Wednesday, May 12, 2010

Pregnancy Depression Antidepressants Part 2

I want to talk today about the study published in the May issue of the Archives of Pediatrics and Adolescent Medicine entitled Prenatal Effects of Selective Serotonin Reuptake Inhibitor Antidepressants, Serotonin Transporter Promotor Genotype (SLC6A4) and Maternal Mood on Child Behavior at 3 Years of Age. As I mentioned earlier I have great interest in any new information that is related to antidepressant use in pregnancy and whether or not the medication has any effect on the developing child.

The study authors review the information already known that maternal mood disturbance in pregnancy is one of life's first adverse experiences that sets a course for increased risk of psychiatric problems later in life. They review the effects of "gestational stress" but make the point that the biggest factor that seems to affect the developing brain is maternal depression and anxiety after the child is born. We do, however want to know of any adverse effects that the antidepreassants may have. The selective serotonon reuptake inhibitors (SSRI'S) such as Prozac, Zoloft, Paxil, Lexapro, and Celexa are the most commonnly used antidepressants in pregnancy and were the focus of this study. The critical question is how to differentiate the effects of the prenatal SSRI exposure from the underlying maternal disorder

The researchers evaluated 98 mothers in their second trimester of pregnancy. All of the SSRI treated mothers had already been on antidepressant medication at the time of conception. Maternal mood was assessed during the third trimester of pregnancy, at 3 months post partum and at the end of 3 years. The children were evaluated at 3 years of age. 75 mother-child pairs completed the study (33 SSRI treated mothers and 42 non medicated mothers). Levels of maternal depression and anxiety symptoms during pregnancy and 3 months post partum were 2-3 times higher in the SSRI treated group. The children were evaluated by The Child Behavior Checklist which is a well validated maternal self report checklist that looks at internalizing behaviors (emotional reactivity, depression, anxiety, withdrawal, physical complaints and sleep problems) and externalizing behaviors (attention and aggression).

What they found was that prenatal SSRI exposure resulted in higher 3 year internalizing scores and that externalizing behaviors were much more associated not with medication exposure but by levels of maternal anxiety and depression at the 3 year point. The particularly interesting finding was that these risks were affected by the type of gene for the serotonin transporter protein (SLC6A4). I will talk more about this tomorrow.

Thought for the day

"Judge not, so that you will not be judged".


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