Magazine article Drug Topics

Neurochemical of the Decade

Magazine article Drug Topics

Neurochemical of the Decade

Article excerpt

When deciding whether to treat a depressed pregnant woman, physicians appear to feel damned if they don't and, perhaps, damned if they do. Although the question of whether antidepressants are truly safe in the unborn babies these patients are carrying cannot be definitively answered, new studies may offer some insight into the matter. In a review of these trials, published in the October issue of the Journal of the American Medical Association, author Katherine L. Wisner, M.D., concluded that tricyclic antidepressants, fluoxetine, and newer selective serotonin reuptake inhibitors (SSRIs) did not increase the risk of intrauterine fetal death, major birth defects, and growth impairment. However, there were no solid conclusions on the risk fluoxetine posed to prenatal growth and birth weights of infants.

Wisner also found reassuring evidence that children who were prenatally exposed to tricyclic antidepressants and fluoxetine showed no difference in cognitive function, temperament, and general behavior, compared with kids who were not exposed.

One area of concern is the observation of withdrawal symptoms in some newborns whose mothers were treated with antidepressants near the end of the pregnancy. Some symptoms have included transient jerky movements and seizures, rapid heartbeat, irritability, feeding difficulties, and profuse sweating. Keeping this information in mind, it should be noted that fluoxetine currently belongs to pregnancy category C, and amitriptyline has been designated as pregnancy category D.

Neurochemical of the decade

From depression to nausea, serotonin-or a lack of it-has been implicated in just about every ailment imaginable. And now researchers have started tampering with it when treating patients with irritable bowel syndrome (IBS). An investigational class of compounds has been developed to target and modulate the serotonin receptor subtype 5-HT4, which is known to be present throughout the entire gastrointestinal tract and is believed to play a role in GI motility and pain perception.

Zelmac (tegaserod), one such agent under development by Novartis, has been shown in studies of constipation-predominant IBS patients to reduce symptoms such as abdominal pain or discomfort and bloating. Bowel function improved within one week of starting treatment, and overall symptom improvement was sustained throughout the 12-week study period. …

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