Author Interviews, Depression, Pain Research, Psychological Science / 19.06.2019 Interview with: Dr. Markus Rütgen PhD Post-doctoral researcher Social, Cognitive and Affective Neuroscience Unit Faculty of Psychology University of Vienna What is the background for this study? Response: Previous research has reported empathy deficits in patients with major depressive disorder. However, a high percentage of patients taking part in these studies were taking antidepressants, which are known to influence emotion processing. In our study, we wanted to overcome this important limitation. We were interested in whether the previously reported empathic deficits were attributable to the acute state of depression, or to the antidepressant treatment. To this end, we performed a longitudinal neuroimaging study, in which we measured brain activity and self-reported empathy in response to short video clips showing people in pain. We measured acutely depressed patients twice. First, before they started their treatment, second, after three months of treatment with a state-of-the-art antidepressant (selective serotonin reuptake inhibitors). (more…)
Author Interviews, BMJ, Depression, Weight Research / 30.05.2018 Interview with: Dr Rafael Gafoor Research Associate Kings College London What is the background for this study? Response: Obesity and weight gain are global public health problems, with approximately 60% of UK adults currently overweight or obese. Depression is common in people who are severely obese and the rate of antidepressant prescribing is increasing, which could have potential impact on public health. However, little research has been reported on the impact of widespread antidepressant treatment on weight gain. So a UK based research team, led by Rafael Gafoor at King’s College London, set out to investigate the association between the use of antidepressants and weight gain. The researchers analysed body weight and body mass measurement data from the UK Clinical Practice Research Datalink (CPRD) for over 300,000 adults with an average age of 51, whose body mass index (BMI) had been recorded three or more times during GP consultations from 2004-2014. Participants were grouped according to their BMI (from normal weight to severely obese) and whether or not they had been prescribed an antidepressant in a given year. Participants were then monitored for a total of 10 years. (more…)
Author Interviews, JAMA, Mental Health Research, OBGYNE, Pediatrics / 11.04.2018 Interview with: Jiook Cha, PhD Assistant Professor Division of Child and Adolescent Psychiatry Columbia University Medical Center New York, NY 10032 What did we already know about the connection between maternal SSRI use during pregnancy and infant brain development, and how do the current study findings add to our understanding? What’s new/surprising here and why does it matter for mothers and babies? Response: Prior studies have shown mixed results in terms of the associations between maternal SRI use during pregnancy and offspring’s brain and cognitive development. Neurobiological studies with animal models suggest that SSRI use perturbs serotonin signaling and that this has important effects on cognitive development (a study conducted an author of this paper, Jay Gingrich, MD, PhD: Ansorge et al., 2004, Science). The human literature has been more mixed in terms of the associations of prenatal exposure to SSRI with brain and cognitive development. In our study, we used neonatal brain imaging because this is a direct, non-invasive method to test associations between SSRI use and brain development at an early developmental stage, limiting the effects of the post-natal environment. In our study, we had two different control groups, that is, a non-depressed SSRI-free group (healthy controls), and depressed but SSRI-free (SSRI controls) group. Also, in our study we used rigorous imaging analytics that significantly improve the quantitative nature of MR-derived signals from the brain structure using two of the nation’s fastest supercomputers (Argonne National Laboratory and Texas Advanced Computing Center) and allows robust reconstruction of brain’s grey and white matter structure in the infants’ brains. We report a significant association of prenatal exposure to SSRI with a volume increases within many brain areas, including the amygdala and insula cortex, and an increase in white matter connection strength between the amygdala and insular cortex. We were surprised by the magnitude of the effects (or the statistical effect size), compared with other brain imaging studies in psychiatry with children or adults’ brains. Importantly, it should be noted that our estimates of brain structure are still experimental and for research-purpose only. This means that our data need to be replicated and rigorously tested against confounders in order to make a firm conclusion. While our study suggests a “potential” association between prenatal exposure to SSRI and a change in fetal or infant brain development, we still need more research. tracts_in_the_brain (more…)
Author Interviews, Mental Health Research, Pharmacology, Psychological Science / 10.10.2017 Interview with: Vanda Faria PhD Department of Psychology Uppsala, Sweden What is the background for this study? What are the main findings? Response: It has been debated whether selective serotonin reuptake inhibitors (SSRIs), which are commonly prescribed for depression and anxiety, are more effective than placebo. Concerns have been raised that the beneficial effects of SSRIs, as measured in double-blind clinical trials, may be explained by expectancies (a crucial placebo mechanism) rather than the biochemical compound. But no study has tested experimentally the extent to which the SSRI treatment effect can be influenced by expectancies induced by verbal suggestions. We compared the efficacy of overt vs. covert administration of an SSRI (escitalopram) in patients with social anxiety disorder. Rather than comparing the SSRI with placebo, we compared it with itself while manipulating the patients’ expectations of improvement. This was achieved by informing one group correctly about the SSRI and its effectiveness (overt group) whereas the comparison (covert) group received incorrect information. By use of a cover story, the covert group was led to believe they were treated with a so called “active placebo”, an ineffective neurokinin-1 antagonist yielding similar side effects as the SSRI but lacking anxiety-reducing properties. But the treatment, dosage and duration was in fact identical in both groups. Results showed that overt outperformed covert SSRI treatment, as the number of treatment responders was more than three times higher on the main clinical outcome measure when correct information was given. Using neuroimaging (fMRI) we also noted differences between the overt and covert SSRI groups on objective brain activity measures. There were differences between the groups e.g. with regard to activation of the posterior cingulate cortex with treatment, and the functional coupling between this region and the amygdala which is a brain region crucially involved in fear and anxiety. The fMRI results may reflect the interaction between cognition and emotion as the brain changes differently with treatment pending on the expectations of improvement. (more…)
Author Interviews, BMJ, Mental Health Research, OBGYNE, Pharmacology / 10.09.2017 Interview with: Xiaoqin Liu, PhD Department of Economics and Business Economics Aarhus University What is the background for this study? What are the main findings? Response: Previous research on the long-term neurodevelopmental outcomes of serotonin-reuptake inhibitor (SSRI) use during pregnancy has primarily focused on offspring risk of autism spectrum disorder. Given SSRIs cross the placental barrier and affect the fetal brain, in-utero SSRI exposure may increase risks of other psychiatric disorders as well as autism spectrum disorder. We conducted a population-based study to look at a range of diagnostic groups of psychiatric disorders in children whose mothers used antidepressants during pregnancy. This was possible because of the nature of information available in Danish population registers, allowing us to follow children for many years. We found increased risks of various diagnostic groups of psychiatric disorders in children whose mothers continued antidepressant treatment during pregnancy, in comparison to children whose mothers stopped antidepressant treatment before pregnancy. (more…)
Author Interviews, Autism, Depression, JAMA, OBGYNE, Pediatrics / 19.04.2017 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 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. (more…)
AstraZeneca, Author Interviews, Autism, Boehringer Ingelheim, Depression, Eli Lilly, J&J-Janssen, JAMA, Merck, OBGYNE / 17.04.2017 Interview with: Florence Gressier MD PhD Insermk Department of psychiatry CHU de Bicêtrem Le Kremlin Bicêtre France 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. (more…)
Aging, Author Interviews, Depression, Geriatrics, Hip Fractures / 16.01.2017 Interview with: Sanna Torvinen-Kiiskinen MSc (Pharm.), PhD student, Kuopio Research Centre of Geriatric Care and School of Pharmacy University of Eastern Finland What is the background for this study? Response: Antidepressants are widely used among elderly persons, especially persons with Alzheimer’s disease. They are used not only for treatment for major depression, but for treatment of anxiety, insomnia and chronic pain as well as behavioral symptoms caused by dementia. However, antidepressants, as well as other psychotropic drugs, may cause sedation, confusion, orthostatic hypotension and hyponatremia, which increase the risk of falling and fractures. Because of changes in pharmacodynamics and pharmacokinetics due to aging, older persons are at the higher risk of those adverse events. The aim of our study was to investigate whether antidepressant use is associated with an increased risk of hip fracture among community-dwelling persons with and without Alzheimer’s disease. (more…)
Author Interviews, Columbia, Depression, Nature, Orthopedics, Pharmacology / 09.09.2016 Interview with: Patricia Ducy, PhD Associate Professor Department of Pathology & Cell Biology Columbia University New York, NY 10032 What is the background for this study? Response: In the past few years, several large clinical studies have reported an association between the use of selective serotonin reuptake inhibitors (SSRIs) and an increased risk of bone fractures. Yet, a few studies conducted on small cohorts using these drugs for a short time showed a decrease in bone resorption parameters and thus minor bone gain. To understand this paradox and to define how the deleterious effect of SSRIs could be prevented we conducted a series of studies in mice treated with fluoxetine, the active molecule of the widely prescribed SSRI Prozac. (more…)
Author Interviews, Depression, JAMA / 23.09.2014

A001_C001_03160Q Interview with: Dr. Philippe Courtet MD PhD Centre Hospitalier Régional Universitaire de Montpellier, Institut National de la Santé et de la Récherche Médicale , Université Montpellier, Montpellier, France Fondation Fondamental, Créteil, France Medical Research: What are the main findings of the study? Dr. Courtet: Depressed outpatients who are beginning the treatment with a SSRI at higher dose than recommended present an increased risk (x2) of worsening of suicidal ideation during the first 6 weeks of treatment. This is consistent with the study by Miller et al published in the same journal few weeks ago, reporting a double risk of suicide attempt in young subjects (<24 yrs) who are begun an SSRI at higher dose than recommended. Our results showed that the increased suicide risk with the high dose of SSRI is not restricted to youngsters and is independent of the severity of the depression. (more…)
Author Interviews, Depression, Heart Disease, NEJM, OBGYNE / 19.06.2014

Dr. Krista Huybrechts MD PhD Brigham & Women’s Hospital Department of Medicine Division of Pharmacoepidemiology & Pharmacoeconomics Boston, MA 02120 Interview Invitation Dr. Krista Huybrechts MD PhD Brigham & Women’s Hospital Department of Medicine Division of Pharmacoepidemiology & Pharmacoeconomics Boston, MA 02120 MedicalResearch: What are the main findings of the study? Dr. Huybrechts: In this cohort study including 949,504 pregnant women enrolled in Medicaid, we examined whether the use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressants during the first trimester of pregnancy is associated with increased risks for congenital cardiac defects. In order to control for potential confounding by depression and associated factors, we restricted the cohort to women with a depression diagnosis and used propensity score adjustment to control for depression severity and other potential confounders. We found no substantial increased risk of cardiac malformations attributable to SSRIs. Relative risks for any cardiac defect were 1.25 (95%CI, 1.13-1.38) unadjusted, 1.12 (1.00-1.26) depression-restricted, and 1.06 (0.93-1.22) depression-restricted and fully-adjusted. We found no significant associations between the use of paroxetine and right ventricular outflow tract obstruction (1.07, 0.59-1.93), or the use of sertraline and ventricular septal defects (1.04, 0.76-1.41); two potential associations that had been of particular concern based on previous research findings. (more…)