Practice Short cuts

What's new in the other general journals

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7537.351 (Published 09 February 2006) Cite this as: BMJ 2006;332:351
  1. Alison Tonks, associate editor (atonks@bmj.com)

    Pregnancy does not protect women from depression

    Women are often advised to stop taking antidepressants around the time of conception, partly to protect the early fetus but also because the received wisdom is that pregnancy will protect them from depression. In a US cohort of 201 pregnant women, 86 had a relapse of major depression. Discontinuing treatment was associated with a 68% (44/65) risk of relapse. The 82 women who maintained their treatment unchanged throughout pregnancy had a relapse rate of only 26% (21/82). Women who decreased their medication had a risk somewhere between the two (35%; 12/34).

    Credit: JAMA

    All these women had a longstanding history of major depression before they became pregnant. Nearly half (44%) had had more than five episodes, and 53% had other psychiatric problems, such as anxiety or an eating disorder. They were taking a range of antidepressants—mostly fluoxetine, sertraline, venlafaxine, or paroxetine.

    Since the women in this cohort had fairly severe mental illness, these findings may not apply to the majority of young women taking antidepressants, but they could be a useful starting point for discussions about the risks and benefits of antidepressants during pregnancy. It looks as though pregnancy hormones are not as protective as previously thought.

    Stem cell transplantation could help patient with life threatening SLE

    There have been no new treatments for severe systemic lupus erythematosis (SLE) for years, so research activity has focused on minimising the toxicity, and maximising the effectiveness, of existing treatments—specifically the immunosuppressant cyclophosphamide.

    In a preliminary open label study, researchers gave high doses of the drug to 50 patients with severe lupus, along with an autologous stem cell transplant. All the patients had tried standard treatment regimens and some had tried experimental treatments, without success, and now had life threatening disease involving visceral organs. Although one patient died from the treatment, overall five year survival was 84% and disease free survival at five …

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