Antidepressants during pregnancy: use caution
December 25, 2011
Antidepressants during pregnancy can harm the child's health, but stopping these drugs can endanger the health of the mother. Antidepressants - "first aid" in the treatment of any kind of depressive disorders, effectively suppresses the symptoms of depression. Although pregnancy does not worsen the symptoms of depression, fluctuations in hormone levels make women more vulnerable emotionally, complicating the fight against depression.
Refusing to treat depression during pregnancy, a woman may endanger not only their own health but also the health of the unborn baby. Depression robs a woman of energy needed to take care of their own health and the health of the child, can cause addiction to alcohol or smoking. The price is not cured in time of depression is very high: the refusal of the treatment of depression can lead to premature birth, birth defects, increase the risk of postpartum depression.
In general, the risk of birth defects and other health problems to a child when the woman taking antidepressants during pregnancy is very low. However, some drugs used to treat depression during pregnancy are contraindicated, as indeed can harm a child's health. There are a number of antidepressants, which take during pregnancy can, without fear for their own health and the health of your baby.
Types of Antidepressants
Selective serotonin reuptake inhibitors
- Citalopram. Potential risks - a rare but serious lung disorder in newborns (neonatal persistent pulmonary hypertension) at a reception in the third trimester of pregnancy and the risk of birth defects of the brain and skull (anencephaly, craniosynostosis). Deemed acceptable during pregnancy.
- Fluoxetine. The potential risk - persistent pulmonary hypertension in newborns when taking the second half of pregnancy. Deemed acceptable during pregnancy.
- Paroxetine. The potential risk - congenital heart disease
Heart defects - time heals?
in newborns when taken in the first trimester of pregnancy, and anencephaly, craniosynostosis and omphalocele. Contraindicated in pregnancy.
- Sertraline. The potential risk - persistent pulmonary hypertension
Hypertension - Control your blood pressure
newborns when taking the second half of pregnancy, and septal congenital heart defects and fetal hernia. Deemed acceptable during pregnancy in some cases.
Persistent pulmonary hypertension of the newborn, anencephaly, craniosynostosis and omphalocele - a very rare disease. Even with long-term treatment of antidepressants - selective serotonin reuptake inhibitors during pregnancy the risk of such diseases in the baby is very small.
- Amitriptyline. The potential risk - hypoplasia of the limbs (not confirmed the latest medical research). Deemed acceptable during pregnancy.
- Nortriptyline. The potential risk - hypoplasia of the limbs (as is the case with amitriptyline, nortriptyline influence on the development of the limbs of the child is not confirmed the latest research). Deemed acceptable during pregnancy.
Antidepressants - monoamine oxidase inhibitors
- Phenelzine. The potential risk - a sharp increase in blood pressure, provoking a heart attack. Contraindicated in pregnancy.
- Tranylcypromine. The potential risk - a sharp increase in blood pressure
Blood pressure - dangerous if his swing?
Provoking a heart attack. Contraindicated in pregnancy.
- Bupropion. Because of the lack of potential risks is considered one of the most effective drugs for the treatment of depression
Depression - a little more than a bad mood
Pregnancy and Roaccutane - can not combine
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, Which includes the retinoid or a synthetic analogue of vitamin A. Vitamin A is needed during pregnancy, but in small amounts in the form of short courses. Overdose of vitamin A is very dangerous for pregnant women because it may cause fetal abnormalities.
Structure and mechanism of action of Roaccutane
Active ingredient of Roaccutane Isotretinoin is a retinoid. This drug is produced only in the form of capsules for oral administration and has a general (systemic) effect on the body.
Action Roaccutane related to the suppression of proliferation (proliferation) and differentiation (specialization tissue cells, they differ from other cells), epithelial cells lining the sebaceous glands. It accumulates in these cells, and then discharged outside sebum. Additionally, isotretinoin helps normalize the chemical composition of sebum and dead cells dissolution (keratolytic action) - these cells are mixed with sebum, sebaceous gland is sealed, there multiply pathogens inflammatory processes, which leads to the formation of acne.
Roaccutane does not have anti-bacterial and anti-inflammatory properties, but increased saloobrazovaniya suppression and changes in the composition of sebum along with keratolytic action helps to ensure that infectious agents multiply less active inflammatory process and is not developing.
What is dangerous for pregnant women Roaccutane
Roaccutane contains high doses of retinoids - synthetic analogues of vitamin A. Today, it is well established that high doses of the vitamin have teratogenic effects, that is, cause various malformations in the fetus, which is obviously due to the suppression of cell proliferation and differentiation of tissues. It may be some anomalies such as cleft lip and cleft palate, do not allow your child to suck and swallow normally. There may be more significant anomalies, for example, from brain (microcephaly, hydrocephalus, etc.), with the circulatory system (high heart disease), and other organs and systems. In addition, it increases the risk of miscarriage
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Vitamin A is needed by pregnant women, but not in such doses. The situation is exacerbated by the fact that pregnant women are reduced functional activity of the liver, whereas retinoids (as well as natural vitamin A) accumulates in the liver and adipose tissue and are used by the body slowly. This further contributes to a drug overdose.
Roaccutane has other side effects:
- on the part of the brain and sensory organs - headaches, bouts of depression, increased intracranial pressure, seizures, various visual and hearing impairment;
- the part of the digestive system - nausea, inflammation of the walls of the small intestine and colon, gastrointestinal bleeding, pancreatitis, transient liver problems, sometimes - hepatitis
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- on the part of the musculoskeletal system - joint pain
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and muscles, hyperostosis (pathological proliferation unmodified bone, including compression of the spinal column with the spinal cord) and other bone changes;
- from the blood - decrease in the number of white blood cells (leading to decreased immunity and development of infectious and inflammatory processes), red blood cells (anemia), and platelets (increased bleeding) in the blood;
- In addition, lymph nodes may increase, the appearance of protein in the urine and blood development vasculitis (inflammation in the walls of small blood vessels).
When receiving Roaccutane may also increase the content of cholesterol and uric acid in blood, which increases the risk of cardiovascular diseases.
Pregnancy and Roaccutane: manufacturers warn
The manufacturer of Roaccutane is a Swiss pharmaceutical company F. Hoffmann-La Roche Ltd. The company has developed a number of requirements for the use of Roaccutane in women of childbearing (reproductive) age, in order to avoid the risk of teratogenic effects of the drug on the fetus. Roaccutane can not be applied to women of reproductive age. The exception is a woman:
- with severe acne that had previously unsuccessfully treated by other methods of treatment;
- women who know about the teratogenicity of Roaccutane and that it can not be taken, both during pregnancy and during the months prior to its occurrence; if they agree to comply with all the requirements of a doctor, including the use reliable contraception; while a woman must certify in writing that he understands why those precautions required;
- surveyed pregnancy two weeks before the start of treatment; further pregnancy tests should be conducted on a monthly basis, as well as after treatment;
- during one menstrual cycle before treatment, during treatment (course begins third day of the next menstrual cycle) and one menstrual period after the end of a woman (even if she is suffering from infertility) should use reliable methods of contraception.
Thus, the experimentally confirmed teratogenic effects of Roaccutane, not allows the use of this drug during pregnancy and during its planning.