Antidepressants and Pregnancy, Bone Loss, Personalized Drugs & Suicide (and Dutch Women & Depression)
Taking an antidepressant like Prozac may increase a pregnant woman’s risk of having a baby with a birth defect, but the chances appear remote and confined to a few rare defects, researchers are reporting today.
The findings, appearing in two studies in The New England Journal of Medicine, support doctors’ assurances that antidepressants are not a major cause of serious physical problems in newborns.
But the studies did not include enough cases to adequately assess risk of many rare defects; nor did they include information on how long women were taking antidepressants or at what doses. The studies did not evaluate behavioral effects either; previous research has found that babies suffer withdrawal effects if they have been exposed to antidepressants in the womb, and that may have implications for later behavior.
In one study, older women who took SSRI antidepressants showed a 60% acceleration in bone loss, compared with women who did not take antidepressants. . . .
The accelerated bone loss was not seen in women who took another type of antidepressant.
The men in the [second] study who took SSRIs had lower bone density in the hip and lower spine than men who took no antidepressants. There were no significant differences between those who took tricyclic antidepressants and men who took no antidepressants.
“That sounds very alarming, but we don’t really know if it is clinically meaningful, and we cannot definitively say that the SSRI use was the reason for the bone loss,” Diem says. “These are preliminary findings which need to be confirmed.”
Because depression itself is associated with an increased risk for bone loss in older people, a better understanding of the impact of antidepressants on bone is urgently needed, he says.
Instead of the hit-or-miss approach . . . it will soon be possible for a psychiatrist to biologically personalize treatments. With a simple blood test, the doctor will be able to characterize a patient’s unique genetic profile, determining what biological type of depression the patient has and which antidepressant is likely to work best.
Data on more than 130,000 new episodes of depression showed that regardless of treatment type, the number of suicide attempts was highest in the month before therapy, next highest in the first of month of therapy, and lowest thereafter, the investigators reported in the July issue of the American Journal of Psychiatry.
“Our study indicates that there’s nothing specific to antidepressant medications that would either make large populations of people with depression start trying to kill themselves-or protect them from suicidal thoughts,” said Dr. Simon.
“Instead,” he said, “we think that, on average, starting any type of treatment-medication, psychotherapy, or both-helps most people of any age have fewer symptoms of depression, including thinking about suicide and attempting it.”
After scores of interviews with historians, psychologists, fashion designers, image-profilers, personal shoppers, magazine editors and ordinary Dutch women, Ellen de Bruin, a Dutch psychologist and journalist, throws down the gauntlet. [S]he argues that women in the Netherlands are a whole lot happier than their counterparts in most parts of the world.
“It has to do with personal freedom,” said de Bruin, whose work, sure enough, is titled “Dutch Women Don’t Get Depressed.” “Personal choice is key: in the Netherlands people are free to choose their life partners, their religion, their sexuality, we are free to use soft drugs here, we can pretty much say anything we like. The Netherlands is a very free country.”[via Kevin, MD]