-induced structural alterations in the postpartum NAc shell and mPFC. We also found that gestational stress increased spine density within the postpartum BLA, an effect which was not reversed by Citalopram treatment. Overall, these data highlight the usefulness of gestational stress as a valid and informative translational model for PPD. Furthermore, they suggest that structural alterations in the mPFC-NAc pathway may underlie stress-induced depressive-like behavior during the postpartum period and provide much needed information on how SSRIs may act in the maternal brain to treat PPD.
Collapse
Affiliation(s)
- Achikam Haim
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | | | - Morgan Sherer
- Department of Psychology, The Ohio State University, Columbus, OH 43210, USA
| | - Emily Mills
- Department of Psychology, The Ohio State University, Columbus, OH 43210, USA
| | - Benedetta Leuner
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Department of Psychology, The Ohio State University, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University, Columbus, OH 43210, USA.
| |
Collapse
|
38
|
Gemmel M, Rayen I, Lotus T, van Donkelaar E, Steinbusch HW, De Lacalle S, Kokras N, Dalla C, Pawluski JL. Developmental fluoxetine and prenatal stress effects on serotonin, dopamine, and synaptophysin density in the PFC and hippocampus of offspring at weaning. Dev Psychobiol 2015; 58:315-27. [DOI: 10.1002/dev.21372] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 10/07/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Mary Gemmel
- Department of Biological Sciences; Ohio University; Athens OH
| | - Ine Rayen
- School for Mental Health and Neuroscience; Maastricht University; Maastricht Netherlands
| | - Tiffany Lotus
- Department of Biological Sciences; Ohio University; Athens OH
| | - Eva van Donkelaar
- School for Mental Health and Neuroscience; Maastricht University; Maastricht Netherlands
| | - Harry W. Steinbusch
- School for Mental Health and Neuroscience; Maastricht University; Maastricht Netherlands
| | | | - Nikolaos Kokras
- Department of Pharmacology, Medical School; University of Athens; Athens Greece
| | - Christina Dalla
- Department of Pharmacology, Medical School; University of Athens; Athens Greece
| | - Jodi L. Pawluski
- Department of Biological Sciences; Ohio University; Athens OH
- School for Mental Health and Neuroscience; Maastricht University; Maastricht Netherlands
- University of Rennes 1, IRSET-INSERM U1085; Rennes Cedex France
| |
Collapse
|
39
|
Sharma V, Sommerdyk C. Obsessive-compulsive disorder in the postpartum period: diagnosis, differential diagnosis and management. ACTA ACUST UNITED AC 2015; 11:543-52. [PMID: 26246310 DOI: 10.2217/whe.15.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Childbirth can trigger or exacerbate a variety of psychiatric disorders but the extant literature has focused primarily on mood disorders. Obsessive-compulsive disorder (OCD) after childbirth can occur alone or in combination with other psychiatric disorders such as major depressive disorder. Due to the general lack of awareness of the relationship between childbirth and OCD among clinicians as well as patients, the disorder may be underdiagnosed or misdiagnosed as major depressive disorder. This article describes the prevalence, clinical features, common psychiatric comorbidities, differential diagnosis and potential consequences of underdiagnosis or misdiagnosis. Using case vignettes strategies for its detection and clinical management are suggested. Finally, areas in need of further research are proposed.
Collapse
Affiliation(s)
- Verinder Sharma
- Western University, London, ON, N6A 3K7, Canada.,St. Joseph's Health Care, Parkwood Institute, London, ON, N6C 0A7, Canada
| | | |
Collapse
|
40
|
Uguz F. Gastrointestinal Side Effects in the Baby of a Breastfeeding Woman Treated with Low-Dose Fluvoxamine. J Hum Lact 2015; 31:371-3. [PMID: 25896469 DOI: 10.1177/0890334415582207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/24/2015] [Indexed: 11/15/2022]
Abstract
Depression and anxiety disorders are frequently seen in the postpartum period. Primary pharmacological agents for these disorders are antidepressants, especially selective serotonin reuptake inhibitors. Despite no adverse reports, data on safety for the maternal use of fluvoxamine on breastfed infants are limited. This case report presents diarrhea and vomiting in the breastfed baby of a woman using fluvoxamine at 50 mg/d.
Collapse
Affiliation(s)
- Faruk Uguz
- Department of Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| |
Collapse
|
41
|
Yang Y, Qin J, Chen W, Sui N, Chen H, Li M. Behavioral and pharmacological investigation of anxiety and maternal responsiveness of postpartum female rats in a pup elevated plus maze. Behav Brain Res 2015; 292:414-27. [PMID: 26159828 DOI: 10.1016/j.bbr.2015.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/28/2015] [Accepted: 07/02/2015] [Indexed: 01/26/2023]
Abstract
The present study investigated the validity of a novel pup-based repeated elevated plus maze task to detect reduced anxiety and increased maternal responsiveness in postpartum female rats and explored the roles of dopamine D2, serotonin transporter and GABA/benzodiazepine receptors in the mediation of these processes. Sprague-Dawley postpartum or nulliparous female rats were tested 4 times every other day on postpartum days 4, 6 and 8 in an elevated plus maze with 4 pups or 4 pup-size erasers placed on each end of the two open arms. When tested with erasers, untreated postpartum mother rats entered the open arms proportionally more than nulliparous rats. They also tended to spend more time in the open arms, indicating reduced anxiety. When tested with pups, postpartum rats retrieved pups into the closed arms, entered the open arms and closed arms more and had a higher moving speed than nulliparous rats, indicating increased maternal responsiveness. Both haloperidol (0.1 or 0.2 mg/kg, sc) and fluoxetine (5 or 10 mg/kg, ip) dose- and time-dependently decreased the percentage of time spent in the open arms and speed, but did not affect the percentage of open arm entries. Diazepam (1.0 or 2.0 mg/kg, ip) did not affect pup retrieval, open arm time/entry in lactating rats. Thus, the percentage of open arm entries appears to be the most sensitive measure of anxiety in postpartum female rats, while speed could be used to index maternal responsiveness to pups, which are likely mediated by the dopamine D2 and serotonin transporter systems.
Collapse
Affiliation(s)
- Yu Yang
- Key Laboratory of Cognition and Personality (Southwest University), Ministry of Education, China; Faculty of Psychology, Southwest University, Chongqing, China
| | - Jingxue Qin
- Key Laboratory of Cognition and Personality (Southwest University), Ministry of Education, China; Faculty of Psychology, Southwest University, Chongqing, China
| | - Weihai Chen
- Key Laboratory of Cognition and Personality (Southwest University), Ministry of Education, China; Faculty of Psychology, Southwest University, Chongqing, China
| | - Nan Sui
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Hong Chen
- Key Laboratory of Cognition and Personality (Southwest University), Ministry of Education, China; Faculty of Psychology, Southwest University, Chongqing, China.
| | - Ming Li
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588-0308, USA.
| |
Collapse
|
42
|
Correia-Leite de Marcelos PG, Regueira LS, Santiago-Jaegger IM, Cruz Perez DE, de Moraes Ramos-Perez FM, Evêncio Neto J, Baratella-Evêncio L. Effects of treatment with fluoxetine on mandibular development: A morphological study in rats. Acta Histochem 2015; 117:582-9. [PMID: 26071855 DOI: 10.1016/j.acthis.2015.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 01/31/2023]
Abstract
AIM To verify whether the use of fluoxetine during gestation and lactation interferes in mandibular bone formation in rats. METHODS Twenty-four Wistar rat pups were used and distributed into four groups: CG - control of gestation; CL - control of gestation and lactation; FG - treated with fluoxetine during gestation and FL - treated with fluoxetine during gestation and lactation. At 25 days of life, after anesthesia, perfusion and decapitation, the mandibles were removed. Radiographic, histologic, histometric and polarizing microscopy analyses were performed. Statistical analysis was used considering a level of 5% significance. RESULT The FL group compared with its control (CL) was shown to differ statistically from the other groups as regards histometry and radiopacity, revealing a reduction in the inferior cortical thickness, reduction in number of osteocytes, with consequent reduction in radiographic bone density. There was also reduction in the number of osteoblasts in FG. CONCLUSION The long-term use of fluoxetine via oral route by pregnant and lactating rats modifies the mandibular bone mass.
Collapse
|
43
|
Abstract
AIMS Untreated perinatal depression and anxiety disorders are known to have significant negative impact on both maternal and fetal health. Dilemmas still remain regarding the use and safety of psychotropics in pregnant and lactating women suffering from perinatal depression and anxiety disorders. The aim of the current paper was to review the existing evidence base on the exposure and consequences of antidepressants, anxiolytics, and hypnotics in women during pregnancy and lactation and to make recommendations for clinical decision making in management of these cases. MATERIALS AND METHODS We undertook a bibliographic search of Medline/PubMed (1972 through 2014), Science Direct (1972 through 2014), Archives of Indian Journal of Psychiatry databases was done. References of retrieved articles, reference books, and dedicated websites were also checked. RESULTS AND CONCLUSIONS The existing evidence base is extensive in studying multiple outcomes of the antidepressant or anxiolytic exposure in neonates, and some of the findings appear conflicting. Selective serotonin reuptake inhibitors are the most researched antidepressants in pregnancy and lactation. The available literature is criticized mostly on the lack of rigorous well designed controlled studies as well as lacunae in the methodologies, interpretation of statistical information, knowledge transfer, and translation of information. Research in this area in the Indian context is strikingly scarce. Appropriate risk-benefit analysis of untreated mental illness versus medication exposure, tailor-made to each patient's past response and preference within in the context of the available evidence should guide clinical decision making.
Collapse
Affiliation(s)
- Daya Ram
- Director, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - S. Gandotra
- Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India
| |
Collapse
|
44
|
Lupu D, Pop A, Cherfan J, Kiss B, Loghin F. In vitro modulation of estrogen receptor activity by norfluoxetine. ACTA ACUST UNITED AC 2015; 88:386-90. [PMID: 26609274 PMCID: PMC4632900 DOI: 10.15386/cjmed-476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 12/17/2022]
Abstract
Background and aims Selective serotonin reuptake inhibitors (SSRIs) are antidepressants increasingly prescribed for pregnancy and postpartum depression. However, these compounds can cross the placenta and also pass into breast milk, thus reaching the fetus and infant during critical developmental stages, potentially causing adverse effects. Fluoxetine, a widely used SSRI, has been shown to affect (neuro)endocrine signaling in various organisms, including humans. This compound can also interact with estrogen receptors in vitro and cause an estrogen-dependent uterotrophic response in rodents. Consequently, the aim of the present study was to assess if the active metabolite of fluoxetine, namely norfluoxetine (NFLX), shares the same capacity for estrogen receptor interaction. Methods The in vitro (anti)estrogenic activity of norfluoxetine was assessed using a firefly luciferase reporter construct in the T47D-Kbluc breast cancer cell line. These cells express nuclear estrogen receptors (ERs) that can activate the transcription of the luciferase reporter gene upon binding of ER agonists. Light emission was monitored in case of cells exposed to norfluoxetine or mixtures of norfluoxetine-estradiol. Cell viability was assessed using a resazurin-based assay. Results During individual testing, NFLX was able to induce a significant increase in luciferase activity compared to control, but only at the highest concentration tested (10 μM). In binary mixtures with estradiol (30 pM constant concentration) a significant increase in luminescence was observed at low submicromolar norfluoxetine concentrations compared to estradiol alone. Conclusion Norfluoxetine can induce estrogenic effects in vitro and can potentiate the activity of estradiol. However, further studies are needed to clarify if these observed estrogenic effects may have detrimental consequences for human exposure.
Collapse
Affiliation(s)
- Diana Lupu
- Department of Toxicology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca Pop
- Department of Toxicology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Julien Cherfan
- Department of Toxicology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Béla Kiss
- Department of Toxicology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Felicia Loghin
- Department of Toxicology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
45
|
H. Bjørk M, Veiby G, A. Engelsen B, Gilhus NE. Depression and anxiety during pregnancy and the postpartum period in women with epilepsy: A review of frequency, risks and recommendations for treatment. Seizure 2015; 28:39-45. [DOI: 10.1016/j.seizure.2015.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 10/23/2022] Open
|
46
|
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]
|
47
|
Developmental exposure to SSRIs, in addition to maternal stress, has long-term sex-dependent effects on hippocampal plasticity. Psychopharmacology (Berl) 2015; 232:1231-44. [PMID: 25304865 DOI: 10.1007/s00213-014-3758-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 09/23/2014] [Indexed: 12/12/2022]
Abstract
RATIONALE During pregnancy and postpartum period, 20 % of women are affected by depression, which is a growing health concern. Selective serotonin reuptake inhibitor (SSRI) medications are popular treatments for maternal depression; however, the effect of maternal depression and perinatal SSRI exposure on offspring's neural development needs further investigation. OBJECTIVES This study aims to determine the role of developmental fluoxetine exposure on hippocampal plasticity in the adult offspring. METHODS Sprague-Dawley rat offspring were exposed to fluoxetine beginning on postnatal day 1. Offspring were also exposed to prenatal maternal stress. Four groups of male and female offspring were used: (1) prenatal stress + fluoxetine, (2) prenatal stress + vehicle, (3) fluoxetine alone, and (4) vehicle alone. Hippocampi were analyzed for levels of cell proliferation, immature neurons, and new cell survival (3 weeks after 5-bromo-2-deoxyuridine injection) in the granule cell layer, as well as synaptophysin density in the CA3 region and granule cell layer. TPH staining was assessed in the dorsal raphe nucleus. RESULTS Developmental fluoxetine exposure to prenatally stressed offspring reversed the effect of prenatal stress or fluoxetine exposure alone on the number of immature neurons. Prenatal stress alone, regardless of developmental exposure to fluoxetine, markedly decreased hippocampal cell proliferation and tended to decrease new cell survival. Furthermore, in adult female offspring, developmental fluoxetine exposure greatly increased new cell survival and significantly decreased synaptophysin density in the granule cell layer. CONCLUSIONS There are long-term effects of developmental SSRI exposure on hippocampal plasticity that is differentially affected by expose to maternal adversity and offspring sex.
Collapse
|
48
|
Pinheiro E, Bogen DL, Hoxha D, Ciolino JD, Wisner KL. Sertraline and breastfeeding: review and meta-analysis. Arch Womens Ment Health 2015; 18:139-146. [PMID: 25589155 PMCID: PMC4366287 DOI: 10.1007/s00737-015-0499-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/04/2015] [Indexed: 01/16/2023]
Abstract
We examined the risk-benefit profile of sertraline treatment during breastfeeding, summarized the available literature on sertraline use, presented previously unpublished data, and performed a correlation-based meta-analysis of sertraline serum levels in mother-infant pairs. We conducted a search of PubMed and the National Library of Medicine LactMed database. We performed a meta-analysis to examine correlations between maternal and infant serum sertraline levels in the existing literature and in previously unpublished data. Of 167 available infant sertraline levels, 146 (87.4 %) were below the limit of detection, and the meta-analysis found no significant relationship between maternal and infant sertraline concentrations. Of 150 infant desmethylsertraline levels, 105 (70.0 %) were below the limit of detection. The correlation analysis revealed a significant relationship between maternal and infant desmethylsertraline concentrations, but this metabolite has only a fraction of the activity of sertraline. A significant relationship was also found for the sum of sertraline and desmethylsertraline, which stems primarily from the contribution of desmethylsertraline. Sertraline is a first-line drug for breastfeeding women due to documented low levels of exposure in breastfeeding infants and very few adverse events described in case reports. Based on the current literature, neither routine serum sampling nor genotyping is warranted for breastfeeding mothers taking sertraline and/or their infants. Routine pediatric care is appropriate monitoring for breastfed infants of women who take sertraline monotherapy.
Collapse
Affiliation(s)
- Emily Pinheiro
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 1000, Chicago, IL, 60611, USA.
| | - Debra L Bogen
- Department of Pediatrics, University of Pittsburgh School of Medicine, 3420 Fifth Ave., Pittsburgh, PA, 15213, USA
| | - Denada Hoxha
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 1000, Chicago, IL, 60611, USA
| | - Jody D Ciolino
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Katherine L Wisner
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 1000, Chicago, IL, 60611, USA
| |
Collapse
|
49
|
[Psychotropic drugs during pregnancy and lactation: development practice]. Presse Med 2015; 44:271-83. [PMID: 25595818 DOI: 10.1016/j.lpm.2014.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 07/12/2014] [Accepted: 07/28/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Pregnancy and the postpartum periods are particular for the mother's use of drugs. Therapeutic prescription must take into account the potential risk of fetal malformation, newborn's withdrawal syndrome, feeding type and potential risk of untreated maternal mental illness. Recommendations for good practice are constantly remodeling and their conclusions are sometimes contradictory. METHOD The aim of this work is to develop an updated review, easy to use for any professional involved in the monitoring or prescription of a psychotropic medication (antidepressants, anxiolytics-hypnotics, neuroleptics, mood stabilizers and substitution treatment of opioid dependance) for pregnant or nursing women. RESULTS These updates in tabular form are also based on our clinical experience as a team specializing in perinatal medicine.
Collapse
|
50
|
Ahmadzai H, Tee LBG, Crowe A. Pharmacological role of efflux transporters: Clinical implications for medication use during breastfeeding. World J Pharmacol 2014; 3:153-161. [DOI: 10.5497/wjp.v3.i4.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 09/03/2014] [Accepted: 09/24/2014] [Indexed: 02/06/2023] Open
Abstract
The World Health Organisation recommends exclusive breastfeeding for the first six months of an infant’s life and in combination with solid food thereafter. This recommendation was introduced based on research showing numerous health benefits of breastfeeding for both the mother and the infant. However, there is always concern regarding the transfer of medications from mother to their breastfed baby via milk. Pharmacokinetic properties of a drug are usually used to predict its transferability into breast milk. Although most drugs are compatible with breastfeeding, cases of toxic drug exposure have been reported. This is thought to be due to active transport mechanisms whereby efflux transporter proteins expressed in the epithelial cells of the mammary gland actively secrete drugs into milk. An example of such efflux transporters including the breast cancer resistance protein which is strongly induced during lactation and this could result in contamination of milk with the substrates of this transporter which may place the suckling infant at risk of toxicity. Furthermore, there is little known about the substrate specificity of most efflux transporters as we have highlighted in this review. There also exists some degree of contradiction between in vivo and in vitro studies which makes it difficult to conclusively predict outcomes and drug-drug interactions.
Collapse
|