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Post by Admin on Aug 25, 2015 9:48:15 GMT -4
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Post by Jason YH Hsieh on Aug 25, 2015 21:08:37 GMT -4
Birth defects, it can be link to many associations such as family history, genetic, drugs usage, exposures, & etc…. However, it has been shown in various studies, just like the article stated, paroxtine is grouped to Category D as a contra-indication to pregnant women but I haven’t heard much about fluoxetine’s association. I’m sure there are many triggering factors that lead to birth defect including some SSRI. I agree with the article that there is a slight increase chance of birth defect whiles the pregnant women who took SSRI. Matter in fact, the other articles I read from UpToDate, it has stated that SSRI does slightly increase birth defect for those infant whose mom expose to SSRI comparing to whose doesn’t by increasing 0.5% (3.7 vs 3.2 percent). However, some studies have shown there is no association. As to most UpToDate studies, SSRI has been study mostly comparing to other anti-depressant, so it is safe to said SSRI is more safer to use for pregnant women comparing to other anti-depressant.
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Post by Anjani Singh on Aug 26, 2015 1:12:03 GMT -4
The problem is that since psychiatry is so based on pharmacotherapies, birth side effects tend to go unnoticed because medications are prescribed so habitually. I agree that when the article noted in the discussion part that not all pharmacotherapies act the same, even when they are in the same drug category. Paroxetine is different to fluoxetine which is different to sertraline. There has to be a reason why more people are taking sertraline more so than any other SSRI. Some doctors prefer one over the other, but again, the article does not specify how it may affect different people. Pregnant women tend to be more and more careful about what they consume, regarding drugs or anything else now and days, so the fact that 33% thought it was acceptable to take antidepressants makes it apparent that more research needs to be regarding this topic to put more and more warning labels out when it comes to SSRIs. It would be interesting to see if any other antidepressants like Buproprion or others have any associations with birth defects as well.
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Post by Mario F Vigil on Aug 26, 2015 21:39:33 GMT -4
The study provides suitable evidence that link some SSRIs with birth defects. As stated on the research, women treated with paroxetine or fluoxetine early in pregnancy had a 2-3.5-increase risk of having their babies with birth defects. More evidence is needed to help increase the confidence of physician in treating depression with SSRIs since they need to provide evidence based information to the patients, to help them in making informed decisions about their health. Sertraline has a better side effect profile compared to the other medications but still, we need to follow this medication closely since it is in the same class of SSRI.
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Claire-Louise Young
Guest
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Post by Claire-Louise Young on Aug 26, 2015 23:04:04 GMT -4
This is a great study that examines the correlation between SSRIs and birth defects. Mothers need to know if there is a need to change or stop taking their medication before conception or during pregnancy. Physicians can be mindful to avoid paroxetine or fluoxetine in woman of child-bearing age. I would like to see further studies completed on the association between the drug exposure dosages of SSRI and birth defect. It would be of great importance in practice to know if there is a “safe level” in pregnant mothers or peripregnant woman that does not result in significant birth defects.
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Post by ivania on Aug 27, 2015 8:45:23 GMT -4
This is a case-control study about SSRI in pregnant patients and its relationship with birth defects. The serious consequences of using paroxetine during pregnancy is very well known since it is a category D medication. Teratogenic effects vary between cardiovascular malformations, anencephaly and abdominal wall defects and potential PPHN (after 20 weeks of GA) when exposed in the first trimester of pregnancy and later exposition in the third trimester with neonatal adaptation symptoms such as tachypnea, hypoglycemia, irritability and seizures that resolve within 2 weeks after delivery. I am particularly pleased with the way they tried to avoid bias, and the avoidance of including patients that didn’t meet the criteria in the study as well. The study has a strong OR of 95%. I also agree with the advantage of seeing the assessment of individual SSRI and individual birth defect outcomes but there are still many limitations when considering the wellness of babies when it is time for a clinician to take the decision to prescribe SSRI for the future mother since each one of them are classified as a category C during pregnancy (except for paroxetine). Incidence of depressive disorder is approximately 10% among pregnant women, maybe half of these may have major depression. This allows us to think that pregnancy does not protect against psychiatry disorder. Some of the recommendations for pregnant patients is if the patient has had a history of MDD or a serious suicide attempt you should continue their medications and do not augment or switch medication too early. SSRI is safer and better tolerated than TCAs and MAO inhibitors. Even considering the potential risk of all of this medication it is better to keep in mind that with a patient with mild to moderate depression should be managed by cognitive behavioral therapy or interpersonal psychotherapy to have the better outcome.
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Post by ivania on Aug 27, 2015 9:33:59 GMT -4
Just one more thing. This study combined the Bayesian analysis and analysis from a population based case-control study of birth defects. Bayesian analysis is a statistical procedure which endeavors to estimate parameters of an underlying distribution based on the observed distribution. Unique features of Bayesian analysis include an ability to incorporate prior information in the analysis, an intuitive interpretation of credible intervals as fixed ranges to which parameter is known with a prespecified probability and an ability to assign an actual probability to any hypothesis of interest. However the Bayesian analysis is somewhat controversial because the validity of the result depends on how valid the prior distribution is, and this cannot be assessed statistically. Thanks:)
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Post by Raven Price on Aug 27, 2015 9:51:02 GMT -4
With the rise in number of patients being diagnosed with mental illness, there will be an increase in the number of medicated patients. With approximately half of these patients being female, the potential risk for birth defects because of these medications is of high concern. Jennita Reefhuis (2015), research health scientist, explains the potential for birth defects when taking SSRIs. During this study they found that the most common drug for mental illness that was used among pregnant women was Sertraline. It was also stated that the age of these mothers were reported to be older than mothers that were taking other medications that were included in the paper. A limitation of the study was found to be that there is no way of knowing if there is underlying maternal disease within the patient that can affect the fetus. According to the American College of Obstetricians and Gynecologist (2014), “Older women are more likely to have pre-existing health problems than younger women.” This includes high blood pressure, diabetes, and increased risk for chromosomal defects in fetuses; all of which can have a limiting effect on the growth of a fetus and end with a possible deformity of the fetus. It would be interesting to see if the same growth pattern/deformities are seen among mothers that are taking Sertraline that are from a younger age group. Reference Reefhuis, Jennita. (2015). Specific SSRIs and birth defects: Bayesian analysis to interpret new data int eh context of previous reports. Retrieved from www.bmj.com/content/351/bmj.h3190
The American College of Obstetricians and gynecologist. (2014). Having a Baby After Age 35. Retrieved from www.acog.org/~/media/For%20Patients/faq060.pdf
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Post by David Feldman on Aug 27, 2015 9:52:46 GMT -4
While unknown why SSRI’s cause birth defects in children, it has been shown that more than 2.0-3.5 times more likely to develop birth defects. The birth defects that you are most likely to develop are heart defects with paroxetine, which ended up why the drug was banned in 2005 by the FDA. It is confusing why 33% of expecting mothers feel it is still ok to use SSRIs during pregnancy. This study could have delved in to this area more by finding out if the women who were taking the SSRIs were depressed. Although this study did not address whether the birth defects were due to some underlying disease, or some other environmental factor. Its strength lies in that it was able to measure the SSRIs and the birth defects individually.
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Post by Ramez Ghanbari on Aug 27, 2015 10:22:42 GMT -4
The study by Reefhuis et al., examines the impact of antidepressants, in particular SSSRIs, on birth defects. The authors report significant birth defects associated with the use of paroxetine and fluoxetine. Some of the defects include anecephaly, atrial septal defect and gastroschisis. The findings of the study are in line with the previously reported data in literature on the teratogenic impact of some SSRIs on the fetus. In fact, the impact of paroxetine, a category D agent, on birth defects has been well documented.
It is, however, essential to state that some studies have not shown birth defects. It is, thus, important to look at the concentration of SSRIs in maternal blood as well as breast milk. Another important factor to keep in mind is to look at the genetic markers and its correlation with the use of SSRIs and birth defects. For instance, patients with serotonin s/s alleles may have more detrimental effects, while on SSRIs, when compared to patients with the heterogeneous sub-type (s/l). The Study definitely sheds light on the association of the use of SSRIs and birth defect. But, it is important to note that lack of use of antidepressants during pregnancy has both short- and long-term effects on the well-being of the newborns. Indeed, there are reports stating that newborns whose mothers did not take antidepressants during pregnancy exhibited agitation, anxiety and depressive symptoms in their teenage years. More studies are needed to look at the correlation between the blood concentration of the antidepressants and birth defects.
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Post by Karishma Nathani on Aug 27, 2015 10:57:08 GMT -4
This article and case study is thorough in its investigation into the effects of SSRIs during pregnancy and its association with birth defects. I have read in many studies that paroxetine, specifically, is contraindicated judging pregnancy. This study proves that the most significant defects have been reported with paroxetine use, including anencephaly, atrial septal defects, right ventricular outflow tract obstructions, gastroschisis, and omphalocele. Based on the study it seems that sertraline is the SSRI with the least significant side effects. It would be interesting to do a study on a the specific SSRI and the specific birth defects it can cause and whether or not there is any safe dose to be given during pregnancy. In many studies, the use of antidepressants and its side effects during pregnancy have been studied and it seems that SSRIs are still the safest choice. Further studies should be done to monitor the safety of SSRIs during pregnancy and whether or not there are safe doses that can be given throughout he whole pregnancy.
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Post by Patricia O'Dierno on Aug 27, 2015 11:15:40 GMT -4
This study showed that certain SSRIs were linked to a slightly higher chance of birth defects. Luckily, the most commonly used SSRI, sertraline, was not. But the question remains if the slightly higher risk of birth defects is worth not being on an SSRI at all during pregnancy. Although the risks of birth defects are higher, it's a slight increase. Also, many other factors play into birth defects, such as genetics and lifestyle. Is it better for the mother to be on SSRIs and feel better, or not be on one at all? Because the risk of birth defects is only slightly higher, and some SSRIs have no increased risk, it may be better to keep the woman on a SSRI but switch to a safer one. In general, the woman should be told the risks and be given the option of what she wants to do. But because the risks are low, it might be better for the woman to feel good during the pregnancy and continue the SSRI.
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Post by mitpatel on Aug 27, 2015 12:00:06 GMT -4
This study examines the relationship between the use of SSRIs and specific birth defects. It has been well known that paroxetine, a category D drug, has been associated with birth defects. In this study, paroxetine had the strongest OR for developing anencephaly and RV outflow tract obstruction cardiac defect. Fluoxetine and escitalopram were also associated with birth defects. Sertaline, the most commonly used SSRI (~40%), however was not associated with birth defects. So the question is: At this point, is it better to asses a certain drug individually rather than grouping them together as a class? It would be interesting to see a future study target an individual drug while incorporating other factors such as dosing, compliance, and drug concentration to possibly arrive at stronger conclusions regarding the use of SSRIs during pregnancy.
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Post by Ankita Gandhi on Aug 27, 2015 16:18:03 GMT -4
Almost with any type of medications, it is expected to increase the risk of birth defects. Some birth defects are very observable and some are not. I think the SSRIs have the same issues. While taking SSRIs during the pregnancy increases the chances of birth defect 2.0-3.5 times more. Among from many SSRI, Paroxetine is the one causing severe heart defects. Still it is not sure why many physician prescribe one of the SSRI for depression or any psychological disorder during pregnancy and still be okay. The birth defect might be more common in women with prior existing conditioning. The study has shown us a lot about the increase risk of birth defect with SSRIs but have not mentioned if the mother had any sort of diseases before. If the patient really needs SSRI for any existing condition during the pregnancy, I think it would be a better option to prescribe one of those with lesser side effects and less severe birth defects. Also it is very important to mention about the specific and the general side effects to the patients.
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Post by Nora Magrabi on Aug 27, 2015 16:26:34 GMT -4
This is an interesting article that discusses the association between specific SSRIs and specific birth defects. According to the study, the use of paroxetine and fluoxetine periconceptionally is associated with cardiac defects, gastroschisis, omphalocele and anencephaly. This study helps clinicians evaluate the risks compared with the benefits of specific SSRIs during pregnancy. It is important to determine whether specific SSRIs are associated with specific birth defects to advise patients accordingly. Since evidence suggests that some birth defects occur 2-3.5 times more frequently among the infants of women treated with paroxetine or fluoxetine early in pregnancy, clinicians need to ensure that their patients stop use of these medications during pregnancy.
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