PAXIL: Postpartum: Mother Has Worsening Depression with 2nd Baby

PAXIL:   PostpartumMother Has
Worsening Depression with 2nd Baby After Taking Antidepressants:  Had

Postpartum with 1st Baby and Recovered With No Meds:
U.S.A.

Sentences three through seven read:  ” I went through postpartum depression with my first baby eight years ago but at
that time I didn’t have anxiety and I didn’t take any medication.
And I started getting better after 3½ months itself. But now it’s
been three months that I am going through this. I have been
taking medications (Paxil 20 mg, Buspar 10 mg) and getting counseling but
it’s not helping much. I still don’t feel myself and am having unwanted
thoughts.”

http://www.cnn.com/2009/HEALTH/expert.q.a/09/08/postpartum.depression.raison/

Expert Q&A

updated 10:03 a.m. EDT, Tue September 8,
2009

How long will my postpartum depression last?

Asked by Sheeza Ashraf, Fremont, California

I have a
4-month-old baby. I am going through postpartum depression with a lot of anxiety
and panic attacks. I went through postpartum depression with my first baby eight
years ago but at that time I didn’t have anxiety and I didn’t take any
medication. And I started getting better after 3½ months itself. But now it’s
been three months that I am going through this. I have been taking medications
(Paxil 20 mg, Buspar 10 mg) and getting counseling but it’s not helping much. I
still don’t feel myself and am having unwanted thoughts. How long does

postpartum depression last? Is this temporary? Will this anxiety and depression
ever go away? Should I stop the medications and try it on my own? Does exercise
help to get out of the depression? Will I ever be normal like I was
before?

Mental Health Expert Dr.
Charles Raison
Psychiatrist,
Emory University Medical School

Expert answer

Dear Sheeza,

I am sorry to hear of your difficulties —
you are far from alone in your struggles with postpartum depression. Indeed, up
to 20 percent of women become depressed in the six months following delivery,
but company doesn’t help much when it comes to depression — or at least the
company we typically provide in the U.S. Traditional cultures understood the
vulnerability of new mothers and would often surround them with family and
friends to help with the significant emotional and practical burdens of coping

with the newborn.

I am going to make some general recommendations about
what you might want to consider doing, based only on the information you have
provided above. As always, this should not be taken as specific advice for your
actual situation. That kind of advice can come only from a clinician who knows
you and is involved in your care.

First and most important, it is very
important to continue medication when one is still depressed, so given what you
describe, I would counsel against stopping the antidepressant. It is not clear
how long you have been on the Paxil (generic: paroxetine), but let’s assume
you’ve been on it for at least six weeks. You are on a low dose. A reasonable
first step would be to talk with your doctor about raising the dose to 40 mg a
day and trying this dose for at least several weeks.

If you see no
benefit, there are in general two paths your doctor might recommend (and I say
doctor in the generic sense, given that many folks nowadays see physician
assistants or nurse practitioners who often — in my experience — do a better
job diagnosing and treating depression than do MDs). First, your doctor might
add a second antidepressant or an atypical antipsychotic to your Paxil. Although
they are called “antipsychotics,” these agents (for example Seroquel, Abilify,
Zyprexa) are also widely used to help with severe depression and anxiety and are
often quite effective. Second, your doctor might switch you from the Paxil to
another antidepressant. Unfortunately, we have no scientific way of knowing
which agent you should switch to — our best data suggest that they are all
about equal. But one thing is clear: Many people who don’t do well with one
antidepressant will have a great response to a different one.

Anxiety and
panic are quite common when one has a bad depression, and they can be more
miserable to endure than the feeling of depression itself. It is unlikely that
the low dose of Buspar (generic: buspirone) you are taking is of much benefit.
You might want to discuss with your doctor raising the dose to at least 10 mg
three times a day or discontinuing it. The best immediate way to relieve
disabling anxiety is through the use of benzodiazepines (for example lorazepam
or clonazepam). These medications can be lifesavers, but if you take them for
more than three or four weeks your body will become dependent upon them, and
should you want to stop, you will have to reduce them slowly under the
supervision of a doctor.

Let me say a word about exercise. Yes, exercise

has been shown in many studies not only to raise a person’s mood immediately,
but also to work over time as an antidepressant. Therefore, I strongly recommend
adding regular exercise to your treatment regimen. Try to exercise in the
morning, especially when it is sunny. To get the best effect you will need to
work up a sweat. I find that it is even better if you can exercise in a place
with some natural beauty — as being in nature is itself quite comforting for
most of us.

I don’t have an answer to your question about how long the
depression will last and whether it will ever go away. Everyone is different. We
do know, however, that the longer one stays depressed and/or the more episodes
one has had, the harder it is to treat the condition. This is just the
frightening truth of the disease, and it really highlights how important it is
for you to really get aggressive about your treatment. My sincere hope is that
whatever specific treatment route you follow, you will start feeling like
yourself again as quickly as possible.

Finally, whenever I talk about
specific pharmacologic treatments I need to disclose that in addition to my
academic work I have given lectures for two pharmaceutical companies in the last
year: Lilly and Wyeth. I have also served on an advisory board for Lilly in the
last 12 months.
[]

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PAXIL: Postpartum Depression Medication Worsens Depression

Sentences three through seven read:  ” I went through
postpartum depression with my first baby eight years ago but at
that time I didn’t have anxiety and I didn’t take any medication.
And I started getting better after 3½ months itself. But now it’s
been three months that I am going through this. I have been
taking medications (Paxil 20 mg, Buspar 10 mg) and getting counseling but
it’s not helping much. I still don’t feel myself and am having unwanted
thoughts.”

http://www.cnn.com/2009/HEALTH/expert.q.a/09/08/postpartum.depression.raison/

Expert Q&A

updated 10:03 a.m. EDT, Tue September
8, 2009

How long will my postpartum depression last?

Asked
by Sheeza Ashraf, Fremont, California

I have a 4-month-old baby. I am
going through postpartum depression with a lot of anxiety and panic attacks. I
went through postpartum depression with my first baby eight years ago but at
that time I didn’t have anxiety and I didn’t take any medication. And I started
getting better after 3½ months itself. But now it’s been three months that I am
going through this. I have been taking medications (Paxil 20 mg, Buspar 10 mg)
and getting counseling but it’s not helping much. I still don’t feel myself and
am having unwanted thoughts. How long does postpartum depression last? Is this
temporary? Will this anxiety and depression ever go away? Should I stop the
medications and try it on my own? Does exercise help to get out of the

depression? Will I ever be normal like I was before?

Mental
Health Expert
Dr.
Charles Raison
Psychiatrist,
Emory University Medical School

Expert answer

Dear Sheeza,

I am sorry to hear
of your difficulties — you are far from alone in your struggles with postpartum
depression. Indeed, up to 20 percent of women become depressed in the six months
following delivery, but company doesn’t help much when it comes to depression
or at least the company we typically provide in the U.S. Traditional cultures
understood the vulnerability of new mothers and would often surround them with
family and friends to help with the significant emotional and practical burdens
of coping with the newborn.

I am going to make some general
recommendations about what you might want to consider doing, based only on the
information you have provided above. As always, this should not be taken as
specific advice for your actual situation. That kind of advice can come only
from a clinician who knows you and is involved in your care.

First and
most important, it is very important to continue medication when one is still
depressed, so given what you describe, I would counsel against stopping the
antidepressant. It is not clear how long you have been on the Paxil (generic:
paroxetine), but let’s assume you’ve been on it for at least six weeks. You are
on a low dose. A reasonable first step would be to talk with your doctor about
raising the dose to 40 mg a day and trying this dose for at least several weeks.

If you see no benefit, there are in general two paths your doctor might
recommend (and I say doctor in the generic sense, given that many folks nowadays
see physician assistants or nurse practitioners who often — in my experience —
do a better job diagnosing and treating depression than do MDs). First, your
doctor might add a second antidepressant or an atypical antipsychotic to your
Paxil. Although they are called “antipsychotics,” these agents (for example
Seroquel, Abilify, Zyprexa) are also widely used to help with severe depression
and anxiety and are often quite effective. Second, your doctor might switch you
from the Paxil to another antidepressant. Unfortunately, we have no scientific
way of knowing which agent you should switch to — our best data suggest that
they are all about equal. But one thing is clear: Many people who don’t do well
with one antidepressant will have a great response to a different
one.

Anxiety and panic are quite common when one has a bad depression,
and they can be more miserable to endure than the feeling of depression itself.
It is unlikely that the low dose of Buspar (generic: buspirone) you are taking
is of much benefit. You might want to discuss with your doctor raising the dose
to at least 10 mg three times a day or discontinuing it. The best immediate way
to relieve disabling anxiety is through the use of benzodiazepines (for example
lorazepam or clonazepam). These medications can be lifesavers, but if you take
them for more than three or four weeks your body will become dependent upon
them, and should you want to stop, you will have to reduce them slowly under the
supervision of a doctor.

Let me say a word about exercise. Yes, exercise
has been shown in many studies not only to raise a person’s mood immediately,
but also to work over time as an antidepressant. Therefore, I strongly recommend
adding regular exercise to your treatment regimen. Try to exercise in the
morning, especially when it is sunny. To get the best effect you will need to
work up a sweat. I find that it is even better if you can exercise in a place
with some natural beauty — as being in nature is itself quite comforting for
most of us.

I don’t have an answer to your question about how long the

depression will last and whether it will ever go away. Everyone is different. We
do know, however, that the longer one stays depressed and/or the more episodes
one has had, the harder it is to treat the condition. This is just the
frightening truth of the disease, and it really highlights how important it is
for you to really get aggressive about your treatment. My sincere hope is that
whatever specific treatment route you follow, you will start feeling like
yourself again as quickly as possible.

Finally, whenever I talk about
specific pharmacologic treatments I need to disclose that in addition to my
academic work I have given lectures for two pharmaceutical companies in the last
year: Lilly and Wyeth. I have also served on an advisory board for Lilly in the
last 12 months.
[]

302 total views, no views today

ZOLOFT: Violent Behavior in Young Girl: USA CNN

First two sentences read: “My daughter was treated for anxiety with Zoloft around a year ago. However, her school reported alarming, violent behavior (she never had that before), and we stopped it after only a week.”

http://www.cnn.com/2009/HEALTH/expert.q.a/08/18/zoloft.adverse.effects.raison/

Is my daughter’s violent reaction to a drug an allergy?

Asked by Sharon, USA

My daughter was treated for anxiety with Zoloft around a year ago. However, her school reported alarming, violent behavior (she never had that before), and we stopped it after only a week. I always understood this to be an “adverse effect,” but a nurse today told me it was an allergy. An allergy means she should never take it again, but an adverse effect could be grown out of, and doesn’t rule out similar drugs. Was the nurse just dumbing things down, or was she correct?

Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Sharon,

The nurse may have been trying to “dumb it down” as you say, but she was not correct. We’ll talk about bad reactions to antidepressants in a moment, but let’s talk about allergies first. An allergy is a very specific type of reaction that is caused by an arm of the immune system often referred to as Th2. Allergies can be mild or extremely serious, but whatever their intensity, what they share in common is that the immune system is needlessly going into overdrive in response to something that is not really dangerous.

Because allergies are a type of inflammatory response, their symptoms tend to be fairly stereotyped: itching, redness, swelling, runny nose and eyes, hives and shortness of breath (from airway swelling) when severe. When one takes a medication and has this type of reaction, that is an allergic response to the medicine. While all medications can cause an allergic reaction, some (for complicated reasons) are much more likely to do this than others. The classic example is penicillin, to which many people are allergic. Antidepressants have a very low likelihood of inducing an allergic response.

OK, that’s the scoop on allergies. So your daughter didn’t have an allergic response, but she did have a serious side effect to the Zoloft and one that is not uncommon. In fact, behavioral agitation –while not as common as other side effects such as loss of sexual function or stomach upset — is one of the most worrisome reactions elicited by antidepressants. One reason why you don’t want your doctor to start you on an antidepressant and tell you to “come back in six weeks” is that he or she should be on much closer lookout to make sure that you don’t develop severe anxiety or agitation in the first week or two of treatment.

Psychiatrists have debated endlessly about what causes antidepressant-induced agitation. There are probably several explanations, with each being true for individual patients. There is evidence that the acute effects of antidepressants can directly cause agitation in some people. There is also evidence that many people who get agitated may have, or be at risk for, having bipolar disorder (i.e. manic depression). We have known for years that many bipolar patients will have a first manic or hypomanic episode in response to being placed on an antidepressant. That is why I always tell patients to call me immediately if they start feeling too happy or too jazzed up too quickly, as that can be a sign of developing mania. Mania can also manifest as extreme agitation or irritability, especially in children and adolescents.

I am not suggesting that your daughter has a bipolar condition. I noticed that you chose the topic “autism” when you submitted your question. If your daughter has an autistic disorder, this might also put her at increased risk of having a bad reaction to an antidepressant.

I do not think your daughter needs to avoid all antidepressants forever, because each of these agents is different. Frequently, someone who can’t tolerate one antidepressant does just fine on another. But it goes without saying that I would certainly be cautious if you elect to try another antidepressant with your daughter. You might think about doing it during a break from school so that you can watch her closely and also so that if the agitation happens again, she won’t be in a place where it might affect her social relationships outside the family.

Finally, as the director of my residency program told me years ago, “Any medication that actually works will have side effects.” I’ve never forgotten that.

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