The British researchers also found that women prone to aggressive and disruptive behavior in their teen years are more likely to become depressed during pregnancy, which shows that a mother’s history predicts her children’s antisocial behavior.

The study included 120 inner-city youth and their mothers. The children’s mothers were interviewed while they were pregnant, after they gave birth, and when their children were 4, 11 and 16 years old.

Mothers who were depressed during pregnancy were four times more likely than normal to have boys and girls who were violent at age 16. The mothers’ depression was predicted by their behavior problems as teens.

“Although it’s not yet clear exactly how depression in pregnancy might set infants on a pathway toward increased antisocial behavior, our findings suggest that women with a history of conduct problems who become depressed in pregnancy may be in special need of support,” Dale F. Hay, a professor of psychology at Cardiff University in Wales, said in a news release.

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But given that depression itself is a well-established risk factor for early death, heart disease and other ills, the study’s author told Reuters Health, women who need to take these medications shouldn’t see the new findings as a reason to quit.

“Women should not stop taking the medications based on this one study,” Dr. Jordan W. Smoller of Massachusetts General Hospital in Boston said in an interview. “What our study does is give patients and doctors a little bit more information about the risk-benefit calculation for older women.”

Antidepressant use in the US has more than quintupled since the early 1990s, Smoller and his colleagues note in their report in the Archives of Internal Medicine.

So-called selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft are now the first-line treatment for most patients, having replaced older medications called tricyclic antidepressants that may harm the heart.

But little is known about how SSRIs affect heart health, especially in postmenopausal women, who are at increased risk for both heart disease and depression.

To investigate, Smoller and his team looked at 136,293 women participating in the Women’s Health Initiative, an ongoing investigation of women’s health after menopause. None of the women were taking antidepressants at the study’s outset.

During follow-up, which lasted about six years, 5,496 of the study participants started taking antidepressants. While there was no association between antidepressant use and heart disease, the researchers did find that women taking SSRIs had a 45 percent increase in risk of stroke and a 32 percent increase in risk of dying from any cause during follow up, compared with nonusers. Use of older tricyclic antidepressants wasn’t linked to stroke, but it did increase by 67 percent the risk of death during follow up.

It’s important to remember, Smoller said, that these numbers represent “relative risk.” The actual risk of stroke or death for women taking the medications was higher than for women who weren’t using them, but it was still quite small.

For example, he explained, during a given year 0.8 percent of the women not using antidepressants would die, compared to 1.2 percent to 1.4 percent of the women taking the medications. And while 0.3 percent of women who weren’t taking SSRIs would have had a stroke in a typical year, 0.42 percent of women using SSRIs would suffer a stroke annually.

Another limitation to the findings, Smoller added, is that the effect observed with antidepressants could have been related to the fact that women who used the medications had other risk factors that couldn’t be completely accounted for — like being depressed.

The increased risk of death and stroke associated with depression itself, he added, is similar to that seen with the antidepressants used in the study.

No matter what, the researcher said, the relationship between antidepressants and death must be investigated further. “More than 10 percent of Americans are taking antidepressants,” he said. “It’s an important category of medication for us to understand better.”

SOURCE: Archives of Internal Medicine, December 14/28, 2009.

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“But statistical significance can be different from clinical significance,” stressed Dr. Jordan W. Smoller, an associate professor of psychiatry at Harvard Medical School, and lead author of a report in the Dec. 14 issue of Archives of Internal Medicine. “It is possible that a statistically detectable effect may not be a problem for most people.”

The study compared six-year data on 5,500 postmenopausal women who began taking antidepressants after enrolling in the Women’s Health Initiative trial to data on more than 130,000 who did not take the drugs.

It found that women on selective serotonin uptake inhibitors (SSRIs, which include Celexa, Paxil, Prozac and Zoloft) had a 45 percent increase in risk for stroke and a 32 percent increase in risk for death from any cause, compared to non-users. Similar results were found for women on tricyclic antidepressants.

But the overall risk for any one woman remained very small, the authors stressed.

“The annual risk [of stroke] was 0.3 percent for women who did not take antidepressants, and ranged from 0.4 to 0.5 percent for women who did,” said Smoller, who is also assistant vice chairman of psychiatry at Massachusetts General Hospital. “In a sample this large, that is a statistically significant difference, but it means that by far, most women did not have a stroke.”

No increased risk for other heart problems was found in the study.

So, the decision as to whether and when an older woman with depression should take an antidepressant remains, “an individualized matter between a patient and her physician,” Smoller said. “This study provides one more piece of information when considering options for treating depression.”

Those options can include psychotherapies such as cognitive behavioral therapy, which have been shown to benefit many persons with depression, Smoller said.

“There are many ways to treat depression,” he said. “But for serious depression, medication is often part of the treatment. For most women with serious depression, the benefits of medication outweigh the risks.”

Depression itself “is a very serious and often debilitating illness that has its own effects, such as heart disease,” Smoller noted. And he added that the study was not a randomized, controlled trial, which makes it difficult to distinguish the effects of depression itself from those of antidepressant medications.

Someone who is taking an antidepressant and is worried about cardiovascular problem such as stroke, “should be vigilant about risk factors such as smoking, weight and cholesterol,” Smoller said.

That point was echoed by Sylvia Wassertheil-Smoller, a professor of epidemiology and public health at Albert Einstein College of Medicine, and a member of the research team (and mother of Jordan W. Smoller).

“Women who are on antidepressants should pay particular attention to other cardiovascular risk factors,” she said. “There is lots of stuff that we know is effective but don’t do. We know that hypertension is a risk factor, yet only a third of hypertensives have it under control.”

A woman’s decision about taking an antidepressant “depends on how severe and how debilitating her condition is,” Wassertheil-Smoller said. “You have to weigh the risk and the benefit. But that applies to any drug, even aspirin.”

It would take a major controlled trial to establish the risk-benefit ratio for antidepressants, and such a trial is highly unlikely, she said. “It would have to be a long-term trial, and you couldn’t ethically assign people not to take antidepressants if they need antidepressants,” she explained.

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What could be causing your decreased sex drive?

The most commonly used class of antidepressants is selective serotonin reuptake inhibitors (SSRIs). This class includes Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine) and others. SSRIs work by helping to restore the right balance of the brain chemical serotonin. SSRIs are effective and have fewer and less severe side effects than the older types of antidepressants. They can have one possible side effect, though: decreased libido. And this can be bothersome for some.

But, before giving your antidepressant the heave-ho, consider these other possible causes of sexual dysfunction. One or more of them may be contributing to your diminished sex drive.

• Depression. Decreased sex drive is a common symptom of depression. So as your depression lifts with treatment, your sex drive may improve as well. But, be patient. It usually takes three to six weeks to feel the full effects of an SSRI.
• Treatment for depression. Decreased sex drive is also a common side effect of many, but not all, SSRIs. Along with reduced libido, SSRIs may also cause delayed orgasm or other erection problems that may affect your sex life.
• Other medications. Certain other types of medication can contribute to a declining sex drive. This includes several antipsychotic drugs and certain heart medications. Check all your medications with your doctor.
• Hormones. If your sex drive doesn’t improve along with your depression, you should talk with your doctor. Not having an adequate amount of certain hormones may affect your sex drive.
• Life stressors. Relationship problems and stressful events, such as going through a divorce or losing a job, may trigger depression. It can also lead to reduced sexual desire.
• Alcohol and drugs. Drinking too much alcohol or taking some recreational drugs can inhibit sex drive, too.
• Other medical conditions. Certain chronic illnesses, such as diabetes, heart or lung problems may have negative effects on your sex drive.

What can be done to boost your sex drive?

Luckily, you can do something to get your sex drive back to where it was. Start by telling your doctor that you are having a problem. There’s no need to feel embarrassed - this is a common complaint among people being treated for depression. To help, your doctor may:

• Reduce the dose of your antidepressant
• Switch you to a different antidepressant, such as bupropion, that has fewer sexual side effects
• Add medications that can help relieve sexual side effects
• Suggest you take a one- or two-day drug “holiday” off your antidepressant
• Ask you to consider counseling to work out any relationship problems or other psychological issues

IMPORTANT: Do not stop taking your antidepressant or reduce the dose of this medication without discussing it with your doctor first.

You don’t have to live with depression or a low sex drive. Relieving both conditions at the same time is possible. Take the first step toward a better life - talk to your doctor.

Note:  Anyone being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. This warning applies to everyone - adults, teens and children. Bring up your concerns immediately with a doctor.

View the original ‘Are antidepressants affecting your sex drive?‘ article on myOptumHealth.com

SOURCES:

• Rakel RE. Medical human sexuality in family medicine practice. In: Textbook of Family Medicine. 7th ed. Philadelphia, PA: Saunders Elsevier; 2007.
• Ferguson JM. The effects of antidepressants on sexual functioning in depressed patients: a review. Clinical Psychiatry. 2001;62(S3):22-34.
• Phillips RL Jr, Slaughter JR. Depression and sexual desire. American Family Physician. 2000;62(4):782-786.
• Brown University Psychopharmacology Update. Sexual side effects of antidepressants common, but still seriously underestimated by physicians. Accessed: 01/28/2008

Technorati Tags: antidepressant side effects, Antidepressants, Treatment for depression

Scope

• In-depth analysis of the current and future antidepressant drug class market across the US, Japan, France, Germany, Italy, Spain and the UK.
• Country-specific total brand sales forecasts for key products, generics and pipeline agents across the seven major markets to 2018.
• Assessment and appreciation of the numerous opportunities and threats present in the antidepressant market, with analysis of emerging markets trends.
• Case study evaluation of the strategies employed by key players in the antidepressant drug class market, including Wyeth, Forest, and Lundbeck.

Highlights

Japan will remain a key growth market for antidepressant sales, shown through the launch of Remeron (mirtazapine; Schering Plough), Lexapro (escitalopram; Lundbeck and Mochida), Cymbalta (duloxetine; Eli Lilly and Shionogi) and Pristiq (desvenlafaxine; Wyeth).

Eli Lilly’s efforts to gain a broad range of indication approvals for Cymbalta has been a key differentiator from Effexor (venlafaxine, Wyeth). The approvals for diabetic peripheral neuropathic pain (US and EU) and fibromyalgia (US only) will help drive Cymbalta’s uptake through the forecast period, before the entry of generic duloxetine in 2012.

With its innovative mode of action, strong efficacy and favorable side-effect profile, Valdoxan (agomelatine; Servier and Novartis) is an exciting new antidepressant. Assuming US launch in 2012 (EU launch came in 2009), Datamonitor expects Valdoxan to prosper due to the lack of other truly novel pipeline products over the 10-year forecast period.

Reasons to Purchase

• Quantify the current and future size of the antidepressant drug class market.
• Assess the impact of recent and anticipated events (patent expiries and new product launches) on the antidepressant drug class market.
• Understand the country-specific impact of key events in the antidepressant drug class market during the forecast period 2009 to 2018.

Commercial Insight: Antidepressants - Novel mechanism offers hope in depressed market: http://www.companiesandmarkets.com/r.ashx?id=78M5Y18N4162144

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The increase seemed to span virtually all demographic groups.

“Over 10 percent of people over the age of 6 were receiving anti-depression medication. That strikes me as significant,” said study author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University/New York State Psychiatric Institute in New York City.

According to background information in the study, antidepressants are now the most widely prescribed class of drugs in the United States. The expansion in use dates back to the 1980s, with the introduction of the antidepressant Prozac (fluoxetine).

The study found that 5.84 percent of U.S. residents aged 6 and over were using antidepressants in 1996, compared with 10.12 percent in 2005. That’s 13.3 million people, up to 27 million people.

“This is a 20-year trend and it’s very powerful,” remarked Dr. Eric Caine, chair of the department of psychiatry and co-director of the Center for the Study of Prevention of Suicide at the University of Rochester Medical Center.

This happened despite a “black box” warning mandated for many antidepressant medications by the U.S. Food and Drug Administration in 2004, the study authors noted.

Lower rates of increases in antidepressant use were seen in blacks (3.61 percent in 1996 versus 4.51 percent in 2005) and in Hispanics (3.72 percent versus 5.21 percent in 2005), the researchers found.

Still, about the same number of people were being treated for depression (26.25 percent in 1996 versus 26.85 percent in 2005), indicating that the drugs were being used to treat other diagnoses, such as anxiety and other mood disorders.

At the same time, those receiving antipsychotic medications increased from 5.46 percent to 8.86 percent, and the proportion of people using psychotherapy dropped from 31.5 percent to 19.87 percent.

“The reasons [for the growth] are unclear but they may include the introduction of new antidepressants over the last 10 to 12 years or so and a broadening in the clinical indications of antidepressant treatment. Years ago, these drugs were largely focused on depression. Today, more different conditions are treated with antidepressants,” Olfson said. “There’s also been an increase in direct-to-consumer advertising and a lessening of the stigma associated with seeking mental health care.”

Indeed, a study released last week found that roughly five of six Americans now have a positive opinion on psychiatric medications, a marked increase from about a decade ago.

Depression may also be more common in the population, or at least more people may be acknowledging it and seeking help, the authors suggested.

“It is encouraging that there is apparently an increased awareness and increased willingness to seek assistance for emotional distress . . . and that is a big step forward,” said Dr. Kathryn J. Kotrla, chairwoman and associate professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine.

“I think part of the increased rate is increased awareness, as well as national depression screening all over the country,” added Dr. M. Beatriz Currier, an associate professor of clinical psychiatry at the University of Miami Miller School of Medicine. “Education and screening decrease stigma.”

Of concern, however, was the finding that the majority of Americans taking antidepressants were not receiving care from a psychiatrist.

Also troubling was not knowing what the prescriptions were being written for exactly.

“One wonders if the medication is being used as a possible panacea for a number of psychosocial issues which might be better served by counseling,” Kotrla said.

“Who’s really taking these medications?” Caine said. “It’s not clear that it makes anyone healthier. That’s a fundamental issue that we don’t know. We don’t have any way of telling if this made people’s lives better.”

A second study in the same issue of the journal followed 306 preschoolers aged 3 to 6 years for 24 months and found that depression in this group tends not to just go away as the child gets older, but can linger as a chronic condition.

“This is exciting because it gives us an opportunity for early intervention,” Kotrla said.

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There are certain drugs that are very helpful in controlling the symptoms of depression and if taken regularly, the person won’t stay depressed for very long.  There are still people who believe that taking depression stress relief pills makes them weaker or less than the people around them.  It just isn’t true and the word needs to get out that depression stress relief pills are no different than a cast on a leg or crutches to help people walk.  With that attitude, more people might come forward and get the help that they need.  There are many medicines now that can affect the brain by better regulating the chemical release of serotonin.  A person’s mood will get better and that allows the person to better control the many things that originally were becoming stress and depression.
Zoloft

One more depression stress relief pill is Zoloft.  Zoloft is even more powerful than the others.  It is prescribed for people that suffer from extreme depression.  People with major depression will be in a very low mood that stays that way everyday.  People with major depression are more susceptible to having thoughts of suicide.  Taking a depression stress relief pill can help a person to feel better and handle stress better.

Prozac

Many people have heard about the drug called Prozac but not everyone understands what it does.  Prozac is a pill that effectively controls depression; a continuing depression that interferes with daily functioning.  It also has a generic equal called Fluoxetine.  They are the same depression stress relief pills; just one cost less because it is a generic which means that there isn’t a brand name on it.

Wellbutrin

Another type of depression stress relief pills is called Wellbutrin.  Wellbutrin works by affecting two chemicals in the brain that are believed to help moods; dopamine and norepinephrine.  It usually comes in 150 mgs to 200mgs.  This as with all prescription drugs should be monitored by a doctor.  If something doesn’t feel right make sure to call your physician and discuss symptoms.

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Key points to remember

• Antidepressants work best when you take them exactly as your doctor prescribes them. This also helps reduce side effects.
• You may start to feel better within 1 to 3 weeks after you start to take an antidepressant. If you have not improved at all in 3 weeks, you may need to try a different medicine.
• Antidepressants can cause side effects, but most of them are mild and go away after you take the medicine for a few weeks.
• Taking an antidepressant for at least 6 months after you feel better can help keep you from getting depressed again.
• Be sure your doctor knows about any other health conditions you have and any medicines you take regularly. This information can affect which antidepressant your doctor prescribes for you.
• Quitting antidepressants suddenly can cause withdrawal symptoms or cause depression to return. If you are having a problem with your medicine or are ready to quit taking antidepressants, work with your doctor to slowly reduce the dose over a period of a few weeks.

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The list is reviewed by The Cleveland Clinic Neuroscience Center.

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Heterocyclic antidepressants

How It Works

These medications balance certain brain chemicals (neurotransmitters) that cause depression when out of balance. When these brain chemicals are in proper balance, the symptoms of depression may be relieved.

Why It Is Used

This type of medicines is used to help relieve the symptoms of major depression. These drugs may be used when other types of antidepressants have been ineffective.

When these antidepressants are not used

• Some of these medicines are not given to older adults, because the medications cause too many negative side effects.
• Cyclic antidepressants usually are not given to people with certain heart problems, such as irregular heartbeats or low blood pressure.

How Well It Works

Like other antidepressants, cyclic antidepressants relieve depression in about 60% of people with depression.

Antidepressant Side Effects

Side effects may vary among these medications, and most of them improve as the person continues to take the medication. Cyclic antidepressants tend to have more common and more serious side effects than other, newer types of antidepressant medications, such as serotonin reuptake inhibitors (SSRIs). Side effects include:

• Stomach upset and other digestive problems, such as constipation.
• Dry mouth, blurred vision, and/or drowsiness.
• Lowered blood pressure.
• Weight gain.
• Tremors and sweating.
• Inability to urinate (urinary retention).
• Sexual dysfunction.
• Confusion or delirium, in older adults.
• Fatigue.

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

What To Think About

Antidepressant medications need to be started at low doses, and the dose should be increased gradually to reduce the severity of side effects. Regular blood tests may be needed to check the amount of the medication in your blood. Too much of this type of medication in the bloodstream can be dangerous.

Do not suddenly stop taking these medications. If you decide to stop taking your antidepressant, you will need to lower your dose slowly, with your doctor’s help.

You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.

Desipramine and nortriptyline have the fewest side effects and may be given to older adults for this reason. However, these medications may not be the preferred choice for treatment of depression in older adults, due to the severity of the side effects.

You may need to be hospitalized until these medications are working, especially if you are feeling suicidal, because it is possible to overdose on this type of medication.

Tricyclic antidepressants (TCAs) and heterocyclic medications are not usually used with some heart medicines, such as digoxin (Lanoxin), and some seizure medicines, such as phenytoin (Dilantin). Make sure your doctor has a complete list of all the medicines you are taking.

@ 1995-2007, Healthwise, Incorporated.

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