A new Dutch study finds that the maternal use of antidepressants during pregnancy appears to increase the risk of the child developing a mental health issue. Risk increased for conditions such as autism, depression, anxiety, and attention deficit hyperactivity disorder (ADHD).
However, investigators are uncertain as to the role of hereditary as part of the elevated risk. Moreover, untreated severe depression during pregnancy can lead to negative outcomes for both the mother and child.
Experts acknowledge that the use of antidepressants among pregnant women has been on the rise for many years. Currently, between two and eight percent of pregnant women are on antidepressants.
In the new study, 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.
“When we look at children born to mothers who discontinued and continued antidepressant treatment during pregnancy, we can see an increased risk of developing a psychiatric disorder if the mothers continued antidepressant treatment while pregnant,” says Xiaoqin Liu.
Liu is the lead author of the article, which appears in the BMJ-British Medical Journal.
Researchers divided the children into four groups depending on the mother’s use of antidepressants before and during pregnancy.
The children in group one had not been exposed to antidepressants in the womb. In group two, the mothers had been taking antidepressants up until the pregnancy, but not during. In group three, the mothers were using antidepressants both before and during the pregnancy. Group four consisted of children, whose mothers were new users of antidepressants and had started taking the medication during the pregnancy.
The result of the study showed an increased number of children with psychiatric disorders in the group in which the mothers had been using antidepressants during their pregnancy.
Approximately twice as many children were diagnosed with a psychiatric disorder in group four (14.5 percent) than in group one (eight percent). In groups two and three respectively, 11.5 percent and 13.6 percent were diagnosed with a psychiatric disorder at age 16 years.
Despite the apparent medication link, researchers are quick to note that psychiatric disorders are hereditary.
Therefore, the investigators took into account that heritability also plays a part in determining who will be diagnosed with a psychiatric disorder, and that it is not just a question of being exposed to antidepressants in the womb.
“We chose to conduct the study on the assumption that psychiatric disorders are highly heritable. For this reason, we wanted to show that is too narrow if you only look at autism, which is what many previous studies have done.
If heritability plays a part, other psychiatric disorders such as depression, anxiety, ADHD-like symptoms would also appear in the data,” says Trine Munk-Olsen, who is also one of the researchers behind the study.
Indeed, the study also shows that the increase covers not only autism but also other psychiatric disorders such as depression, anxiety, and ADHD.
Thus it becomes clear that the mother’s underlying psychiatric disorder matters in relation to the child’s mental health later in life. At the same time, it cannot be ruled out that the use of antidepressants further increases the risk of psychiatric diseases in the child.
“Our research shows that medication seems to increase the risk, but that heritability also plays a part,” says Trine Munk-Olsen, who also points out that it might be the mothers who suffer from the most severe forms of depression who need to take medication during their pregnancy.
The findings are murky. Indeed, the researchers hope the study can increase the focus on the fact that the research results are not just black and white.
This could help doctors advise women on the use of antidepressants both before and after their pregnancy. Some women might be able to discontinue treatment with the medication while pregnant.
However, the researchers also acknowledge that some women need medication and stress that the consequences of an untreated depression are severe and can lead to serious consequences to both mother and child.
The most important message is that we ensure and safeguard the mental well-being of the pregnant women, and for some women, this involves the use of antidepressants.
“These women should not feel guilty about taking antidepressants. Even though there is an increased risk of the child developing a psychiatric disorder later in life, our research shows that we cannot blame medication alone. Heritability also plays a part,” says Trine Munk-Olsen.
Source: Aarhus University
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A new study suggests some of the most effective medications for chronic pain are the same medications that are used for depression.
At doses lower than those needed to treat depression, antidepressants can relieve chronic pain in conditions ranging from diabetic neuropathy, migraine and tension headaches, to osteoarthritis and fibromyalgia.
Experts explain, however, that most medications have significant associated side-effects and the ability to tolerate these side effects varies between individuals.
Side effects may depend on other medications an individual is using, or could be influenced by other existing health issues. Therefore, predicting the ability to tolerate such side effects could be crucial for the success of an antidepressant in treating pain.
This scenario is discussed in a recent article by Dr. Carina Riediger and colleagues in Dr. Timo Siepmann’s group at the University Hospital Carl Gustav Carus, in Dresden, Germany. The paper appears in the online journal Frontiers in Neuroscience.
“Understanding adverse effects and their impact on patients’ quality of life is crucial in modern clinical medicine and poses a substantial challenge to clinicians who face a exponentially growing range of available medical therapies” said Siepmann, the principal investigator of this study.
To help physicians match a chronic pain sufferer to a suitable antidepressant, their group performed a systematic study and meta analysis of the reported adverse effects for a wide variety of commonly used antidepressant drugs, each with its own side effect profile.
These antidepressants fall into different categories based on their mechanism of action, such as tricyclic antidepressants amitriptyline (Elavil) and nortriptyline (Pamelor), and serotonin reuptake inhibitors venlafaxine (Effexor), duloxetine (Cymbalta) and milnacipram (Ixel), among others.
The study collected all reported adverse effects for these drugs in the clinical literature from the past two decades. These side effects ranged from dizziness, dry mouth, and drowsiness, to palpitations, weight gain, sexual and urinary dysfunction, and hypertension, to name a few. The researchers also took into account whether treatment was discontinued due to the severity of these side effects.
Researachers found that almost all antidepressants presented significant side effects, and no drug was clearly superior to others. However, clinical data also showed that some individuals might better tolerate certain side effects than others, and therefore, the authors recommend personalized medicine.
For instance, dizziness and drowsiness as side effects may not be acceptable for individuals who drive vehicles or operate heavy machinery. On the other hand, some sedation might be tolerated, and perhaps even be desirable, in a chronic pain patient with sleep disruptions or insomnia.
These results may help physicians improve treatment outcomes by better matching the health status of chronic pain patients to their antidepressant medication.
“Dr. Riediger’s work contributes to this understanding, but further research is needed to improve general treatment recommendations and enable personalized multimodal therapy which is tailored to the patient’s individual health situation and includes non-pharmacological strategies in addition to pharmacotherapy,” Siepmann said.
Emerging research suggests children are at a greater risk of sleeping poorly if their mothers suffer from insomnia symptoms.
Experts say attention to sleep challenges is an important health issue as sleep plays an essential role for adults’ and children’s well-being.
In the study, investigators from the University of Basel and the University of Warwick assessed sleep characteristics among nearly 200 school-aged children and their parents.
Researchers focused on the relationship between parents’ insomnia symptoms and their children’s sleep. Short sleep and poor sleep quality may affect mental health, learning, memory, and school achievement in children. In Switzerland and America, around 28 percent of adult women and 20 percent of men suffer from disturbed sleep.
Sleep was measured in healthy 7-12-years old children by in-home electroencephalography (EEG); around half of the children were born pre-term. In addition, parents reported their own insomnia symptoms and their children’s sleep problems.
As reported in the journal Sleep Medicine, researchers discovered children of mothers with insomnia symptoms fall asleep later, get less sleep, and spend less time in deep sleep as measured by EEG. However, there was no association between the fathers’ sleep problems.
It is possible that mothers’ sleep is more closely related to children’s sleep than fathers’ sleep. Researchers posit that this may occur because mothers on average still spend more time with their children than fathers. Therefore, the mother’s sleeping behavior has a stronger influence on the child.
When parents reported their children’s sleep, both mothers and fathers with sleep problems more often reported that their children had difficulties getting into bed and did not sleep enough.
Investigators note that several mechanisms could account for the relationship between parents’ and children’s sleep:
Source: University of Basel
Swedish researchers find that a growing number of middle-aged adults between the ages of 50 and 60 appear to be seeking help for memory-related problems — often concerned they are in the beginning stages of dementia — but after testing, they are found to be quite normal.
“We are seeing a growing number of people who are seeking help because of self-perceived cognitive problems, but have no objective signs of disease despite thorough investigation,” said Marie Eckerström, doctoral student at the Institute of Neuroscience and Physiology and licensed psychologist at the Memory Unit of Sahlgrenska University Hospital in Gothenburg.
These patients represent one-third of those coming to the memory unit at the hospital, and clinicians wanted to get an idea of who they are. The memory unit investigates suspicions of early stages of dementia in those who seek help.
For her study, Eckerström followed a few hundred of these patients, both women and men, for an average of four years.
These patients are often highly educated professionals who are relatively young in this context, between the ages of 50 and 60. When tested at the hospital, their memory functions are intact. However, in their daily environment where they are often under pressure to learn new things, they believe something is not right.
The link between self-perceived memory problems and stress was shown to be quite strong. Seven out of 10 in the group had experiences of severe stress, clinical burnout, or depression.
“We found that problems with stress were very common. Patients often tell us they are living or have lived with severe stress for a prolonged period of time and this has affected their cognitive functions to such an extent that they feel like they are sick and are worried about it,” said Eckerström.
“In some cases, this is combined with a close family member with dementia, giving the patient more knowledge but also increasing their concern.”
Perceived memory problems are common and may be an early sign of future development of dementia. Among the study participants who also had deviating biomarkers in their cerebrospinal fluid (beta-amyloid, total-tau, and phospho-tau), the risk of deteriorating and developing dementia was more than double. And yet, the majority of participants showed no signs of deterioration after four years.
“These individuals have no objective signs of dementia. The issue instead is usually stress, anxiety, or depression,” Eckerström said.
Only one in 10 patients with self-perceived memory problems only developed dementia during the study period. And while this is a higher percentage than the population in general, it is still low, according to Eckerström.
“It is not a matter of just anyone who has occasional memory problems in everyday life. It is more a matter of individuals who sought medical attention to investigate whether they are developing serious problems,” said Eckerström.
Source: University of Gothenburg
“Doctors urge me to take my meds. When I don’t, they become agitated. I take their meds to calm them down.” – Brian Spellman Up until…
Children who are suspended from school are more likely to develop a range of mental disorders, such as depression and anxiety as well as behavioral disturbances, according to a new study published in the journal Psychological Medicine.
Researchers at the University of Exeter in England investigated the impact of exclusion from school among the general population and found that suspension may lead to a new onset mental disorder, and that, separately, poor mental health can lead to suspension from school.
The findings show that consistently poor behavior in the classroom is the primary reason for school exclusion, with many students, particularly those in middle and high school, facing repeated dismissal from school. Relatively few pupils are completely expelled from school, but the researchers warn that even temporary exclusions can exacerbate psychological distress.
The researchers assert that identifying and supporting children who struggle in class could prevent suspension and improve their success at school.
“For children who really struggle at school, exclusion can be a relief as it removes then from an unbearable situation with the result that on their return to school they will behave even more badly to escape again,” said Professor Tamsin Ford, a child and adolescent psychiatrist at the University of Exeter’s Medical School.
“As such, it becomes an entirely counterproductive disciplinary tool as for these children it encourages the very behavior that it intends to punish. By avoiding exclusion and finding other solutions to poor behavior, schools can help children’s mental health in the future as well as their education.”
Suspension is more common among boys, secondary school students and those living in socio-economically deprived circumstances. Poor general health and learning disabilities, as well as having parents with mental illness, is also associated with suspension.
The study involved analyzing the responses of more than 5000 school-aged children, their parents and their teachers in the British Child and Adolescent Mental Health Surveys. The research team omitted children who had a previous mental disorder from this analysis.
The findings show that children with learning difficulties and mental health problems such as depression, anxiety, ADHD, and autism spectrum conditions were more likely to be excluded from the classroom. In addition, during the follow-up, the researchers found more children with mental disorders among those who had been excluded from school, than those who had not been excluded.
The researchers conclude that there is a “bi-directional association” between psychological distress and suspension: Children with psychological distress and mental-health problems are more likely to be suspended in the first place but suspension predicted greater levels of psychological distress three years later.
“Although an exclusion from school may only last for a day or two, the impact and repercussions for the child and parents are much wider. Exclusion often marks a turning point during an ongoing difficult time for the child, parent and those trying to support the child in school,” said Claire Parker, a researcher at the University of Exeter Medical School, who carried out doctoral research on the project.
Source: University of Exeter
A new study from Brazil compares the benefit of medicinal therapy against low-intensity electrical brain stimulation for relief of depression.
Specifically, investigators attempted to determine if transcranial direct-current stimulation (tDCS) is a comparable alternative to treatment with antidepressant drugs.
In the clinical trial, researchers at the University of São Paulo’s teaching hospital (HU-USP) and the Psychiatry Institute of Hospital das Clínicas (HC-FMUSP-IP), the largest general hospital in Brazil, compared tDCS to escitalopram (Lexapro), a common antidepressant medication.
André Brunoni, a professor in the Psychiatry Department of the University of São Paulo’s Medical School and colleagues randomly divided 245 patients with depression into three groups.
One group was treated with tDCS plus oral placebo, the second received sham tDCS treatment plus the anti-depressant, and the third received sham tDCS treatment plus oral placebo.
The tDCS treatment was administered in 30-minute sessions for 15 consecutive weekdays, followed by seven once-weekly sessions. Escitalopram was administered at a dose of 10 mg per day for three weeks and 20 mg per day for another seven weeks.
tDCS treatment involves transmission of very mild direct current stimulation via a headband with twin electrodes placed on the patient’s temples. Positioning the electrodes is important so that the current runs through the dorsolateral prefrontal cortex – a brain area that displays diminished activity in depressed people.
In the trial, researchers found that tDCS treatment was less beneficial that oral medications.
“We found that treatment with tDCS was not half as effective as treatment with escitalopram and concluded that transcranial stimulation cannot be recommended as first-line therapy. The anti-depressant is easier to administer and much more effective. On the other hand, tDCS performed better than placebo in our previous studies,” explains Brunoni.
The discovery is important as about 12 -14 percent of the world’s population is estimated to suffer from depression. Moreover, given the ubiquity of the internet it is relatively easy to find self-help websites with videos showing how to administer tDCS at home.
“It’s very striking,” Brunoni said. “These sites that claim to show how to stimulate your brain represent a huge risk for patients with depression.
“‘Do-it-yourself’ solutions are strongly contra-indicated. In fact, they’re dangerous. I expect our study to have an impact on this phenomenon because we’ve proved there are adverse side effects and that it’s not as effective as many people think.”
According to the study, patients who received tDCS treatment presented with higher rates of skin redness, tinnitus (ringing in the ears) and nervousness than the other two groups, and new-onset mania developed in two patients in this group.
Brunoni stressed the importance of not confusing tDCS with other methods such as electroconvulsive therapy (ECT). ECT involves a far stronger current — typically 800 milliamperes, or 800 times the current used in tDCS — and is designed to produce a controlled seizure.
Other differences include the fact that ECT delivers a brief pulse rather than a steady current.
“People with depression display cerebral hypoactivity, especially in this brain region but also in others,” Brunoni said. “The action mechanism of stimulation was believed to increase brain activity in this region, but no such effect has yet been proven.”
Other techniques designed to change the brain’s electrical activity include transcranial magnetic stimulation, transcranial alternating-current stimulation, deep-brain stimulation and focused ultrasound.
“Of these, only transcranial magnetic stimulation and electroconvulsive therapy are currently cleared by the Food and Drug Administration [FDA] for the treatment of depression, and deep-brain stimulation has a humanitarian device exemption for the treatment of obsessive-compulsive disorder,” writes Sarah H. Lisanby, director of the Division of Translational Research at the US National Institute of Mental Health (NIMH), in an editorial in the same issue of the New England Journal of Medicine.
Lisanby believes the study performed in Brazil shows that parameters are needed to measure the functioning of tDCS.
Brunoni agreed. “There are no parameters that enable us to know whether the tDCS dose is right,” he said. “I know two pills are a higher dose than one. Moreover, some drugs can be measured in the bloodstream. The most common example is lithium. You can dose magnetic stimulation. In electrical stimulation, however, it isn’t what you see. It’s a very weak current that can be altered even by anatomical aspects in each patient.”
Brunoni is currently a visiting postdoctoral fellow at the University of Munich in Germany, where he plans to finish analyzing data collected from his clinical trial. He hopes the data will suggest if tDCS works better for a particular patient profile — as some believe those who have never experienced stimulation will show a better response.
He also plans to question the stimulation parameters to discover if a specific type of depression may respond more readily to the treatment.
Study findings appear in the New England Journal of Medicine.
Source: University of São Paulo