Helena Bradford, chairwoman of the Ruth Rhoden Craven Foundation for Postpartum Depression Awareness, sent me the following information on the results of a study entitled "Women's Views of Antidepressants in the Treatment of Postnatal Depression."
An abstract of the study, which was conducted at the Faculty of Health and Sciences at Staffordshire University in Britain, stated that:
Little research has been carried out on the treatment of postnatal depression [which we call postpartum depression here in the U.S.] and clinicians must currently rely on general recommendations for the use of antidepressants. Antidepressant medication as the main treatment for depression in general practice has been shown to be effective when used as prescribed. However, research has shown that depressed patients consistently receive either no medication or consistently low doses of medication. This study investigated women's experiences of taking antidepressant medication for postnatal depression. Thirty-five women with a clinical diagnosis of postnatal depression who had been prescribed antidepressant medication completed a questionnaire detailing their experiences of taking medication … Of the 35 women who were prescribed medication, four chose not to take it because they were breastfeeding. Twenty of the women described finding medication helpful. Although only four women directly reported not taking antidepressants as prescribed, the comments made by a further nine women suggest that compliance may have been poor. This study suggests a need to improve information about medication for postnatal depression. If this information is not provided, women are likely to continue to self-manage medication at a dosage that may be clinically ineffective.
Helena says that her experience has been that most physicians unfamiliar with treating postpartum depression fall into the same trap as described in the last sentence of the report, undertreating the illness. "My prayer," she said, "is that better information surrounding the safety of SSRI's used during pregnancy and lactation will be forthcoming — and quickly." I second that.
From the PSI mailing list:
Click here: Antidepressants in pregnancy may pose risks http://www.post-gazette.com/pg/05138/506074.stm
With this topic more widely in the news PRC of NY asked Shari Lusskin, MD for her comments.
The article in JAMA reviews published studies on neonatal complications in babies exposed to antidepressants during the third trimester of pregnancy.
Most of these studies have significant limitations, primarily not controlling for the severity of maternal mental illness, or for the use of illicit substances. The complications reported are, for the most part,
transient and mild, requiring no treatment.Fortunately, the majority ofexposed babies are symptom-free. The authors' recommendation to lower the dose of medications in the third trimester is based on limited data, and fails to take into consideration the fact that many patients require a dosage increase in the third trimester, and that the immediate postpartum
period is a time of increased risk for relapse. The risks of untreated or under-treated maternal mental illness during pregnancy and postpartum are
significant. The decision to use medications must be based on a careful analysis of the risks and benefits for the individual patient.
Shari I. Lusskin, MD
Director of Reproductive Psychiatry
Clin. Asst. Prof. of Psychiatry and Ob/Gyn
New York University School of Medicine
Office:
155 E. 29th Street, Suite 26J
New York, NY 10016
USA
Tel: 212-779-3660
Fax: 212-696-9411
Website: http://www.med.nyu.edu/clinician/lussks01.html
Email: shari.lusskin@med.nyu.edu