Multiple articles over the past several years have cited perinatal symptoms in newborns whose mothers were taking an antidepressant late in pregnancy prostate cancer 3 months buy rogaine 2 60 ml, including transient restlessness prostate cancer genetics buy cheap rogaine 2 60 ml on line, jitteriness prostate cancer progression discount generic rogaine 2 canada, tremulousness, and difficulty feeding. There have now been enough reports to suggest certain vulnerable children or subgroups of newborns who were exposed in utero may be at a slightly increased risk for this syndrome. Last year, the Food and Drug Administration required the addition of related information to the labels of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). The results of a recent study of 93 cases worldwide (including 64 associated with paroxetine) from a World Health Organization adverse event reporting database do not represent new findings. The reports include descriptions of nervousness, agitation, abnormal crying, and tremors, which the authors consider a "signal" for perinatal or neonatal toxicity. The study also refers to 11 reports of neonatal convulsions and two grand mal seizures, with no further description of the cases (Lancet 2005;365:482-7). Although the report of neonatal convulsions is relatively new, the study itself has several notable limitations. It is difficult to interpret these results because they are from a spontaneous adverse event reporting system, where typically adverse outcomes are over-reported and do not provide adequate information on when the drug was used, the duration of illness, or whether the woman was depressed during pregnancy. And the absence of a controlled sample makes it difficult to estimate the incidence, which likely is very low, considering the wide use of these medications among reproductive age women. Moreover, depression in the mother has been associated with many of the newborn symptoms reported. The use of the term "withdrawal" syndrome is a dicey clinical call at best. Acknowledging the probable biases involved with collecting and reporting these cases, the report provides another data set that calls attention to the possibility of some type of perinatal syndrome associated with SSRI exposure later in pregnancy, which may not necessarily be a causal relationship. The authors suggest their findings are more of a "signal" that a problem may exist. When considered with other case series, this study may indicate the potential risk for some type of perinatal syndrome associated with the use of these medications, particularly around the acute peripartum period. What is of concern, however, is the impact this report may have on appropriate prescribing of these drugs to pregnant women, and that patients, as well as physicians, will uniformly and arbitrarily avoid these drugs during pregnancy. The article falls profoundly short in terms of helping the clinician. While the results indicate that more vigilance is necessary during the peripartum period in cases of SSRI use, the data do not imply any particular SSRI should be avoided in women of reproductive age. The authors conclude that the signal is stronger for paroxetine, which they say should either not be used during pregnancy or used at the lowest effective dose. I certainly would not rule out using paroxetine in women of reproductive age on the basis of this report, with the possible exception of a woman with immediate plans to become pregnant or a woman with recurrent disease. A reduction in the appropriate use of these drugs in depressed pregnant women would be a serious problem because relapse of recurrent depression during pregnancy is exceedingly common, and depression during pregnancy is the strongest predictor of risk for postpartum depression. Reducing the dose or discontinuing the antidepressant around the time of labor and delivery increases the risk of relapse, although some women may tolerate this approach, particularly if the drug is reinstituted immediately post partum. Physicians should remain vigilant and carefully plan their treatment approach in pregnant patients with depression. The data may, in fact, be a signal that a problem exists. But a signal should be a beacon that guides the clinician. In this case, we have more fog than we have clarification of an already complicated situation. The report concluded that "third-trimester exposure to therapeutic doses of fluoxetine... Information in the report, while comprehensive and technically correct in most cases, might easily be misconstrued by women and their families.
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The bottom line is that a hallmark of anorexia is the massive denial that accompanies the illness man health institute buy discount rogaine 2 60ml online. I have known many persons with so-called "borderline" illness who went on to have significant problems that could have been avoided if they had gotten the help they needed earlier prostate kidney failure rogaine 2 60ml without prescription. I suggest you face the harsh realities of your situation and get the help you need prostate vitamins supplements order generic rogaine 2 line. Brandt, you mentioned earlier that there were some exciting new drug and psychological therapy treatments coming for treating eating disorders. The first point I would make is that the newer medications used to treat as Prozac, Zoloft, Paxil, and others are highly effective in the treatment of some patients with severe eating disorders. We are part of a multicenter study looking at a major antidepressant in decreasing relapse rates in bulimia nervosa and the results are quite promising. Further, the newer drugs can be used with greater ease in persons at low weight. From a psychotherapy perspective, there has been tremendous progress in dynamic psychotherapy, cognitive behavioral therapy, and group therapy techniques in the treatment of eating disorders. Additionally, we are using videotaping in expressive arts therapies to work on body image distortion. Brandt: The newest drugs that we are trying are mirtrazepine (Remeron) and the selective serotonin reuptake inhibitors, as well as the mood stabilizing agents ( depakote, gabapentin, lamotrigine ). Pharmacologic treatment of the eating disorders is complicated by the comorbidity that we see with anxiety, mood disorders, personality disorders, and other psychiatric illnesses. Angela98: What about people who have symptoms of both anorexia and bulimia? This a particularly serious form of eating disorder that requires intensive treatment approaches. One needs to pay attention to the dangers of starvation coupled with dangers of purging. It is ruining my life, but it was so hard to deal with the first time. Brandt: I think you have made an important first step. People with eating disorders are not happy DESPITE being at a low weight. The bottom line is that life can be a whole lot better if you take responsibility and face your illness. I have seen many recover through the years and it is very rewarding. Bob M: There are some parents in the audience tonight who think their children may have an eating disorder. What is your advice to them, or a friend of a potential e. Brandt: I think it is perfectly reasonable to approach a family member or friend if there is suspicion of an eating disorder. I think it is important to be direct, open, and honest with the person, but not judgmental. Parents often have to play a major role in helping their child get the treatment that is essential. It is probably better to focus on the way the individual is feeling as opposed to focusing on food, calories, weight, etc.
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