An estimated 500,000 pregnancies in the United States each year involve women who have or who will develop psychiatric illness during the pregnancy. The use of psychotropic medications in these women is a concern because of the risks of adverse perinatal and postnatal outcomes. However, advising these women to discontinue medication presents new risks associated with untreated or inadequately treated mental illness, such as poor adherence to prenatal care, inadequate nutrition, and increased alcohol and tobacco use. Use of psychiatric medications during pregnancy and lactation. 2007;110(5):1180–1182Ten to 16 percent of pregnant women meet diagnostic criteria for depression, and up to 70 percent of pregnant women have symptoms of depression. Ideally, decisions about psychiatric medication use during and after pregnancy should be made before conception. Use of psychiatric medications during pregnancy and lactation. 2007;110(5):1180–1182*—The FDA classifies drug safety using the following categories: A = controlled studies show no risk; B = no evidence of risk in humans; C = risk cannot be ruled out; D = positive evidence of risk; X = contraindicated in pregnancy Adapted with permission from the American College of Obstetricians and Gynecologists. Studies have shown a relapse rate of 68 percent in women who discontinue antidepressant therapy during pregnancy. The use of a single medication at a higher dosage is preferred over multiple medications, and those with fewer metabolites, higher protein binding, and fewer interactions with other medications are also preferred. Food and Drug Administration has categorized medications according to risk during pregnancy *—The FDA classifies drug safety using the following categories: A = controlled studies show no risk; B = no evidence of risk in humans; C = risk cannot be ruled out; D = positive evidence of risk; X = contraindicated in pregnancy Adapted with permission from the American College of Obstetricians and Gynecologists. Untreated maternal depression is associated with increased rates of adverse outcomes (e.g., premature birth, low birth weight, fetal growth restriction, postnatal complications), especially when depression occurs in the late second to early third trimesters. All psychotropic medications cross the placenta, are present in amniotic fluid, and can enter breast milk. There is limited evidence of teratogenic effects from the use of antidepressants in pregnancy and adverse effects from exposure during breastfeeding. Exposure to selective serotonin reuptake inhibitors (SSRIs) late in pregnancy has been associated with transient neonatal complications; however, the potential risks associated with SSRI use must be weighed against the risk of relapse if treatment is discontinued. where to buy ciprodex This generally leads these individuals into thinking they are going to need to have an operation. For many, when they think of gallstones, removal is what they assume is the only option for them. What do you know about possible treatments for gallstones? Preventive measures are always better than the treatment options for gallstones. Removal of gallstones is not always necessary, in the cases where the gallstones are not posing a problem, usually the ones where the gallstones were found during testing for other medical conditions. These are usually not problematic, thus do not require removal. 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Sertraline is used for a number of conditions, including major depressive disorder (MDD), obsessive–compulsive disorder (OCD), body dysmorphic disorder (BDD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), panic disorder, and social anxiety disorder (SAD). The comparative efficacy of sertraline and TCAs for melancholic depression has not been studied. A 1998 review suggested that, due to its pharmacology, sertraline may be more efficacious than other SSRIs and equal to TCAs for the treatment of melancholic depression. A meta-analysis of 12 new-generation antidepressants showed that sertraline and escitalopram are the best in terms of efficacy and acceptability in the acute-phase treatment of adults with unipolar MDD. Sertraline used for the treatment of depression in elderly (older than 60) patients was superior to placebo and comparable to another SSRI fluoxetine, and TCAs amitriptyline, nortriptyline (Pamelor) and imipramine. Sertraline had much lower rates of adverse effects than these TCAs, with the exception of nausea, which occurred more frequently with sertraline. In addition, sertraline appeared to be more effective than fluoxetine or nortriptyline in the older-than-70 subgroup. placebo in elderly patients showed a statistically significant (that is, unlikely to occur by chance), but clinically very modest improvement in depression and no improvement in quality of life. A meta-analysis on SSRIs and SNRIs that look at partial response (defined as at least a 50% reduction in depression score from baseline) found that sertraline, paroxetine and duloxetine were better than placebo. Zoloft (sertraline) belongs to a class of medications called selective serotonin reuptake inhibitors, or SSRIs. These medications work by increasing the level of serotonin in the brain. Low levels of serotonin in the brain are linked to a depressed mood in addition to cognitive difficulties like poor memory. 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