Postpartum affective disorder (AD), including postpartum depression (PPD), affects more than one in two hundred women with no history of prior psychiatric episodes, and raises the risk of later affective disorder for those women, according to a new study published in PLOS Medicine by Marie-Louise Rasmussen from Statens Serum Institut, Denmark, and colleagues.
PPD is estimated to affect more than 5 percent of all women following childbirth, making it the most common postnatal complication of childbearing. In the new study, researchers analyzed data from the Danish national registries on 457,317 women who had a first child (and subsequent births) between 1996 and 2013 and had no prior psychiatric hospital contacts or use of antidepressants. Postpartum AD was defined as an antidepressant prescription fill or hospital contact for depression within six months after birth.
The use of antidepressants has been on the rise for many years. Between 2 and 8% of pregnant women are on antidepressants. Now researchers from the National Centre for Register-based Research at Aarhus BSS show that there is an increased risk involved in using antidepressants during pregnancy.
The researchers, headed by Xiaoqin Liu, have applied register-based research to the study of 905,383 children born between 1998 and 2012 with the aim of exploring the possible adverse effects of the mother’s use of antidepressants during her pregnancy.
They found that out of the 905,383 children in total, 32,400 developed a psychiatric disorder later in life. Some of these children were born to mothers who were on antidepressants during their pregnancy, while other children had not been exposed to medication.
Antidepressants treat symptoms of depression by increasing levels of brain signaling molecules (neurotransmitters) such as serotonin, as with the most widely used type of antidepressant, selective serotonin reuptake inhibitors (SSRIs). However, many of the 350 million people worldwide thought to be affected with depression do not respond to SSRI treatment.
Now, researchers in the Department of Neuroscience and Cell Biology at Osaka University have found that an activator of the serotonin type 3 receptor (5HT3R) produces antidepressant effects in mice and increases nerve cell growth in the part of the brain responsible for memory and spatial navigation (the hippocampus). They also showed that it functions using a different mechanism than the commonly used SSRI fluoxetine, and therefore may be suitable for patients with depression who do not respond favorably to current medication.
When they work, antidepressant medications may take weeks or months to alleviate symptoms of depression. Progress in developing new and more effective antidepressant treatments has been limited, though a new study published in Biological Psychiatry offers new insights into how antidepressants work.
Using a mouse model of depression, researchers found that a therapeutic response to antidepressant medication may stem from changes in gene expression that induce resilience and reverse vulnerability to exhibiting depression-like responses to stress. The study, led by Dr. Eric Nestler of the Icahn School of Medicine at Mount Sinai in New York, teases apart the mechanisms of two different antidepressant drugs- the conventional tricyclic antidepressant imipramine and fast-acting ketamine.
Despite the fact that more than four percent of the world’s population suffer from depression, and even though approximately 1,500 individuals commit suicide each year in Sweden, the understanding of the pathophysiology of depression remains unclear and only a few new discoveries of mechanisms behind it have been made in recent years. New approved pharmacological interventions are mainly absent, despite intensive research on the subject.
Researchers at Karolinska Institutet have characterized the role of the enzyme CYP2C19 in depression and functional and morphological changes in the brain. The enzyme is responsible for the metabolism of many neuroactive compounds, including antidepressants, and is located in the fetal brain and adult liver.
SSRI antidepressants (Selective Serotonin Reuptake Inhibitors, the best known being Prozactm) are amongst the most commonly taken medicines. However, there seems to be no way of knowing in advance whether or not SSRIs will work effectively. Now a group of European researchers has developed a new theory of SSRI action, and tested it in stressed mice. The results, which are presented at the ECNP conference in Vienna, show why the circumstances we find ourselves in may influence whether an antidepressant works or not.
According to researcher, Silvia Poggini (Istituto Superiore di Sanità, Rome), “There is no doubt that antidepressants work for many people, but for between 30 and 50% of depressed people, antidepressants don’t work. No-one knows why. This work may explain part of the reason.”
Psychiatrists nearly always responded with prescriptions for antidepressants when clients complained of bad marriages, according to a new study spanning 20 years at a Midwestern medical center.
The assumption that people struggling with their marriages or other domestic issues are suffering from depression is not supported by the way depression is defined medically, said Jonathan M. Metzl, Frederick B. Rentschler II Professor of Sociology and Medicine, Health and Society at Vanderbilt and the study’s lead author. The study, conducted using a Midwestern medical center’s records from 1980 to 2000, appears in the current issue of the Yale Journal of Biology and Medicine
Notably, Metzl said, the time period of analysis followed a 1974 decision that removed the term “homosexuality” from the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard reference book of psychiatric illnesses.
In a study appearing in the June 28 issue of JAMA, Christiane E. Angermann, M.D., of University Hospital Wurzburg, Germany, and colleagues examined whether 24 months of treatment with the antidepressant escitalopram would improve mortality, illness, and mood in patients with chronic heart failure and depression.
Previous meta-analysis indicates that depression prevalence in patients with heart failure is 10 percent to 40 percent, depending on disease severity. Depression has been shown to be an independent predictor of mortality and rehospitalization in patients with heart failure, with incidence rates increasing in parallel with depression severity. Long-term efficacy and safety of selective serotonin reuptake inhibitors (SSRIs), which are widely used to treat depression, is unknown for patients with heart failure and depression.
Women with severe depressive symptoms have a decreased chance of becoming pregnant, while the use of psychotropic medications does not appear to harm fertility, a study by researchers from the Boston University Schools of Public Health and Medicine shows.
The study, published in the American Journal of Obstetrics and Gynecology, found a 38 percent decrease in the average probability of conception in a given menstrual cycle among women who reported severe depressive symptoms, compared to those with no or low symptoms. The results were similar, regardless of whether the women were on psychotropic medications.
Despite associations in prior studies between infertility and the use of antidepressants, antipsychotics or mood stabilizers among already infertile women, “current use of psychotropic medications did not appear to harm the probability of conception,” said lead author Yael Nillni, an assistant professor of psychiatry at the School of Medicine and a researcher with the National Center for PTSD, Women’s Health Sciences Division of the VA Boston Healthcare System. “Our findings suggest that moderate to severe depressive symptoms, regardless of current psychotropic medication treatment, may delay conception.”
A study to be published in the May 2016 issue of the Journal of the American Academy of Child and Adolescent Psychiatry(JAACAP) reports that use of certain antidepressants during pregnancy can result in offspring depression by early adolescence.
Using national register data from Finland, researchers found that children exposed to selective serotonin reuptake inhibitors (SSRIs) during gestation had more chance of being diagnosed with depression after age 12, reaching a cumulative incidence of 8.2% by age 15. For children exposed to maternal psychiatric illness but no antidepressants, the incidence was 1.9%. Rates of anxiety, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) diagnoses did not differ significantly between the two groups. Comparing SSRI-exposed children to children of mothers with neither antidepressant use nor psychiatric diagnosis, researchers found the rates were significantly elevated for each outcome.
Animal studies already demonstrated that exposure to SSRIs during early brain development can result in depression-like behavior in adolescence; this is the first study that follows children beyond childhood to monitor the development of depressive disorders, which typically emerge after puberty has started. The increasing rate of SSRI prescriptions to pregnant women since their introduction 30 years ago makes the study of affected children particularly urgent. Today 6% of pregnant women in the US and 4% in Finland are on SSRIs at some stage of pregnancy.