Primary Pulmonary Hypertension News - Menu Antidepressants pose risks for newborns February 9, 2006 - A UCSD study released today is fueling concerns about the effects of certain antidepressant drugs on pregnant women, saying that their use late in pregnancy can significantly increase the chance of deadly lung problems in newborns. NANCEE E. LEWIS / Union-Tribune The antidepressants that increased that risk are in a class called SSRIs or selective serotonin reuptake inhibitors. They include citalopram, fluoxetine, paroxetine and sertraline sold under 19 brand names, including Celexa, Prozac, Paxil and Zoloft. Babies born with the lung disorder, persistent pulmonary hypertension or PPH, often require mechanical assistance to breathe. Between 10 percent and 20 percent will die soon after birth, while others will have developmental delays, hearing loss and brain abnormalities. Chambers said she didn't want pregnant women now taking the drugs to become scared. “Ninety-nine women in 100 who take SSRIs late in pregnancy will not have a baby with PPH, so the risk is fairly low,” Chambers said. “But the risk is higher than if the women don't take the drugs, so I think it's important to get the information out there so health providers and women aren't navigating in the dark.” Dr. Sandra Kweder, deputy director of the FDA's Office of New Drugs, added that the report comes only a few weeks after a flurry of other large studies on other problems with antidepressants, particularly SSRIs. Kweder said the FDA will issue a “public health advisory” in the next few days that may include a recommendation that manufacturers of antidepressant drugs conduct additional safety studies. Women should not go off their antidepressants cold turkey, Kweder said. “Don't panic,” she said, adding that women with concerns should talk to their doctors. A decision about whether to stop taking the drugs should take into account the severity of the depressive symptoms that prompted the prescription. “Stopping these medicines on your own can sometimes create more problems than it solves,” Kweder said. “Often these medicines are associated with withdrawal symptoms, which can be problematic for many patients.” Recent reports have linked SSRIs and other antidepressants with problems in newborns such as not eating properly, jitters and seizures. One study published last week in The Archives of Pediatrics & Adolescent Medicine said 30 percent of infants exposed to SSRIs in the womb develop sugar imbalance, sleep disturbances and difficulty eating that show up like the symptoms of drug withdrawal. In December, the FDA warned that the use of one SSRI, paroxetine sold as Paxil, during the first trimester is associated with increased risk of birth abnormalities such as cardiac defects. Another study published last week in the Journal of the American Medical Association dispelled a previously held belief that hormonal and other biochemical changes in pregnant women somehow protected them from clinical depression. Dr. Lee S. Cohen, a psychiatrist at Massachusetts General Hospital and lead author of the report, wrote that 68 percent of women who discontinued antidepressant treatment after getting pregnant had a significant relapse into depression before giving birth. Published reports suggest that the use of antidepressants by pregnant women results in some negative impact for as many as 30 percent of their newborns, although most of the time the problems are short-lived and reversible. “Most studies have not suggested a smoking gun for long-term problems with the use of SSRIs,” said Dr. James Mills, a researcher with the National Institute of Child Health and Human Development. “But that's not true for PPH. In that group (of newborns) the story is very different” because PPH is so serious. In Chambers' study, the higher incidence of PPH did not occur in women who took non-SSRI antidepressants. These include tricyclics such as amitriptyline sold as Elavil, bupropion sold as Wellbutrin, venlafaxine sold as Effexor and trazodone sold as Desyrel. The higher risk also was not seen in women who stopped taking SSRIs by the 20th week of pregnancy, her study found. Asked if she she would take an SSRI if she were pregnant and depressed, Chambers said that it would depend on how depressed she was, what other coping mechanisms were available and whether she were given options for alternative medications. She stressed that more research is needed to look further into the future for children exposed in the womb to antidepressants. Chambers urged the FDA and drug companies to develop “better information about this group of antidepressants, and as it is developed it needs to be disseminated.” The UCSD study, done with colleagues in Boston, Toronto and Philadelphia, is published in today's New England Journal of Medicine. Participants were enrolled from more than 100 hospitals, including 17 in San Diego County. As they read Chambers' study, San Diego area psychiatrists yesterday said they were rethinking the way they prescribe this class of medication to patients who may be thinking of having children. But sometimes they have no choice, they said, in the case of a patient who is severely depressed and for whom other categories of antidepressants don't work. “Sometimes there is no other way to help a woman who is in a severely restless and agitated state,” said Dr. Rodrigo Munoz, a psychiatrist and former president of the San Diego County Medical Society. “No doubt giving the woman any medication during pregnancy is taking a risk.” Mission Valley psychiatrist Dr. Catherine Moore said she takes into account how sick her patient is. “Some women are so depressed, they're not eating well, and that may have an effect on a baby's low birth weight or cause developmental delays,” Moore said. That absolutely needs to be taken into account, she said. The FDA's Kweder said the Chambers study, added to the others, “absolutely highlights the critical need for more and better information about the safety and best uses of drugs during pregnancy. “What you're seeing is that our society's increasing reliance on pharmaceuticals is finally extending to pregnant women, but there's a paucity of information designed to look at this in a systematic way,” Kweder said. Family marks five years since mother's double lung transplant By: Kristina Herrndobler, The Enterprise Billie Marie was in her den awaiting her next medical treatment, which was keeping her alive while she awaited a double lung transplant. Her own lungs, diseased by primary pulmonary hypertension, were no longer capable of pumping oxygen through her body. She called her daughter, Linda G. Clark, who was at work, and said "Houston called. I've got lungs." Linda cried and then rushed to pick up Billie Marie and help get her to the hospital. Her son, Ransom "Duce" Jones, was eating lunch at a local restaurant. He didn't believe his mother when she told him that her two-year ordeal was about to end. But she wasn't making it up, and on Wednesday, five years after the transplant, Billie Marie, three of her children and a grandson commemorated five years of life over lunch at Suga's Deep South Cuisine in downtown Beaumont. "Instead of (saying) 'Five years ago, our momma passed away,' it is good to say 'Five years ago, our momma got new life,'" said Clark, 49, a Lamar University instructor. Before the transplant, Billie Marie carted around oxygen tanks and endless medication. The illness forced her to retire from her job at Christus St. Elizabeth Hospital in Beaumont. Getting worse each day, she went from doctor to doctor, trying to figure out what was making her so tired, so breathless. At 63, it was unlikely a double lung transplant would be possible. It was even less likely that new life would be given to someone that old. But even as the disease was worsening and time was running out, Billie Marie said she never considered herself a dying woman. "My momma never thought she was going to pass away," Linda added. "But we did." Even if she were to get a transplant, the children knew her weak body might reject it, or that she could die in surgery. "I tried to ask her not to do it," said Duce, 50, who will soon take office as a Jefferson County justice of the peace. "But she said, 'Baby, I've had a good run in life and I don't want to live like this. I'm going for it.' " The lungs that she had prayed for meant someone else had to die, but still she thanks God for them and for the family who donated them. She was told the lungs came from a young man who died in a car crash. Billie Marie said she would like to thank that family, but does not know who they are or anything else about the young man who died that day. Because of that young man's gift of life, eldest daughter Sarah Jones Heath, 51, has changed her mind about donorship. "When I died, I wanted all my stuff to be there," said Heath, an escort driver for a railroad company. But since a donor's lungs kept her mother alive, that is no longer the case. Billie Marie still lives with primary pulmonary hypertension, a rare lung disorder in which the blood pressure in the pulmonary artery rises far above normal levels for no apparent reason, as explained by the American Heart Association. The transplant likely caused her to develop diabetes, something she never had before. But it also reduced the amount of medication she has to depend on and it certainly extended her life and improved the quality of it, the family said. Billie Marie goes for her annual check-up on Tuesday. There are no worries though, because she believes she has a long life ahead of her. After all, her grandmother lived to be 102, she said. Her mother is still alive at 85 and doing well. "I'm going to be here a long time," Billie Marie said. kherrndobler@beaumontenterprise.com |