Study Finds No Link To Autism, ADHD In Offspring From Antidepressant Use In Pregnancy

MedicalResearch.com Interview with:

Simone Vigod, MD, MSc, FRCPC Psychiatrist and Lead, Reproductive Life Stages Program Women’s Mental Health Program Women’s College Hospital Toronto, ON

Dr. Vigod

Simone Vigod, MD, MSc, FRCPC
Psychiatrist and Lead, Reproductive Life Stages Program
Women’s Mental Health Program
Women’s College Hospital
Toronto, ON

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Depression is one of the most common problems that can complicate a pregnancy. Untreated, or incompletely treated, it can be associated with significant harm to mother and child. While psychotherapies alone may be effective for women with mild (or even moderate) severity symptoms, sometimes antidepressant medication is required. In these cases, the benefits of treatment must be weighed against potential risks. Previous research suggested that there may be an increased risk for autism in children exposed to antidepressant medication during pregnancy. However, previous studies were limited in their ability to account for other potential causes of autism in their analyses. In our study, we used several different strategies to try to compare children whose pregnancy exposures were very similar, except for exposure to an antidepressant.

The main finding was that after using these strategies, there was no longer a statistically significant association between in-utero antidepressant exposure and autism.

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Review of Risk for Autism Spectrum Disorders According to Period of Prenatal Antidepressant Exposure:

MedicalResearch.com Interview with:
Florence Gressier MD PhD

Insermk Department of psychiatry
CHU de Bicêtrem Le Kremlin Bicêtre
France

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Results from recent studies have suggested an increased risk for Autism Spectrum Disorders (ASDs) in children exposed to antidepressants in utero.

We performed a systematic review of and a meta-analysis of published studies to assess the association between ASDs and fetal exposure to antidepressants during pregnancy for each trimester of pregnancy and preconception.

Our systematic review and meta-analysis suggests a significant association between increased ASD risk and maternal use of antidepressants during pregnancy; however, it appears to be more consistent during the preconception period than during each trimester. In addition, the association was weaker when controlled for past maternal mental illness. Maternal psychiatric disorders in treatment before pregnancy rather than antenatal exposure to antidepressants could have a major role in the risk for Autism Spectrum Disorders.

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Rare Gene Variant Linked To Depressive Symptoms

MedicalResearch.com Interview with:
Najaf Amin, PhD
Erasmus University Medical Center
Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Identifying genetic risk factors for depression has not been easy. Over a decade of genetic research did not yield a single replicable genetic factor for depression. It was only recently that 15 common genetic variants mostly in the non-coding parts of the genome were identified through a large genome-wide association study performed by 23andMe. All of these variants add a very small risk to depression individually (odds ratio < 1.05). These common variants cannot explain the cases that have a family history of depression.

Our hypothesis is that such familial cases are enriched for variants that are rare, lie in the coding region of the genome and thus have a large effect on depression. Such variants are enriched in families and isolated populations and therefore have a higher chance of being discovered compared to more cosmopolitan populations. Through gene-based analysis of rare coding variants we have identified a novel gene NKPD1 that may be relevant for depression. Further, we have noticed that the more deleterious the effect of the variant is on the protein, the larger the effect is on depressive symptoms.

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Vagus Nerve Stimulation Improved Treatment-Resistant Depression

MedicalResearch.com Interview with:

Scott T. Aaronson, M.D Psychiatrist, The Retreat at Sheppard Pratt Director of Clinical Research Sheppard Pratt Health System Baltimore, MD

Dr. Aaronson

Scott T. Aaronson, M.D
Psychiatrist, The Retreat at Sheppard Pratt
Director of Clinical Research
Sheppard Pratt Health System
Baltimore, MD

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study is the largest ever conducted on patients with severe, chronic depression, a group typically ignored by clinical research in psychiatry. We looked at individuals who, on average, had received 8 unsuccessful treatment interventions in the past. These individuals were split into two groups and examined over five years. One group was given proven anti-depressant treatments (medications, psychotherapy, and/or electroconvulsive therapy (ECT)), and one group was given both anti-depressant treatments and VNS Therapy—an implantable, pacemaker-like device that stimulates the vagus nerve, which regulates mood in the brain.
• The study found that 67.9% of the VNS therapy group responded to treatment, compared to 40.9% of patients receiving treatment as usual. Importantly, the VNS therapy group reported responses earlier in treatment, and responses were sustained longer than those receiving treatment as usual.
• VNS therapy improved treatment effect in individuals whether they had unipolar or bipolar disorder, and whether or not they had responded to ECT in the past.

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Effect of SSRIs and Depression On Revisions After Hip or Knee Replacement

MedicalResearch.com Interview with:

Hilal Maradit Kremers, M.D. M.Sc.   Associate Professor of Epidemiology Mayo Clinic College of Medicine

Dr. Hilal Maradit Kremers

Hilal Maradit Kremers, M.D. M.Sc. 
Associate Professor of Epidemiology
Mayo Clinic College of Medicine 

MedicalResearch.com: What is the background for this study?

Response: Depression and mood disorders are common comorbidities in patients undergoing total hip and total knee arthroplasty.  Based on previous research, there is evidence to suggest presence of depression in arthroplasty patients is associated with worse functional and clinical outcomes, such as complications, readmissions and mortality.  Although the mechanisms are poorly understood, it is important to identify strategies to effectively manage perioperative depression in an effort to improve arthroplasty outcomes.  One potential strategy is effective medical treatment of underlying depression which can potentially improve depression symptoms, thereby surgical outcomes.

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Antidepressants Have Variable Effects On Symptom Clusters

MedicalResearch.com Interview with:

Adam Chekroud PhD Candidate Human Neuroscience Lab

Adam Chekroud

Adam Chekroud
PhD Candidate
Human Neuroscience Lab
Department of Psychology
Yale University

MedicalResearch.com: What is the background for this study?

Response: We know that depression includes a wide range of symptoms, from low mood and feeling worthless, to problems sleeping, slowed thinking, and suicidal ideation.

We wanted to know whether antidepressants work well in treating all of these symptoms, or whether they are primarily effective on certain kinds of symptoms.

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Self-Guided Internet Based Cognitive Behavioral Therapy Shows Promise For Depression

MedicalResearch.com Interview with:
Eirini Karyotaki, MSc

Department of Clinical Psychology and EMGO Institute for Health and Care Research
Vrije Universiteit Amsterdam
Amsterdam, the Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Depression is broadly acknowledged as a major health issue associated with a great risk of mortality and morbidity. Nevertheless, help-seeking rates are low among individuals with depression. Some of the barriers that impede help seeking are the limited availability of trained clinicians, the fear of stigmatisation and the cost of treatment. Self-guided Internet based Cognitive behavioural therapy (iCBT) has the potential to overcome many of these treatment barriers. However, recent randomised controlled trials (RCTs) have produced mixed evidence regarding the effects of self-guided iCBT in treating adults with depressive symptoms.

To gain more insight in the effectiveness of self-guided iCBT, an Individual Participant Data meta-analysis was performed. 3876 individual participant data across 13 RCTs were collected and analysed.

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Paternal Depression Linked To Not Being in Relationship With Mother

MedicalResearch.com Interview with:
Lisa Underwood, PhD
Research Fellow| Centre for Longitudinal Research
Growing Up in New Zealand | Who are Today’s Dads?
School of Population Health, Faculty of Medical & Health Sciences
University of Auckland  Auckland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study is part of the contemporary, longitudinal study Growing Up in New Zealand, which is tracking the development of more than 6000 children born in 2009 and 2010.

In previous reports we investigated antenatal and postnatal depression symptoms among the mothers of our cohort children. In this study we looked at the partners of those mothers to explore whether men and women have different risks for depression in each perinatal period.

Our main findings were that expectant fathers were at risk if they felt stressed or were in poor health. Elevated depression symptoms following their child’s birth, were also linked to social and relationship problems.

The strongest predictor of postnatal paternal depression was no longer being in a relationship with the child’s mother.

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Disorder-Specific vs Nonspecific Psychotherapy for Chronic Depression

MedicalResearch.com Interview with:

Prof. Dr. phil. Elisabeth Schramm Klinik für Psychiatrie und Psychotherapie

Dr. Elisabeth Schramm

Prof. Dr. phil. Elisabeth Schramm
Klinik für Psychiatrie und Psychotherapie

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Chronic depression is a highly prevalent and disabling disorder. As compared to acute episodically depressed patients, chronic depressives benefit less from psychological and pharmaceutical treatment.

Prior investigations suggest that these patients need longer treatment duration for symptom improvement.

In this randomized clinical trial including 268 adults with early onset chronic depression not taking antidepressant medication, patients treated with a disorder-specific psychological treatment (Cognitive Behavioral Analysis System of Psychotherapy; CBASP) reported significantly less severe depressive symptoms after 20 and 48 weeks as compared to a nonspecific supportive therapy. CBASP patients were also more likely to reach remission and showed significant advantages in global functioning and quality of life.

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Physically Active Children May Have Reduced Symptoms of Depression

MedicalResearch.com Interview with:
Lars Wichstrøm, PhD
NTNU Social Reseach, Trondheim, Norway; and
Department of Psychology
Norwegian University of Science and Technology
Trondheim, Norway

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous research has linked physical activity, and particularly moderate to vigorous physical activity to less depression in adolescents and adults, but the potential prospective relationship between physical activity and depression in middle childhood has not yet been identified.

The main findings in this study support existing research by showing that physically active children have fewer symptoms of depression two years later compared to less physically active children, but there is no relationship between sedentary behavior and depressive symptoms in middle childhood.

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Oxytocin During Labor Linked to Increased Risk of Postpartum Depression

MedicalResearch.com Interview with:

Kristina M. Deligiannidis, MD Associate Professor, Center for Psychiatric Neuroscience The Feinstein Institute for Medical Research Director, Women’s Behavioral Health, Zucker Hillside Hospital Northwell Health Associate Professor, Psychiatry and Obstetrics & Gynecology Hofstra Northwell School of Medicine

Dr. Kristina Deligiannidis

Kristina M. Deligiannidis, MD
Associate Professor
Center for Psychiatric Neuroscience
The Feinstein Institute for Medical Research
Director, Women’s Behavioral Health
Zucker Hillside Hospital Northwell Health
Associate Professor
Psychiatry and Obstetrics & Gynecology
Hofstra Northwell School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Because of effects on social behavior, including maternal behavior, oxytocin has often been seen as a potential mediator of postpartum depression and anxiety.

The original objective of our study was to examine the relationship between the use of synthetic oxytocin during and after labor and the development of depressive and anxiety disorders within the first year postpartum. We hypothesized that women exposed to synthetic oxytocin before or during labor would have a reduced risk of postpartum depressive and anxiety disorders compared with those without any exposure. Our findings told the opposite story.

We found that peripartum synthetic oxytocin exposure was associated with an increase in risk for the development of postpartum depression and anxiety.

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Link Between Antidepressants During Pregnancy and Birth Defects

MedicalResearch.com Interview with:
Anick Bérard PhD FISPE

Research chair FRQ-S on Medications and Pregnancy and
Director, Réseau Québécois de recherche sur le médicament (RQRM)
and Professor, Research Chair on Medications, Pregnancy and Lactation
Faculty of Pharmacy University of Montreal and
Director, Research Unit on Medications and Pregnancy
Research Center CHU Ste-Justine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have over 20 years of research showing that antidepressant use during the first trimester of pregnancy increases the risk of major congenital malformations. However, it still remains that controversies exist because we are not sure which of this increased risk is due to maternal depression. Therefore, we have only studied depressed pregnant women – some of them did not take antidepressant during pregnancy.

We were able to show that among depressed pregnant women, those who took antidepressants were at increased risk of having children with malformations – especially those taking citalopram. We were also able to show that many SSRIs, SNRI and tricyclic antidepressants put women at increased risk of having children with various malformations due to their similar mechanism of action (serotonin inhibition in utero).

MedicalResearch.com: What should readers take away from your report?

Response: Depression is a serious condition that requires medical attention during pregnancy. However, given that up to 85% of depressed pregnant women have mild to moderate depression – other treatment (other than antidepressants) options need to be considered. If a woman finds out she is pregnant and is taking antidepressants however, no abrupt discontinuation is suggested and a discussion with a health care provider is advised.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Very few data on the benefits of antidepressant use during pregnancy is available within depressed pregnant women with mild to moderate depression. Our study results taken together with all the body of literature on this topic should lead to other research on the benefits and risks of other forms of treatment for depression such as psychotherapy.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Anick Bérard, Jinping Zhao and Odile Sheehy. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: An updated analysis of the Quebec Pregnancy Cohort. BMJ Open, January 2017 DOI: 10.1136/bmjopen-2016-01337

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