Mom's Antidepressant Use Poses Little Danger to Baby

(HealthDay News) -- Pregnant women who use antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are not increasing the risk of most birth defects for their newborns, new research suggests.

Drugs within this class -- which include Celexa, Paxil, Prozac and Zoloft -- may increase the risk for certain defects, but, even then, the absolute risk is extremely small, concluded two studies published in the June 28 issue of the New England Journal of Medicine.

"It's a fairly reassuring message for women who need antidepressants and are pregnant or who plan on becoming pregnant," said Carol Louik, lead author of the first paper and an assistant professor of epidemiology at Boston University's Slone Epidemiology Center. "We saw no large risks, and the fewer elevated risks that we did see would only lead to very small absolute risks."

"This is a valuable contribution," added Dr. Jon Shaw, director of child and adolescent psychiatry at the University of Miami's Miller School of Medicine. "It substantiates the need to always be prudent in prescribing antidepressants."

The issue of maternal use of antidepressants, particularly those known as selective serotonin reuptake inhibitors (SSRIs) is a charged one.

Last November, the American College of Obstetricians and Gynecologists recommended that women avoid the SSRI Paxil if they are pregnant or planning on becoming pregnant, due to a potential heightened risk of birth defects.

The guidelines come a year after the U.S. Food and Drug Administration (FDA) issued a warning about possible birth defects associated with Paxil when the drug is taken during the first trimester of pregnancy.

The initial FDA warning came in September of 2005. In December of the same year, the FDA instructed Paxil's maker, GlaxoSmithKline, to reclassify the drug from a Category C to D (a stronger warning) for pregnant women. Category D means studies in pregnant women have demonstrated a risk to the fetus.

Other reports had indicated that SSRIs may cause newborns to have withdrawal symptoms.
To complicate matters further, yet another study found that pregnant women who discontinued their antidepressant medication were five times more likely to relapse into depression than women who continued with the medication.

Women of reproductive age have the highest prevalence of major depressive disorders, with experts estimating that about one in 10 will experience a bout of major or minor depression sometime during pregnancy or the postpartum period.

The first study, conducted by Louik's team of Boston researchers, looked at almost 10,000 infants with birth defects and close to 6,000 infants without birth defects. The researchers wanted to see if there was an association between defects that had been previously linked to SSRIs and the use of these drugs by mothers during their first trimester of pregnancy.

Overall, SSRI use was not associated with significantly increased risks of craniosynostosis (when connections between skull bones close prematurely), omphalocele (when intestines or other abdominal organs protrude from the navel) or heart defects.

There were, however, associations between maternal use of Zoloft (sertraline) and omphalocele and septal defects (defects in the walls that separate the chambers of the heart) and between Paxil and defects that interfere with blood flow to the lungs.

But even if a certain drug increased rates by a factor of four, the risk of having a child affected by the problem would still be less than 1 percent, the researchers said.

The study was funded by grants from the U.S. National Institute of Child Health and Human Development and the U.S. National Heart, Lung, and Blood Institute, as well as drug companies Aventis, Sanofi Pasteur and GlaxoSmithKline (maker of Paxil).

A second study, this time conducted by scientists at the U.S. Centers for Disease Control and Prevention (CDC), Atlanta, found that the use of SSRIs during the first trimester of pregnancy was not associated with any increased risks of most categories of birth defects, including congenital heart defects.

The researchers looked at four SSRIs: fluoxetine (Prozac), sertraline (Zoloft), Paxil and citalopram (Celexa).

There were some associations between maternal SSRI use and anencephaly (a brain defect), craniosynostosis and omphalocele, but, again, the absolute risk was very small. These defects had not previously been associated with SSRI use during pregnancy, the study authors noted.
Louik said she did not anticipate any labeling changes based on these studies, but that she did anticipate more research.

"These studies make a large contribution to the field, but they're not the final word by any means," she said.

More information
There's more on treating depression during pregnancy at the March of Dimes.

'Memory Traces' May Help Spur Chronic Pain

(HealthDay News) -- Even after their injuries have healed, some people continue to suffer chronic pain that can't be totally relieved through traditional analgesic drugs, such as aspirin and morphine derivatives.

Scientists have long tried to uncover the reasons for this kind of serious pain and to find effective treatments for it.

Now, a new study by a researcher at Northwestern University School of Medicine suggests that a main cause of this form of chronic pain may be old "memory traces" that get stuck in the brain's prefrontal cortex, which controls emotion and learning. As a result, the brain seems to remember the injury as if it were fresh, even long after it's healed.

Vania Apkarian, a professor of physiology and anesthesiology, says his findings from research with rats indicates there may be an abnormal cognitive memory and emotional component in the brain that causes the chronic pain.

He also identified a drug -- D-Cycloserine -- that controls persistent nerve pain by targeting the area of the brain that experiences the emotional suffering of pain. Over the past decade, the drug has been used to treat phobic behavior.

In rats, the drug appeared to greatly reduce pain-related emotional suffering and sensitivity of injury sites that had healed.

The next step will be to test the drug in clinical trials, Apkarian said.

The findings appear online in the journal Pain and will be published in print this fall.
The study was funded by the U.S. National Institutes of Health.

More information
The American Academy of Family Physicians has more about chronic pain.

Bone Marrow May Give Rise to Blood Cancers

(HealthDay News) -- Defects in bone marrow can lead to abnormal blood cells that cause precancerous blood diseases in mice, two new studies find.

Blood cells are produced in the bone marrow. It was previously thought that red blood cells themselves were the source of these precancerous diseases, which can sometimes progress to leukemia.

In humans, these precancerous conditions can be difficult to treat, because not much is known about what causes the blood cells to become abnormal, explained researcher Louise Purton, who is affiliated with the Peter MacCallum Cancer Center in Australia, as well as Massachusetts General Hospital and the Harvard Stem Cell Institute in Boston.

Purton said her team found "that the bone marrow microenvironment can make the blood cells become abnormal, like a type of pre-leukemic disease."

The second study was conducted by a team led by Stuart Orkin, a Howard Hughes Medical Institute investigator at Children's Hospital Boston and chairman of pediatric oncology at the Dana-Farber Cancer Institute.

"The defect we see isn't intrinsic to the blood cells themselves. It's a result of the interaction of the blood and support cells in bone marrow. We didn't predict that at all," Orkin said in a prepared statement.

The findings from the two studies, published in the June 15 issue of the journal Cell, could help in the development of new treatments for precancerous blood diseases.

"At the moment, most doctors focus on the blood cell as being the cause of the disease. Hopefully, the (bone marrow) microenvironment will now also be considered as a potential cause, which might lead to better treatments for these patients in the future," Purton said.

More information
The American Society of Hematology has more about blood diseases.

Flu Shot Kick-Starts Fetal Immune System

(HealthDay News) -- Giving flu vaccinations to a pregnant woman kick-starts the immune system of her fetus, a U.S. study says.

The researchers, led by Rachel Miller of the Columbia University Medical Center, used a newly developed technique called MHC tetramer staining to analyze B- and T-cell immune responses in umbilical cord blood after pregnant women were vaccinated with Fluzone.

Anti-Fluzone antibodies were detected in about 40 percent of the blood cord samples. MHC tetramer staining showed that some of the blood cord samples also made T-cells specifically against the vaccine.

These and other findings in the study establish that B- and T-cell responses to antigens occur in utero after pregnant women have received flu vaccinations, the study authors said. This supports the theory that the human neonatal system can respond to environmental exposures.

The findings have important implications for determining when immune responses to environmental exposures begin, the researchers said.

The study is published in the June 1 issue of the Journal of Clinical Investigation.

Influenza vaccinations for pregnant women are considered safe and are recommended by the U.S. Centers for Disease Control and Prevention.

More information
The March of Dimes Birth Defects Foundation has more about vaccinations during pregnancy

Poor Bond With Siblings May Boost Depression Risk

(HealthDay News) -- Men who don't get along with a sibling might be at higher risk for depression, new research shows.

"Among a group of men studied since their late teens, those who said they didn't have a close relationship with even one of their siblings were more likely to be depressed by the time they were 50," said study author Dr. Robert Waldinger, director of the Study of Adult Development at Brigham and Women's Hospital, in Boston.

"Having a close relationship with even one of your siblings made you less likely to be depressed," Waldinger added.

His team published the report in the June 1 issue of the American Journal of Psychiatry.
In the study, Waldinger and his colleagues collected data on 229 men from the time they were teens until they were in their 50s. The researchers looked at the men's quality of life and their relationships with their siblings, the quality of parenting they had, and any family history of depression.

The study has lasted for 68 years and is one of the longest studies of adult psychosocial development ever done, Waldinger noted.

His group found that the two things that predicted depression at 50 were poor relationships with brothers and sisters during childhood and a family history of depression.

The researchers aren't clear about what their finding means. "It could be that not being close to a sibling is an early harbinger of later depression," Waldinger said. "Or it could be that being close to a sibling helps you develop you skills dealing with peers."

"There is this connection," Waldinger said. "But we are not sure why."

One expert said the study provides valuable new insight into the origins of mental illness.

"This long-term study allows a unique opportunity to examine the relationship between early life development and long-term risk for common mental health and substance use problems," said Dr. Gregory Simon, a psychiatrist and mental health researcher at the Group Health Cooperative, in Seattle.

While this study suggests a strong relationship between childhood sibling relationships and adult depression, direction of that relationship can't be determined, Simon said.

"It is certainly possible that poor relationships with siblings during childhood have significant and enduring negative effects on mental health," Simon said. "It is also possible, however, that poor relationships with siblings are one of the early signs of depressive illness."

More information
For more information on depression, visit the U.S. National Institute on Mental Health.