Depression Medication Linked to Gestational Hypertension
Currently SSRI’s (selective serotonin reuptake inhibitors) are commonly prescribed during pregnancy for those who have been previously responsive to SSRI’s and those who have severe depression or anxiety. A March 2009 study in the American Journal of Psychiatry reported increased incidence of gestational hypertension and preeclampsia in women who took SSRI’s during the last trimester of pregnancy.
Should pregnant women take depression medications? This is a complicated question and requires an individual assessment of the woman’s needs. The risks of taking depression medication have to be weighed against the risks of not taking it. We know that some drugs can cause birth defects especially if taken during the first trimester. Some babies experience medication withdrawal after birth if their mothers took antidepressants during pregnancy. On the other hand, we also know that untreated depression during pregnancy carries its own risk to the baby such as preterm labor, smaller head size and lower birth weight. Also, babies born to untreated, anxious, depressed mothers are more difficult to soothe and may have slowed motor development.
So what’s a woman to do? I tend to be on the conservative side of the spectrum with regards to avoiding medication if at all possible, especially during the first trimester when the baby’s organs are forming. However, I think the general trend has been to use SSRI’s even in mild cases of depression. There are definitely women who cannot continue the rest of their pregnancy off depression medication without putting their life and the life of their unborn baby at risk. In general the findings seen in this study should make us give more consideration as to which women should continue on depression medication throughout their pregnancy and which ones should continue off depression medication and be monitored closely.
Depression Medications Don’t Make You Bulletproof
Taking antidepressant medication does not mean you will not feel bad. It’s important to have reasonable expectations of how you should feel on an antidepressant medication. Depression medication corrects a chemical imbalance responsible for the typical depressed symptoms. Some of these symptoms include a depressed mood, appetite changes, poor sleep (too much or too little), anxiety and poor energy and concentration.
Not everyone who is clinically depressed feels sad. But let’s say you take depression medication and notice improvement in your level of anxiety, your sleep problems resolve and you feel less irritable and hopeless. What then happens when you lose your job? You will be upset and experience the emotions you would have felt if you were not on medication. In other words, the depression medication does not protect you from grieving a loss or responding to hardships with emotional upset.
Some people expect to sail through a difficult situation unscathed if they are on depression medication. If a crisis hits and they have a dip in their mood, they fear they are having a relapse. You may be having breakthrough symptoms, but you may be having the usual and expected response to a difficult situation.
I often say having your depression treated with an antidepressant medication helps give you a stronger foundation to weather the storm more effectively than you could if you were depressed. It’s like kicking an athlete in top form versus kicking a sick man who’s already down.
Generic Drug Side Effects May be Different
In a previous post Are Generic Medicines Just as Good?, I made the point that I thought in general, generic drugs are just a good as the brand name drug. I still believe this, however, the key phrase here is “in general.” I have seen a few medications that result in different side effects when patients took the generic drug. For example, Lamictal is known for possibly causing an allergic rash. Now that we increase the dose over six weeks, the incidence of the rash has significantly decreased. I have seen some patients develop the rash at low doses when they took the generic.
Similarly, a common side effect of Wellbutrin is increased activation or agitation. Many patients can take Wellbutrin without this unwanted side effect, but I’ve had some patients feel increased anxiety or agitation when they switched to generic Wellbutrin.
This is all antedoctal, that is, it’s not based on a head to head study of the generic medication versus the brand. Nevertheless, in my experience, it’s happened enough to take notice. Does this mean that the generic lamictal or generic Wellbutrin are not as good? No. It just means that the different generic manufacturers may have different inactive ingredients that can affect you differently. You don’t know what manufacturer you local pharmacy will use, and they may use a different company the next time you refill. The only way to insure consistency is to use the brand because you know what you will get each time.
For the many people who notice no difference when they take the generic drug, then by all means continue to save money by taking the generic drug. But for those who may be more sensitive to medication side effects, you may need your doctor to write “brand neccesary” on the prescription to avoid an unnecessary substitution to the generic drug.
Driving Deemed Safe with Ambien
A recent literature review showed that people who take Ambien at night for sleep are able to drive 5-6 hours later. J. Jason Buckland, D.O. and associates reviewed 10 studies that involved driving tests after the administration of Ambien. These studies showed that there is no residual impairments in the morning, approxminately 5-6 hours later.
Zolpidem, the generic of the short acting Ambien has a half life of 2.5 hrs. The controlled release version, Ambien CR has a half-life of 2.8 hours. What does this mean? It takes roughly 3 half-lives for a drug to be eliminated from your body. By two half lives, the drug level is at the low end of the curve (meaning little noticable effect if any). So if a person only sleeps 6 hours, they have still passed two half lives of the drug and should show no impairment in their driving ability. This is in contrast to drugs like Trazadone that has a half life of 4-7 hrs or Restoril which is 10hrs. It’s the long half-life that can make people who take these drugs for sleep feel groggy in the morning.
Provigil May Help Chemo-Brain
Researchers at Rochester Medical Center have seen good results in Provigil (brand name for modafinil) improving the negative side effects of chemotherapy that impact cognitive function. Chemo-brain is a term used to describe the foggy, fuzzy thinking and poor memory experienced by some patients after they have undergone chemotherapy.
The research group based their findings on a study of 68 women undergoing chemotherapy for breast cancer. They were treated with Provigil for 8 weeks to combat fatigue. However, the women found they had significant improvement in their ability to concentrate as well as memory and learning.
Provigil is a drug prescribed for excessive daytime sleepiness due to Narcolepsy (which is a problematic sleep condition) and shift-work sleep disorder. Provigil activates the brain in the same way as stimulants like amphetamines and caffeine. Why not just use Adderall or caffeine? Provigil does not have the negative effects on the heart as does Adderall so it is potentially safer.
The study uses a small group of patients and is funded by the drug company who makes Provigil. Despite this, the results are promising. If future studies confirm that Provigil improves cognitive deficits due to chemotherapy, this could significantly improve the quality of life for patients undergoing chemotherapy.
Multiple Medications Common in Bipolar Disorder
At the International Conference on Bipolar Disorder, Dr. Rasmus Licht of Denmark reported on a study of 155 adult patients with bipolar disorder. The patients were treated with lithium and lamotragine (lamictal). They found lamictal tended to be more effective in patients whose index episode was depression and lithium was better for patients whose index episode was mania.
Unfortunately, they found that by five years on the single medication, only two out of the original 155 patients were able to remain on one medication. The remaining patients failed treatment (had a relapse of symptoms) and this usually happened within the first 1 1/2 years.
Following bipolar patient’s progress for five years makes this study unique, and it supports the idea that the majority of patients require more than one medication to control their symptoms in the long run.
Hoodia Can Feel Good or Bad
Hoodia is a cactus-type plant from Africa that has many uses, however the native populations of South Africa have used it for indigestion or infection. The plant Hoodia gordonii has been recognized as an appetite suppressant since the late 1970’s in Africa, but in the US there have been no definitive studies establishing it as a safe and effective appetite suppressant.
Despite this, media hype about the drug began around 2004 when 60 minutes aired a special on it’s effectiveness and since then others have followed suit such as the Today Show and Oprah catapulting it’s popularity. To protect consumers, Hoodia exporters must be issued a CITES (the Convention on International Trade in Endangered Species of Wild Fauna and Flora) certificate by the office of Western Cape Nature in order for Hoodia to be legally exported abroad from Africa. It is illegal to export Hoodia without this certification.
Why is a psychiatrist talking about Hoodia? Having treated patients who took Hoodia (at their own initiative), I’ve seen how it has benefited most and also had some negative effects. Most established appetite suppressants available in the US are stimulants and stimulants as a side effect can lessen one’s desire to eat. It’s not clear what the active ingredient (P57) does, but I wouldn’t be surprised if it’s not a naturally occuring stimulant. As such, it can also have the unwanted affects of agitation and anxiety. If you already have anxiety, this could really worsen your condition.
Some people have dealt with this by taking less than the recommended dose. The pills are usually capsules and can’t be split, but rather than taking it three times a day, some people have taken it once a day at the time of their worst cravings. I have heard some people say Hoodia “takes the edge off” their cravings giving them enough contol to choose not to eat junk or munch unneccessarily.
We know there is no magic pill to control weight, as controlling your eating requires behavioral change. So for some who recongize that long term control of eating is a lifetime, lifetstyle adjustment, Hoodia can be something that gets them started in the right direction long enough to get used to a new way of eating and using food.
Of course, as with any drug (and herbal remedies are drugs too, just naturally occuring ones), a person considering starting it should check with their health care provider prior to taking it.
Electric Shocks When Stopping Medication
Medication discontinuation syndrome can happen when a person stops their medication abruptly. In general, medication should be tapered off slowly with medical supervision. But since we don’t know precisely how slow is slow enough for each individual, sometimes tapering off the medication can still result in some withdrawal symptoms.
Usual withdrawal symptoms are things like fatigue, irritability, diarrhea, headache, anxiety, or feeling like you have the flu. These symptoms typically last a few to several days.
There have been some who have experienced electric shock sensations when stopping Effexor and some other serotonin agents such as Cymbalta, Paxil, etc. This is very unusual, but I’ve heard patients describe it as a “brain shock” that was worsened with movement. In the literature, reports of these symptoms last up to 5 days.
The origin of these sensations is not entirely clear, but thought to be a form of paresthesia (which is the sensation of feeling tingling or creeping on the skin). Paresthesias result from our nerves being activated in a particular area when there is no apparent trigger for the activation – for example, feeling a pinprick on your skin when you haven’t been pricked by a pin.
The electric shocks have been helped by adding back the medication that was discontinued and tapering it more slowly or adding another long acting serotonin agent such as Prozac.
Therefore, stopping medication abruptly is usually not a good idea, especially if you have been taking a particular agent for a long time. It’s best to discuss a tapering schedule with your doctor so that you can have the smoothest transition possible.
