On May 28, 2008, The Food and Drug Administration announced a major revision in the labeling of the pregnancy and breast-feeding risk of drugs. The current labeling system was devised in 1979 and has been criticized over the years for being confusing and for failing to incorporate the most recent data.
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Any discussion of psychiatric medications and breastfeeding must begin with the benefits of breastfeeding, which are substantial. While all psychotropic medications enter the breast milk, medication exposure for a nursing infant is much less than the exposure to a fetus during pregnancy.
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Dr. Hendrick, earlier this decade, most experts felt that SSRIs were relatively safe in pregnancy, but lately the pendulum seems to be swinging in the other direction. What do you consider to be the major risks of SSRIs in pregnancy?
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A recent trial examined the impact of augmenting antidepressant treatment with risperidone. Participants had not shown a treatment response after taking an antidepressant for at least five weeks, and were then randomly assigned to receive either risperidone or placebo augmentation along with the same dose of their antidepressant.
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The original Epidemiological Catchment Area (ECA) study (based on interviews conducted in the 1980s) examined the prevalence of mental disorders among adults in five American cities. Taking a fresh look, researchers examined data from 6,832 adults who resided in the community in order to ascertain the relationship between headache and suicidality.
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Dr. Aiken is the Editor in Chief of The Carlat Psychiatry Report; director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments; and Assistant Professor NYU Langone Department of Psychiatry. He has worked as a research assistant at the NIMH and a sub-investigator on clinical trials, and conducts research on a shoestring budget out of his private practice. Follow him on Twitter and find him on LinkedIn.
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