This Week in NEJM

Table 2. Reveals risk of SSRI use in relation to birth defects.



This week in The New England Journal of Medicine 2 articles comment on a once thought problem during pregnancy. Women taking anti-depressants called Selective Serotonin Reuptake Inhibitors (SSRIs) were warned about these drugs which were considered a danger to development of the child. From one study:


Conclusions: Our findings do not show that there are significantly increased risks of craniosynostosis, omphalocele, or heart defects associated with SSRI use overall. They suggest that individual SSRIs may confer increased risks for some specific defects, but it should be recognized that the specific defects implicated are rare and the absolute risks are small......Our analysis did not confirm previously reported associations between overall use of SSRIs and craniosynostosis, omphalocele, or heart defects as a group


The problem is that drugs are not routinely tested on pregnant women. This results in an unknown effect on the fetus/child prior to giving the medicine. The only answers we have are on women who had taken a drug prior to knowing they were pregnant. This leads to very few drugs being available for use in pregnancy.

In addition to the birth defect risk there is a problem with Serotonin Withdrawal Syndrome in the child. While I was a resident in pediatrics at my prior institution I saw 2 patients in 1 month with this horrible problem. It was a tough thing to see those little babies writhing from the withdrawal. They eventually adapted to the lack of serotonin, but I wonder how well the mother would have done with the pregnancy if she was depressed.

The Sherpa Says: Is this personalized medicine? Not Really. But it does have to do with genetics and development. Besides the risk for birth defects, there is another risk for the child. Too bad it is only glossed over in these articles :(

Chronic Hepatitis C and Depression

The goal of personalized medicine is to

1. Apply prevention strategies to those uniquely at risk for disease
2. Give therapies that are uniquely suited for a molecular cause of disease
3. Avoid therapies that would not be useful and in fact may be harmful to those being treated

I am certain there are other goals, but I think these are the over-riding themes.

In a study in the journal Gastroenterology we see another example of how principle 3 comes into play.

This study examined patients with Hepatitis C. The therapy for Hepatitis C includes Interferon. This medication has long been known to cause depressive symptoms in a subset of patients who take this therapy. The study found that those patients who had a polymorphism in the HTR1A gene (aka serotonin receptor 1A) were almost 3 fold more likely to have interferon induced depression. Imagine combining this with the likelihood for cirrhosis polymorphism I mentioned in April. I can see it coming together, the right drug or not, for the right person, and the right disease.

The only catch is that these results need replication in a larger population.

Stay tuned