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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by caraher on July 20, 2006, at 0:22:27
http://news.yahoo.com/s/nm/20060719/hl_nm/antidepressants_dc_1
This seems very serious if the FDA is bringing it up. The short story is that they want warnings for two categories of patients taking SSRIs or SNRIs:
- Patients also taking certain migraine meds (triptans) run a risk of "serotonin syndrome."
- Newborns born to pregnant women taking SSRIs/SNRIs are at risk for a potentially fatal lung condition (persistent pulmonary hypertension)
Posted by Phillipa on July 20, 2006, at 12:27:32
In reply to New AD warnings in US?, posted by caraher on July 20, 2006, at 0:22:27
Years a go I asked for triptans for headaches and my pdoc said no that are incompatible with SSRI's and that was the bad pdoc. Guess he did know something about meds. Love Phillipa
Posted by Glydin on July 20, 2006, at 15:37:15
In reply to New AD warnings in US?, posted by caraher on July 20, 2006, at 0:22:27
> - Newborns born to pregnant women taking SSRIs/SNRIs are at risk for a potentially fatal lung condition (persistent pulmonary hypertension)
~~~ A risk possibly but not a huge risk as noted by the study:[“Based on our findings, we estimate that six to twelve mothers per thousand who use an SSRI after 20 weeks’ gestation, are likely to deliver a child with PPHN,” said Chambers. “Put in practical terms, the risk is relatively low -- about 99 percent of women exposed to one of these medications during the latter half of pregnancy will deliver an infant unaffected by PPHN.”
quote by Lead author on the study, Christina Chambers, Ph.D., M.P.H., of the Departments of Pediatrics and Family and Preventive Medicine at UCSD]
There is also not good evidence as to the pathophysiology to a cause and effect relationship. PPHN, as I've seem, is generally the result of other MANY complications that can cause a lack of being able to switch from fetal circulation patterns to what is required for "being outside". PPHN existed and was a frequent diagnosis for NICU admissions long before the advent of SSRI's or SSNRI's. I think there are sometimes hairtriggers for studies and grant monies.
Posted by caraher on July 20, 2006, at 16:14:22
In reply to Re: New AD warnings in US? » caraher, posted by Glydin on July 20, 2006, at 15:37:15
>
> > - Newborns born to pregnant women taking SSRIs/SNRIs are at risk for a potentially fatal lung condition (persistent pulmonary hypertension)
>
>
> ~~~ A risk possibly but not a huge risk as noted by the study:
>
> [“Based on our findings, we estimate that six to twelve mothers per thousand who use an SSRI after 20 weeks’ gestation, are likely to deliver a child with PPHN,” said Chambers. “Put in practical terms, the risk is relatively low -- about 99 percent of women exposed to one of these medications during the latter half of pregnancy will deliver an infant unaffected by PPHN.”I'm curious what the risk would be otherwise - is this a tenfold, 50% or 5% increase in risk of this particular complication?
I have no ax to grind here, and neither of these warnings affects me directly. But there are obviously lots of women on these drugs who will become pregnant and who will have to make decisions about risks.
Also... did the study conclude that there was no significant effect due to SSRI use before 20 weeks? That would be good to know!
Posted by Glydin on July 20, 2006, at 16:33:59
In reply to Re: New AD warnings in US?, posted by caraher on July 20, 2006, at 16:14:22
> I'm curious what the risk would be otherwise - is this a tenfold, 50% or 5% increase in risk of this particular complication?
>~~~ From what I can tell, the conclusions are saying it's is on the order of 5-6 times higher for risk of PPHN. I have being quite discerning in looking at these stats as in 25 years of experience, I've seen initial studies not bear fruit when held to closer observation. And this one was a retrospective data gathering. I would like more data and some investigations as to what is the etiology.
> I have no ax to grind here, and neither of these warnings affects me directly.
~~~ Didn't think ya did. (smile)
> But there are obviously lots of women on these drugs who will become pregnant and who will have to make decisions about risks.
~~~ Finding what we doing in terms of fetal impact has to be done. I'm just not sure about this particular one.... yet. We do know some of the outcomes for untreated depressive disorders in Mothers.
>
> Also... did the study conclude that there was no significant effect due to SSRI use before 20 weeks? That would be good to know!~~~ Yep, and it's also quite interesting as most tetragenic effects happen early in development. Of course, tetragenesis and structural physiological changes probably would not equate in this case.
Posted by Glydin on July 20, 2006, at 17:31:34
In reply to Re: New AD warnings in US? » caraher, posted by Glydin on July 20, 2006, at 16:33:59
Searching my memory (dangerous attempt - smile), I'm not sure I have ever seen an infant present with JUST PPHN without the potential causive processes of: Meconium aspiration syndrome (most common per my experience), anemia, severe pneumonia, infection, hypoglycemia, and birth asphyxia... the list goes on. Now, I haven't seen it all and everytime I THINK I have, something else will blow that thought right out of the water for me.
I'm being like a dog with a bone, maybe I'm just happy to have something I can actually speak about and really know - that's rare for me here.
This is the end of the thread.
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