Slipping Back Into Depression
The belief that pregnancy produces a sense of well-being that keeps women from getting depressed has been debunked by research published last week in the Journal of the American Medical Association . A study of some 200 women who were taking antidepressants before getting pregnant found that 68 percent of those who went off medication when they conceived relapsed, versus 26 percent of those who kept taking it. And most became depressed again within the first trimester. "They not only relapsed; they relapsed quickly," says lead author Lee Cohen, a perinatal psychiatrist at Massachusetts General Hospital. The dilemma: Both a mom-to-be's depression and certain selective serotonin reuptake inhibitors are associated with risks to the baby. Last year, the FDA issued an alert that the SSRI Paxil may cause fetal heart problems, while maternal depression has been linked to preterm delivery and low birth weight, as well as postpartum depression. Cohen advises women to talk to their doctors about the risks and benefits of going off antidepressants. Those who want to stop might try other ways of coping, including psychotherapy.
A New Drug That Eases the Squeeze; Taking a Double Dose of Nicotine; More Sleep--and More Oxygen
A New Drug That Eases the Squeeze
For some 2 million chronic angina sufferers, surgery, stents, or drugs don't eliminate the crushing chest pain. Last week, the Food and Drug Administration added a new weapon: Ranexa, a medication that in clinical trials worked well for patients who hadn't been helped by other drugs. The attacks, usually brought on by exertion or stress, are a sign that the heart is getting too little blood--and oxygen--from the coronary arteries that encircle it. Most drugs lower blood pressure or in other ways reduce the heart's workload. Ranexa makes the heart function better with the oxygen it gets. The drug may be less effective in women than in men (story, Page 56), and the FDA requires that patients must also be on (and stay on) a beta blocker or amlodipine, a calcium channel blocker. But angina expert Jonathan Abrams, who is on the manufacturer's advisory board, thinks that Ranexa could eventually become the drug of first choice. - Avery Comarow
Taking a Double Dose of Nicotine
It has long been thought that wearing a nicotine patch while smoking could be toxic. But the combination could actually help people give up cigarettes. Of 96 pack-a-day smokers followed in a Duke University study reported last week, those who started the patch two weeks before smoking their last cigarette doubled their odds for success. Researchers say that having nicotine in your bloodstream during those two weeks makes inhaled tobacco smoke less desirable. It's like eating on a full stomach, says study author Jed Rose. The team found no serious side effects--though they say a larger study is needed to ensure that the combination technique is safe. - Cory Hatch
More Sleep--and More Oxygen
People with obstructive sleep apnea stop breathing over and over during the night as their throat relaxes and closes off. In the long term, that raises the risk of stroke--and it ruins any chance of a good night's sleep. The best treatment: a mask and a machine that blows air into the mouth and nose. But the CPAP machine--for "continuous positive airway pressure"--is so unwieldy that many patients refuse to try it, or give it up. New guidelines from the American Academy of Sleep Medicine advise patients with mild to moderate sleep apnea who fall into this group to try an oral appliance that looks like the mouthguards athletes wear. The gadget moves the lower jaw forward, thus opening the airway. Oral appliances aren't as effective as CPAP at oxygenating the blood but are thought to be equally good at improving sleep--and they may be much easier to stick with. - Helen Fields
This story appears in the February 13, 2006 print edition of U.S. News & World Report.
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