Author Interviews, JAMA, Mental Health Research, OBGYNE, Pediatrics / 11.04.2018

MedicalResearch.com Interview with: [caption id="attachment_41081" align="alignleft" width="133"]Jiook Cha, PhD Assistant Professor Division of Child and Adolescent Psychiatry  Columbia University Medical Center  New York, NY 10032 Dr. Jiook Cha[/caption] Jiook Cha, PhD Assistant Professor Division of Child and Adolescent Psychiatry Columbia University Medical Center New York, NY 10032 MedicalResearch.com: 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
Author Interviews, JAMA, Mental Health Research, OBGYNE, Pediatrics / 09.04.2018

MedicalResearch.com Interview with: [caption id="attachment_41072" align="alignleft" width="200"]Claudia I. Lugo-Candelas, PhD Postdoctoral Research Fellow Columbia University Medical Center/ New York State Psychiatric Institute Dr. Lugo-Candelas[/caption] Claudia I. Lugo-Candelas, PhD Postdoctoral Research Fellow Columbia University Medical Center/ New York State Psychiatric Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: We have seen, in the last decade, an increase in the amount of mothers being prescribed SSRIs during pregnancy. While we know that untreated prenatal maternal depression has adverse consequences for both the mother and child, it’s not really clear what, if any, are the consequences of prenatal SSRI exposure on infant’s brain development. There have been some studies finding increased depression and anxiety in children prenatally exposed to SSRIs, but not all studies find these associations. We thus looked at 2-4 week old infants’ brains, using neuroimaging.  We found increased gray matter volume within the amygdala and insula, and increased white matter connectivity between these two structures in infants prenatally exposed to SSRIs. Of note, the statistical significance and the size of the effects we detected are quite large, even greater than the brain changes that we usually observe in our studies of children and adults with psychiatric disorders. Further, because these structures are involved in emotion processing, and alterations in volume and connectivity are sometimes seen in clinical populations, or in people at risk for anxiety, it important to learn more about what these volume and connectivity differences could mean for these infants.
Author Interviews, Depression, Mayo Clinic / 15.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32948" align="alignleft" width="180"]Hilal Maradit Kremers, M.D. M.Sc.   Associate Professor of Epidemiology Mayo Clinic College of Medicine Dr. Hilal Maradit Kremers[/caption] 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.
Author Interviews, Depression, JAMA, McGill, Pharmacology, Stroke / 09.12.2016

MedicalResearch.com Interview with: Christel Renoux, MD, PhD Assistant Professor, Dept. of Neurology & Neurosurgery McGill University Centre For Clinical Epidemiology Jewish General Hospital - Lady Davis Research Institute Montreal  Canada MedicalResearch.com: What is the background for this study? Response: Selective serotonin reuptake inhibitors (SSRIs) increase the risk for abnormal bleeding, in particular, gastrointestinal tract bleeding. Previous studies also suggested an increased risk for intracranial hemorrhage (ICH) in patients treated with SSRIs compared to non users. However, even if this risk exists, the comparison with a non-treated group may exaggerate the strength of a potential association and the comparison with a group of patients treated with other antidepressants may help better delineate the risk. The potential bleeding effect of antidepressants is linked to the strength of serotonin inhibition reuptake, and antidepressants that are strong inhibitors of serotonin reuptake have been associated with the risk for gastrointestinal or abnormal bleeding compared with weak inhibitors but the risk of ICH is unclear.
Author Interviews, Depression, OBGYNE, Pediatrics / 02.10.2015

Marte Handal PhD Division of Epidemiology Norwegian Institute of Public Health Oslo, Norway MedicalResearch.com Interview with: Marte Handal PhD Division of Epidemiology Norwegian Institute of Public Health Oslo, Norway  Medical Research: What is the background for this study? Dr. Handal: The prevalence of depression during pregnancy is estimated to be as high as between 7 and 15%. It is well understood that untreated maternal depression may be harmful to both the mother and the child. When medical treatment of pregnant women is necessary, selective serotonin reuptake inhibitors (SSRIs) is the most common treatment. However, limited information is available on the potential effect of prenatal exposure to SSRIs on the child’s motor development. Medical Research: What are the main findings? Dr. Handal: We did find a week association between prolonged maternal use of SSRIs during pregnancy and delayed motor development in the child even after we had taken the mothers history of depression and her symptoms of anxiety and depression during and after pregnancy into account. However, only a few children were in the least developed category, corresponding to clinical motor delay, indicating that clinical importance is limited.
Author Interviews, Depression, JAMA / 23.09.2014

A001_C001_03160QMedicalResearch.com 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.
Author Interviews, Mental Health Research / 07.09.2014

Sean Clouston Ph.D. Assistant Professor Core Faculty, Program in Public Health Department of Preventive Medicine Stony Brook University  Health Sciences Center Stony Brook, NY 11794MedicalResearch.com Interview with: Sean Clouston Ph.D. Assistant Professor Core Faculty, Program in Public Health Department of Preventive Medicine Stony Brook University  Health Sciences Center Stony Brook, NY 11794 Medical Research: What is the background for this study: Dr. Clouston: A number of epidemiological studies have found that suicide rates have decreased rapidly with the widespread distribution of SSRI antidepressants. Our group has found that proliferation of preventive medicine has, with regard to other causes of death, tended to occur unequally. We hypothesized that if SSRI antidepressants prevent suicide by treating depression, then suicide might also be susceptible to such inequality. Our study used mortality data to show that decreases in suicide were concentrated in regions with higher socioeconomic status. Medical Research: What are the main findings of the study? Dr. Clouston We used the best available data from the US and found that socioeconomic inequalities have increased dramatically in conjunction with the proliferation of SSRI antidepressants.
Author Interviews, BMJ, OBGYNE, Pediatrics / 16.01.2014

Sophie Grigoriadis, MD, MA, PhD, FRCPC Head, Women's Mood and Anxiety Clinic:  Reproductive Transitions, Fellowship Director, Sunnybrook Health Sciences Centre, Scientist, Sunnybrook Research Institute Adjunct Scientist, Women's College Research Institute, Associate Professor, Faculty of Medicine, University of TorontoMedicalResearch.com Interview with: Sophie Grigoriadis, MD, MA, PhD, FRCPC Head, Women's Mood and Anxiety Clinic:  Reproductive Transitions, Fellowship Director, Sunnybrook Health Sciences Centre, Scientist, Sunnybrook Research Institute Adjunct Scientist, Women's College Research Institute, Associate Professor, Faculty of Medicine, University of Toronto MedicalResearch.com: What are the main findings of the study? Dr. Grigoriadis: Infants of women exposed to selective serotonin reuptake inhibitors (SSRIs) during late pregnancy (but not early) are at risk for developing persistent pulmonary hypertension of the newborn (PPHN). PPHN is a condition in which blood pressure remains high in the lungs following birth and which results in breathing difficulties.  The symptoms can range from mild to severe, but the condition can be managed successfully typically after SSRI exposure. It is important to note that the baseline risk for PPHN in the general population is low (about 2 per 1,000 live births), and so the increase in risk with SSRIs still represents a low overall risk for developing PPHN following SSRI exposure in late pregnancy (increasing to approximately 5 per 1,000 live births). This increased risk means that 286 to 351 women would have to be treated with an SSRI during late pregnancy in order to result in 1 additional case of PPHN.