Prescription Of Selective Serotonin Reuptake Inhibitors Research Articles

Suicide-related events in young people following prescription of SSRIs and other antidepressants: a self-controlled case series analysis

ObjectivesWe aimed to examine the temporal association between selective serotonin reuptake inhibitors (SSRI) and tricyclic antidepressant (TCA) prescriptions and suicide-related events in children and adolescents.DesignSelf-controlled case series.SettingElectronic health records were...

The Pharmacoepidemiology of Selective Serotonin Reuptake Inhibitors for Children and Adolescents in Canada from 2005 to 2009: A Database Analysis

The aim of this study was to describe the frequency and trends in prescriptions and recommendations for selective serotonin reuptake inhibitors (SSRIs) for mental health disorders in children and adolescents in Canada from 2005 to 2009. Data were extracted from databases supplied by IMS Brogan (IMS), a proprietary source of pharmacoepidemiologic data. Analyses were performed to obtain descriptive statistics on SSRI prescriptions dispensed, SSRI drug recommendation frequency, reasons for drug recommendations (therapeutic indication), and median duration of use of SSRIs in Canadian children. Canadian census data were used to assess whether changes in SSRI use were related to changes in the number of children in Canada over the time period studied. SSRI prescriptions written by pediatricians increased by 39 %, while SSRI drug recommendations by all specialists for children and adolescents increased by 44 % over the 5-year interval. Over the 5-year period studied, fluoxetine was the most commonly recommended and dispensed SSRI. The use of escitalopram has increased while the use of paroxetine has declined. Between 2005 and 2009, the two most common therapeutic indications for SSRI recommendations were mood disorder (50 %) and anxiety disorder (25 %). Median treatment duration was less than 1 year, with duration generally increasing with patient age. The increase in use of SSRIs in Canadian children and adolescents from 2005 to 2009 suggests that the effects of public health warnings concerning suicidal thinking and behavior associated with these drugs are now dissipating. This may be attributable to the FDA's pediatric approvals for fluoxetine and escitalopram, the growing comfort of clinicians with using SSRIs in children, limited availability of psychosocial treatments, and the influence of marketing. The use of paroxetine has continued to decline, likely because of specific warnings directed toward this agent and limited evidence supporting its efficacy.

Utilization of and expenditures for selective serotonin reuptake inhibitors (SSRIs) and factors associated with change in price per-prescription of brand SSRIs in the Texas Medicaid programme (1991-2009)

Objectives To assess: (1) the utilization of and expenditures for selective serotonin reuptake inhibitors (SSRIs); and (2) the association of events such as generic entries, reformulation entries and new indication approvals with the change in brand SSRI price per-prescription reimbursed (PPPR) in the Texas Medicaid health programme, USA. Methods The Texas Medicaid summary database, containing quarterly data on utilization (number of prescriptions dispensed) and expenditure (US dollar amount reimbursed) for medications between the first quarter of January 1991 and last quarter of December 2009, was used. Annual measures of SSRI utilization and expenditures were reported. Time-series intervention analysis was conducted with the log-transformed ratio (current-to-previous quarter) of brand SSRI PPPR as the dependent variable and specified events (generic entry, reformulation entry and new indication approval) as the independent variables. Key findings The annual utilization of the entire SSRI class of therapy among Texas Medicaid beneficiaries increased by more than 20-fold from 1991 to 2004 (35 933 to 819 952 prescriptions), and then decreased from 2005 to 2008 (779 540 to 183 154 prescriptions). In 2009, the number of SSRI prescriptions increased to 413 103 prescriptions. The annual expenditures for SSRIs followed the same pattern as the utilization measures. For a majority of brand SSRIs, none of the events (noted above) were found to be significantly associated with change in PPPR. Conclusions Annual utilization and expenditures of SSRIs varied over time. For a majority of brand SSRIs, generic entries, reformulation entries and new indication approvals were not related to change in PPPR.

Fractures in users of antidepressants and anxiolytics and sedatives: effects of age and dose.

Antidepressants have been associated with fractures. In a case-control study, increasing age was associated with more fractures in users of selective serotonin reuptake inhibitors and tricyclic antidepressants, whereas for anxiolytics and sedatives, more fractures were seen among the younger users. Depression per se did not seem associated with fractures. This study aims to study the effects of age and dose of selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants (TCA) and anxiolytics/sedatives on fracture risk. The study was designed as a case-control study. From the Danish National Health Service, we identified 124,655 fracture cases and 373,962 age- and gender-matched controls. Crude odds ratios were estimated, and propensity score adjustment was used to minimise confounding by indication. A higher risk of fractures was associated with an increasing dose of anxiolytics and sedatives; the highest excess risk was present in the age stratum below 40 years of age (p < 0.01), and thereafter, the excess risk of fractures declined with age. For SSRI, a growing excess risk of fractures was seen with both increasing dose and age. Regarding TCA, no particular trend with age was present. However, an increasing risk of fractures was associated with increasing TCA dose in the age group above 60 years. Finally, for other antidepressants, no particular trend with age or dose was observed. In our data, a hospital diagnosis of depression or manic depression was associated with fewer fractures. Caution should be shown upon prescription of SSRI to older subjects. A hospital diagnosis of depression or manic depression and thus potentially a more severe disease was not a risk factor for fractures.

Effect of Physician Payment Disclosure Laws on Prescribing

To the Editor: With the enactment of the Physician Payments Sunshine Provision of the Affordable Care Act, pharmaceutical manufacturers are now required to disclose certain types of payments—e.g. payments for consulting, honoraria, gifts, and travel—made to physicians.1 This law is based on the premise that transparency in these kinds of transactions is of public importance and that disclosure requirements can act as a deterrent against quid pro quo exchanges; physicians will be reluctant to accept large payments from pharmaceutical firms if payments are publicly known and perceived as financial compensation for prescribing certain therapies.2,3 To predict possible deterrence effects of the federal sunshine law, we studied the experience of two states, Maine and West Virginia, that previously implemented similar disclosure laws. We focused on the effect of the laws on the prescribing of HMG-CoA reductase inhibitors (statins) and selective serotonin reuptake inhibitors (SSRIs), two therapeutic classes in which marketing plays an important role in physicians' choice of treatment because the members within each class are pharmacologically similar to each other and highly substitutable. We hypothesized that, to the degree that physicians were influenced by industry payments to overprescribe branded therapies—and disclosure deterred doctors from accepting these payments—the disclosure laws would lead physicians to decrease prescribing of branded statins and SSRIs. We also looked at whether any switching from branded therapies to generics that we observed was associated with decreases in out-of-pocket costs for patients or decreases in overall prescription expenditures.

Fractures in users of antidepressants and anxiolytics and sedatives effects of age and dose

Antidepressants have been associated with fractures. In a case–control study, increasing age was associated with more fractures in users of selective serotonin reuptake inhibitors and tricyclic antidepressants, whereas for anxiolytics and sedatives, more fractures were seen among the younger users. Depression per se did not seem associated with fractures. This study aims to study the effects of age and dose of selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants (TCA) and anxiolytics/sedatives on fracture risk. The study was designed as a case–control study. From the Danish National Health Service, we identified 124,655 fracture cases and 373,962 age- and gender-matched controls. Crude odds ratios were estimated, and propensity score adjustment was used to minimise confounding by indication. A higher risk of fractures was associated with an increasing dose of anxiolytics and sedatives; the highest excess risk was present in the age stratum below 40 years of age (p < 0.01), and thereafter, the excess risk of fractures declined with age. For SSRI, a growing excess risk of fractures was seen with both increasing dose and age. Regarding TCA, no particular trend with age was present. However, an increasing risk of fractures was associated with increasing TCA dose in the age group above 60 years. Finally, for other antidepressants, no particular trend with age or dose was observed. In our data, a hospital diagnosis of depression or manic depression was associated with fewer fractures. Caution should be shown upon prescription of SSRI to older subjects. A hospital diagnosis of depression or manic depression and thus potentially a more severe disease was not a risk factor for fractures.

Trends in depression and antidepressant prescribing in children and adolescents: a cohort study in The Health Improvement Network (THIN).

BackgroundIn 2003, the Committee on Safety of Medicines (CSM) advised against treatment with selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine in children, due to a possible increased risk of suicidal behaviour. This study examined the effects of this safety warning on general practitioners' depression diagnosing and prescription behaviour in children.Methods and FindingsWe identified a cohort of 1,502,753 children (<18 y; registered with GP for >6 m) in The Health Improvement Network (THIN) UK primary care database. Trends in incidence of depression diagnoses, symptoms and antidepressant prescribing were examined 1995–2009, accounting for deprivation, age and gender. We used segmented regression analysis to assess changes in prescription rates. Overall, 45,723 (3%) children had ≥1 depression-related entry in their clinical records. SSRIs were prescribed to 16,925 (1%) of children. SSRI prescription rates decreased from 3.2 (95%CI:3.0,3.3) per 1,000 person-years at risk (PYAR) in 2002 to 1.7 (95%CI:1.7,1.8) per 1,000 PYAR in 2005, but have since risen to 2.7 (95%CI:2.6,2.8) per 1,000 PYAR in 2009. Prescription rates for CSM-contraindicated SSRIs citalopram, sertraline and especially paroxetine dropped dramatically after 2002, while rates for fluoxetine and amitriptyline remained stable. After 2005 rates for all antidepressants, except paroxetine and imipramine, started to rise again. Rates for depression diagnoses dropped from 3.0 (95%CI:2.8,3.1) per 1,000 PYAR in 2002 to 2.0 (95%CI:1.9,2.1) per 1,000 PYAR in 2005 and have been stable since. Recording of symptoms saw a steady increase from 1.0 (95%CI:0.8,1.2) per 1,000 PYAR in 1995 to 4.7 (95%CI:4.5,4.8) per 1,000 PYAR in 2009.ConclusionsThe rates of depression diagnoses and SSRI prescriptions showed a significant drop around the time of the CSM advice, which was not present in the recording of symptoms. This could indicate caution on the part of GPs in making depression diagnoses and prescribing antidepressants following the CSM advice.

Are Urology Residents Ready to Treat Premature Ejaculation After Their Training?

The management of premature ejaculation (PE) among urology residents (URs) in the era of standard definition and new treatments is unknown. To determine how future urologists currently address PE and to review their adherence to guidelines. A specifically designed survey on the preferred approaches to the treatment of PE was given to residents during the Eighth European Urology Education Programme. The results were tabled, and descriptive statistics were used to analyze differences in practice patterns. The responses are compared with clinical guidelines and recommendations. A total of 360 URs attended the recommendation course, and 140 answered the survey (response rate: 38.8%). Seventeen (12.1%) of the respondents considered PE to be a very common sexual dysfunction, 62 (44.3%) considered PE to be frequent, 33 (23.6%) considered this condition uncommon, and 28 (20%) did not consider PE to be a dysfunction. Regarding incidents, 67 residents (47.9%) treated one patient per week. To assess PE, 132 (94.3%) used sexual history, 37 (26.4%) used physical examination, 38 (27.1%) used questionnaires, and 4 (2.9%) used laboratory testing. The preferred initial management strategy for PE was psychological/behavioral therapy for 65 (46.4%) residents. Topical anesthetic, andrological referral, and prescription of selective serotonin reuptake inhibitors (SSRIs) on demand were favored by 34 (24.3%), 19 (13.6%), and 8 (12.9%) of the respondents, respectively. Other options were psychiatric referral, which was preferred by two (1.4%) respondents, and prescription of daily SSRIs, which was preferred by two (1.4%) respondents. The preferred secondary treatment for patients who did not improve initially was prescription of SSRIs for on demand, which was 46 (32.9%) respondents. In cases where patients had concomitant erectile dysfunction (ED), 16 (11.4%) URs treated only the ED and 60 (42.9%) treated both conditions. The majority of URs follow the established guidelines for diagnosis of PE, but not for treatment. The URs have an insufficient medical education in sexual medicine.

Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants, Prolactin and Breast Cancer

Selective serotonin reuptake inhibitors (SSRIs) are a widely prescribed class of antidepressants. Laboratory and epidemiologic evidence suggests that a prolactin-mediated mechanism secondary to increased serotonin levels at neuronal synapses could lead to a potentially carcinogenic effect of SSRIs. In this population-based case-control study, we evaluated the association between SSRI use and breast cancer risk as a function of their relative degree of inhibition of serotonin reuptake as a proxy for their impact on prolactin levels. Cases were 2,129 women with primary invasive breast cancer diagnosed from 2003 to 2007, and controls were 21,297 women randomly selected from the population registry. Detailed information for each SSRI prescription dispensed was compiled using the Saskatchewan prescription database. Logistic regression was used to evaluate the impact of use of high and lower inhibitors of serotonin reuptake and duration of use, as well as to assess the effect of individual high inhibitors on the risk of breast cancer. Exclusive users of high or lower inhibitors of serotonin reuptake were not at increased risk for breast cancer compared with non-users of SSRIs (OR = 1.01, CI = 0.88–1.17 and OR = 0.91, CI = 0.67–1.25 respectively), regardless of their duration of use or menopausal status. While we cannot rule out the possibility of a clinically important risk increase (OR = 1.83, CI = 0.99–3.40) for long-term users of sertraline (≥24 prescriptions), given the small number of exposed cases (n = 12), the borderline statistical significance, and the wide confidence interval, these results need to be interpreted cautiously. In this large population-based case-control study, we found no conclusive evidence of breast cancer risk associated with the use of SSRIs even after assessing the degree of serotonin reuptake inhibition and duration of use. Our results do not support the serotonin-mediated pathway for the prolactin-breast cancer hypothesis.

Variants of the Serotonin Transporter Gene, Selective Serotonin Reuptake Inhibitors, and Bone Mineral Density in Risperidone-Treated Boys

Selective serotonin reuptake inhibitors (SSRIs) may reduce bone mineral density (BMD). Here, we investigate whether variants of the serotonin transporter-linked polymorphic region (5-HTTLPR) of the serotonin transporter gene moderate this association in boys. Between November 2005 and August 2009, medically healthy boys, aged 7 to 17 years, were enrolled in a cross-sectional study exploring the effect of risperidone-induced hyperprolactinemia on BMD. Volumetric BMD of the ultradistal radius was measured using peripheral quantitative computed tomography, and areal BMD of the lumbar spine was estimated using dual energy x-ray absorptiometry. Multiple linear regression analysis tested whether the 5-HTTLPR genotypes interacted with SSRI treatment status to affect BMD, adjusting for relevant confounders. Participant enrollment was conducted at the University of Iowa, Iowa City. Of 108 boys (mean ± SD age = 11.7 ± 2.8 years), with DSM-IV clinical diagnoses based on chart review, 52% (n = 56) had been taking an SSRI for a median duration of 2.8 years. After adjusting for pubertal development, anthropometric measures, physical activity, calcium intake, and prolactin concentration, there was a significant 5-HTTLPR genotype × SSRI treatment interaction effect on total lumbar spine BMD z score (P < .05) in non-Hispanic whites. The interaction effect on BMD at the ultradistal radius failed to reach statistical significance. Among LS genotype carriers, those treated with SSRIs had lower lumbar BMD z score and trabecular BMD at the radius compared to those not treated (P < .02 and P < .008, respectively). These findings add to the growing evidence implicating the serotonin system in bone metabolism. They suggest the potential use of 5-HTTLPR genotypes to guide the safer long-term prescribing of SSRIs in youths. However, prospective confirmation in a controlled matched population is warranted.

Antidepressant Prescribing and Suicides in Emilia-Romagna Region (Italy) from 1999 to 2008: An Ecological Study

Anti-depressant (AD) prescribing rose in several countries worldwide over the last 20 years. Some concerns have been raised over the fact that AD use, mainly Selective Serotonin Reuptake Inhibitors (SSRI) may increase the risk of suicide. AD consumption and suicide rates data in Emilia-Romagna region, Italy have been extracted from regional government databases on AD prescribing and suicide rates, from 1999 to 2008. A statistical model using ordinary least squares linear regression was employed. The overall suicide rates decreased during the period under examination, in spite of the observed exponential increase in use of ADs. Despite the doubling in prescribing of SSRI and newer ADs in recent years, there continues to be no negative impact on suicide rates in Emilia Romagna.

Pediatric oncologists' practices of prescribing selective serotonin reuptake inhibitors (SSRIs) for children and adolescents with cancer: A multi‐site study

To survey pediatric oncologists regarding prescription of selective serotonin reuptake inhibitors (SSRIs) and related medications for the treatment of depression and anxiety disorders in children with cancer. Specifically, we sought to determine (a) how frequently pediatric oncologists prescribed SSRIs and what were the most commonly prescribed agents; (b) how decisions were made to prescribe, particularly whether mental health professionals were consulted; (c) how patients were monitored while on the agents; and (d) how the FDA black box warning has affected prescribing practices. Oncologists from nine children's cancer centers (N = 151) from across the U.S. were surveyed, responding to either on-line or paper versions of a questionnaire developed for this study. A majority of oncologists (71%) reported prescribing SSRIs for their patients. Oncologists reported difficulties differentiating symptoms of depression from aspects of cancer treatment. Mental health practitioners are consulted occasionally but not routinely, and oncologists reported a need for increased mental health resources. Approximately half of oncologists (51%) reported that the FDA black box warning had not affected their practice. In addition, only 28% reported monitoring patients on SSRIs at FDA recommended intervals, and only 9% indicated assessing for suicidality. Prescription of SSRIs is a common practice of pediatric oncologists, often without consultation with mental health professionals. Post-prescription monitoring appears to be suboptimal, and does not follow FDA guidelines.

Antidepressant use and colorectal cancer risk: a Danish population-based case–control study

Background:Earlier research suggests that use of selective serotonin reuptake inhibitors (SSRIs), but not tricyclic antidepressants (TCAs), reduces the risk of colorectal cancer (CRC).Methods:We conducted a population-based case–control study to investigate the association between antidepressant use and CRC risk. Cases were diagnosed with a first primary CRC from 1991 through 2008. We selected 10 population controls matched to cases on sex, birth year, and residence from the Danish Civil Registration System using risk-set sampling. We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) associating antidepressant use with colorectal cancer occurrence, controlling for potential confounders.Results:The study included 9979 cases and 99 790 controls. We found no notable reduction in CRC risk in ever users (⩾2 prescriptions) of TCAs (OR=0.94; 95% CI: 0.84, 1.05), SSRIs (OR=0.97; 95% CI: 0.90, 1.05), or other antidepressants (OR=0.95; 95% CI: 0.83, 1.07). Associations for recent and former use of antidepressants were also near null. Intensity of antidepressant use (number of pills divided by total duration of use), regardless of duration, was not associated with CRC risk.Conclusions:We found no evidence that antidepressant use substantially reduces the risk of colorectal cancer.

SSRI-Enhanced Locus Coeruleus Activity and Adolescent Suicide: Lessons from Animal Models

SSRI-Enhanced Locus Coeruleus Activity and Adolescent Suicide: Lessons from Animal Models

Diagnosis and Treatment of Depression and Anxiety in Rural and Nonrural Primary Care: National Survey Results

Diagnosis and Treatment of Depression and Anxiety in Rural and Nonrural Primary Care: National Survey Results

Use of selective serotonin-reuptake inhibitors during early pregnancy and risk of congenital malformations: updated analysis

Data on the safety of selective serotonin-reuptake inhibitors (SSRIs) in pregnancy are inconsistent. We examined associations between SSRI use during early pregnancy and risk of congenital malformations in infants. Set in Northern Denmark, our population-based prevalence study included 216,042 women who had a live birth after the 20th week of gestation. We compared the prevalence of malformation in infants born to women who redeemed at least one SSRI prescription during early pregnancy with the prevalence in infants born to women who redeemed no SSRI prescriptions during their pregnancies. Drug use data were extracted from prescription databases, while data on congenital malformations were obtained from the National Registry of Patients. The 2,062 women with SSRI prescriptions during early pregnancy gave birth to 105 (5.1%) infants with malformations, while the 213,712 women with no SSRI prescriptions gave birth to 7,449 (3.5%) infants with malformations. SSRI use was associated with an increased risk of malformations overall (odds ratio [OR] = 1.3; 95% confidence interval (CI): 1.1-1.6) and cardiac malformations (OR = 1.7; 95% CI: 1.1-2.5). For specific SSRIs, we found an increased risk for septal defects associated with sertraline. We found little overall association between use of SSRIs during pregnancy and congenital malformations, but our findings suggest an association between maternal SSRI use in early pregnancy and cardiac malformations which could be causal.

Psychotropic drugs have contrasting skeletal effects that are independent of their effects on physical activity levels

Popular psychotropic drugs, like the antidepressant selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), and the mood stabilizer lithium, may have skeletal effects. In particular, preclinical observations suggest a direct negative effect of SSRIs on the skeleton. A potential caveat in studies of the skeletal effects of psychotropic drugs is the hypoactive (skeletal unloading) phenotype they induce. The aim of this study was to investigate the contribution of physical inactivity to the skeletal effects of psychotropic drugs by studying bone changes in cage control and tail suspended mice treated with either vehicle, SSRI, TCA or lithium. Tail suspension was used to control for drug differences on physical activity levels by normalizing skeletal loading between groups. The psychotropic drugs were found to have contrasting skeletal effects which were independent of drug effects on animal physical activity levels. The latter was evident by an absence of statistical interactions between the activity and drug groups. Pharmacological inhibition of the 5-hydroxytryptamine (5-HT) transporter (5-HTT) using a SSRI reduced in vivo gains in lower extremity BMD, and negatively altered ex vivo measures of femoral and spinal bone density, architecture and mechanical properties. These effects were mediated by a decrease in bone formation without a change in bone resorption suggesting that the SSRI had anti-anabolic skeletal effects. In contrast, glycogen synthase kinase-3[beta] (GSK-3[beta]) inhibition using lithium had anabolic effects improving in vivo gains in BMD via an increase in bone formation, while TCA-mediated inhibition of the norepinephrine transporter had minimal skeletal effect. The observed negative skeletal effect of 5-HTT inhibition, combined with recent findings of direct and indirect effects of 5-HT on bone formation, are of interest given the frequent prescription of SSRIs for the treatment of depression and other affective disorders. Likewise, the anabolic effect of GSK-3[beta] inhibition using lithium reconfirms the importance of Wnt/beta-catenin signaling in the skeleton and it's targeting by recent drug discovery efforts. In conclusion, the current study demonstrates that different psychotropic drugs with differing underlying mechanisms of action have contrasting skeletal effects and that these effects do not result indirectly via the generation of animal physical inactivity.

Changes in US antidepressant and antipsychotic prescription patterns during a period of FDA actions

To determine if paroxetine versus non-paroxetine selective serotonin reuptake inhibitors (SSRIs) prescribing changed after the June 2003 FDA Paroxetine Public Health Advisory (PPHA) and if antidepressant and antipsychotic prescribing changed after the February 2004 FDA Advisory Committee Meeting (FDACM). Ecologic analysis using estimates of patients dispensed antidepressants and antipsychotics, census data, and promotional spending data. Data sources were SDI: Vector One(R), US Census, and IMS Health(R). Measures were monthly use levels (number of patients dispensed antidepressants, antipsychotics, paroxetine, and non-paroxetine SSRIs prescriptions by age group per population count). Percent changes pre- to post-PPHA were used to assess changes in paroxetine versus non-paroxetine SSRIs prescribing. Interrupted time series (ITS) analysis was performed to examine use level changes post-FDACM by drug groups (all antidepressants and all antipsychotics). Post-PPHA mean paroxetine use levels decreased for all age groups (range: 5.5-34.1%). Mean non-paroxetine SSRIs use levels increased (range: 4.6-17.1%). Post-PPHA changes were greatest for 6-12 and 13-17 year olds. Decreased mean antidepressant drug use levels from pre- to post-FDACM were observed in all groups under 25 years old. A statistically significant decrease in the slopes from pre- to post-FDACM was observed for persons aged 13-17 and 18-24 years. The difference between the forecasted mean use level and the observed mean use level (in 12-month intervals) was statistically significant for all ages combined (-107.26; 95% CI: -166.32, -48.20) and 1-5 (-3.1; 95% CI: -4.62, -1.58), 6-12 (-36.02; 95% CI: -62.92, -9.12) and 25 years, and older groups (-83.17; 95% CI: -153.95, -12.39). For all age groups, decreases in the slopes of antipsychotic drugs use from pre- to post-FDACM were observed, although these slope changes were not statistically significant. The difference between the forecasted mean antipsychotic drugs use level and the observed mean use level (in 12-month intervals) was statistically significantly lower for all age groups. Antidepressant use changed post-PPHA and -FDACM, with a differential pattern by age. There was no evidence of increased antipsychotic use post-FDACM. Ecologic data cannot determine if changes were due to depression not treated with medications or the prescribing of fewer antidepressants for other conditions.

Continuing medical education: SSRIs and pregnancy

Byline: Chittaranjan. Andrade CME Questions In euthymic women with a history of major depression, the planned, voluntary withdrawal of antidepressant medication prior to conception (as compared with the continuation of medication all through pregnancy) is associated with a five-fold increase in the risk of relapse during pregnancy. A longer duration of illness and a larger number of past depressive episodes each predict an increased risk of relapse. About half of the relapses occur during the first trimester.[sup] [1] Untreated depression during pregnancy is itself associated with a large number of adverse maternal and fetal outcomes. These include an increased risk of maternal mortality,[sup] [2] poor weight gain, alcohol or illicit drug use, toxemias of pregnancy, and poor mother-child bonding[sup] [3],[4] and an increased risk of pre-term delivery, low birth weight, operative delivery, and neonatal ICU admission.[sup] [5],[6],[7] There is now an increasing trend to prescribe selective serotonin reuptake inhibitors (SSRIs) to treat depression during pregnancy; in fact, SSRIs are now first-line antidepressants during pregnancy in Denmark and many other European countries.[sup] [8],[9] The epidemiology of SSRI and antidepressant use during pregnancy has been described by Tuccori et al .[sup] [10] With this background, mark True or False against each of the statements in sets A and B: A) Teratogenicity of SSRIs after first-trimester exposure: *SSRIs increase the overall risk of major congenital malformations *SSRIs increase the overall risk of minor congenital malformations *SSRIs increase the risk of septal heart defects *SSRIs increase the risk of certain specific but rare congenital malformations B) Other pregnancy outcomes after exposure to SSRIs *SSRIs increase the risk of spontaneous abortions *SSRIs increase the risk of preterm delivery *SSRIs are associated with low Apgar scores after birth *SSRIs are associated with an approximately 500 g decrease in mean birth weight *SSRIs are associated with decreased head circumference in the newborn *SSRIs increase the risk of persistent pulmonary hypertension in the newborn *SSRI exposure during late pregnancy is associated with a neonatal SSRI withdrawal syndrome C) SSRI-exposed vs. SSRI-unexposed pregnancies in depressed women *It is better to treat depression during pregnancy than to leave it untreated because neonatal outcomes in SSRI-treated depressed women are better than those in untreated depressed women. View Answer CME Answers A) Teratogenicity of SSRIs after first-trimester exposure: 1. False; 2. False; 3. True. 4. True Pedersen et al ,[sup] [11] describe a large, population-based, retrospective cohort study of the teratogenicity of SSRIs using data extracted from four nationwide registers in Denmark. Major and minor congenital malformations were studied in live born children in whom these malformations were detected within a year of birth. Data were excluded if women had used non-SSRI psychotropic drugs or drugs for a variety of medical indications. There were 1370 infants who had been exposed to SSRIs and 493,113 infants who had not been exposed. In this connection, exposure was defined as the redemption of at least two prescriptions for SSRIs from 28 days before conception to 112 days after conception; the assumption was that filling repeated prescriptions implied that the women were actually taking their medications. The risks of teratogenicity with SSRIs were calculated after adjusting for maternal age, marital status, income, smoking, and other variables. This is because women who used SSRIs were more likely to have risk factors such as greater age, living alone, unmarried status, smoking etc. Pedersen et al ,[sup] [11] found that the risk of major malformations in SSRI-exposed vs. unexposed infants was 4.0% vs. …

The use of SSRIs in children and adolescents

The use of SSRIs in children and adolescents