Leapfrog - Should Pregnant Women Take Antidepressants?

This is what I tried to get leapfrogged on Helium to take the place of my earlier article on this subject. You can find the original posted down below. This new one was rejected. If you have comments or suggestions about the two articles and can help me figure out why it failed, please leave them here.

Thanks, Piper


Is it safe to take antidepressants through pregnancy?

It is a simple decision for a pregnant woman to forgo things like cold medicine, caffeine or alcohol in order to protect her baby from potentially harmful substances. The effects of those decisions are short term and not harmful to either mother or child. However, almost 20% of pregnant women experience clinical depression. Left untreated clinical depression can be deadly. Fortunately, there are several options available to treat depression, including psychotherapy, medications, bright light therapy and combinations of these. *[See note]

A study published in the April issue of Pharmacotherapy analyzes the choices available to patients and their doctors. This particular study evaluated the results of several other studies that focused on newer antidepressants, selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephiren reuptake inhibitors. While "information is available on the safety of antidepressant use during pregnancy, it is limited by the small size of most trials and by trial designs that often did not use mothers with depression as control subjects and could not, for ethical reasons, be randomized and double blinded." That paucity makes the decision whether or not to use medication to treat depression during pregnancy that much more difficult. Pregnant women "are subject to the same adverse consequences of depression as are non-pregnant women, including social withdrawal and even suicide."

Pregnant women frequently receive unsolicited and unwelcome advice; even from complete strangers. In addition, pregnant mothers often find themselves on the receiving end of harsh criticism for decisions that they make during their pregnancy. Some decisions can be debatable. For example, is it a good idea for her to take a vacation in the wilderness? In the case of major depression, however, the mother needs to be able to take care of herself and her child without suffering society's condemnation.

Untreated clinical depression during pregnancy has been associated with preeclampsia, miscarriages, and premature labor. "In addition, pregnant women with depression are less likely to attend regular obstetric visits and may have lower than normal weight gain, may lack compliance with prenatal care, and may be more likely to smoke, drink alcohol, or use cocaine."

While data about the gestational pharmacotherapy is sparse, most of the data is encouraging. For example, "preliminary evidence suggests that SSRI exposure in utero does not have significant long-term effects on cognition or behavior." In the end, society needs to realize that a clinically depressed mother-to-be is just like any mother who would do whatever it takes to save her child's life. It is for this reason that doctors and women should weigh all the factors to decide on an appropriate treatment plan. This includes acknowledging the fact that the life of both mother and child may depend on her decision.

http://www.pharmacotherapy.org

*Electoconvulsive therapy is another option, however, it is only used when other therapies have failed to provide relief.

Should Pregant Women Take Antidepressants?

It is a simple decision for a pregnant woman to forgo things like cold medicine, caffeine or alcohol in order to protect their baby from potentially harmful substances. The effects of those decisions are short term and not harmful to either mother or child. However, almost 20% of pregnant woman experience clinical depression. Left untreated clinical depression can be deadly. There are several options available to treat depression, including psychotherapy, medications, bright light therapy and combinations of these.**[see note]

A study published in the April issue of Pharmacotherapy analyzes the choices available to patients and their doctors. This particular study evaluated the results of several other studies that focused on newer antidepressants; selective serotonin reuptake inhibitors (SSRIs) and seratonin norepinephiren reuptake inhibitors. While “information is available on the safety of antidepressant use during pregnancy it is limited by the small size of most trials and by trial designs that often did not use mothers with depression as control subjects and could not, for ethical reasons, be randomized and double blinded.” That paucity makes the decision whether or not to use medication to treat depression during pregnancy that much more difficult. Pregnant women “are subject to the same adverse consequences of depression as are non-pregnant women, including social withdrawal and even suicide.”

Untreated clinical depression during pregnancy has been associated with preeclampsia, miscarriages, and premature labor. “In addition, pregnant women with depression are less likely to attend regular obstetric visits and may have lower than normal weight gain, may lack compliance with prenatal care, and may be more likely to smoke, drink alcohol, or use cocaine.”

While data about the gestational pharmacotherapy is sparce, most of the data is encouraging. For example, “preliminary evidence suggests that SSRI exposure in utero does not have significant long-term effects on cognition or behavior.” Doctors and women should weigh several factors to decide on a treatment plan including the severity of the depression and the preferences of the mother.

**Electoconvulsive therapy is another option, however, it is only used when other therapies have failed to provide relief.

Ethanol Fuel May Pose Health Risks

Ethanol is a renewable alcohol fuel hyped as environmentally friendly solution to air pollution. Proponents claim that ethanol burns cleanly and produces less toxic emissions. It is a linchpin in President Bush's plan to reduce gasoline consumption in the United States by 20% with 10 years. The president announced the plan during the State of the Union address in January 2007.

The most common form is ethanol currently available in the US is E10, a mixture of 90% gasoline and 10% ethanol. E10 is used primarily in urban areas that do not meet clean air standards. All vehicles that use gasoline can run on E10 without a modified engine. The California Air Resources Board (CARB) has been considering the impact of ethanol on air quality. So far, CARB seems ambivalent toward ethanol. It recently applied for a waiver from the U.S. Environmental Protection Agency's rule requiring the use of E10 during the winter months.

That is a valid concern according to Dr. Mark Jacobson, an atmospheric chemist at Stanford University. In the 1970s, Brazil heavily promoted ethanol fuel. At the same time, for reasons that are still unclear, air quality deteriorated. Using that knowledge, a NASA research grant for computational development, and a sophisticated atmospheric computer model, he compared two air quality scenarios for the year 2020: a vehicle fleet fueled entirely by gasoline versus a fuel flexible vehicle (FFV) fleet, which should be common by then. FFVs are vehicles that can run on 100% unleaded gasoline or a mixture of gasoline and up to 85% ethanol. The next generation of ethanol is E85, a blend of 85% ethanol and 15% gasoline. It contains approximately 80% less contaminants than gasoline. The National Ethanol Vehicle Coalition (NEVR) maintains that E85 will reduce greenhouse gas emissions as much as 46%, is non-toxic, water soluble and biodegradable. They claim that the cleaner exhaust will mean less smog and fewer respiratory illnesses. The American Lung Association of the Upper Midwest also endorses E85 as a CleanAirChoice.

However, Dr. Jacobson's study, "Effects of Ethanol (E85) Versus Gasoline Vehicles on Cancer and Mortality in the United States", produced results that contradict NEVR's assertions. This is the first study that examined not just tailpipe emissions, but also "chemical reactions, temperatures, sunlight, clouds, wind and precipitation." He found that E85 emissions did reduce atmospheric levels of two carcinogens, benzene and butadiene. Unfortunately, the atmospheric levels of two other carcinogens, formaldehyde and acetaldehyde, actually increased. Dr. Jacobson adds that "we have found that using E85 will cause at least as much health damage as gasoline, which already causes about 10,000 U.S. premature deaths annually from ozone and particulate matter."

The Renewable Fuels Association published a review** that challenged these results. It was written by Dr. Gary Z. Whitten, who has worked in the field of gas-phase photochemistry since the 1960s. He has testified as an expert witness before Congress, State Legislatures, and the U.S. EPA as an expert witness on the subject of various emission sources and the impact on air quality. While both scientists agree that the future is uncertain with regard to emission technology, regulations and other fuel formulations, they reach entirely different conclusions. Dr. Whitten's primary objection to this study centers on the data Dr. Jacobson entered into the computer model. "The methodology used to assemble existing data... is not described in sufficient detail to assess... that methodology or the range of data variability." He also believes that rapidly developing technology make long-term projections unreliable.

Responding to the review, Dr. Jacobson says, "Dr. Whitten did not realize that simulations were done for present day conditions as well, as reported in the paper. Almost his entire argument centered around uncertainties in future emissions when, in fact, simulations indicated an even greater effect under current emission conditions, which are extremely reliable. Further, four sensitivity tests were run examining different possible future (2020) emission scenarios, and regardless of the uncertainty, the future results held. Dr. Whitten did not realize these results were also stated in the paper. He hypothesized incorrectly that conclusions would change if emissions changed."



This article is based on information from an article entitled "Clearing the Air On Ethanol" published in the April 18 online edition of the journal Environmental Science & Technology (ES&T) and input directly from Dr. Mark Jacobson.