Self reinforcing delusion:
1. a delusion is a false belief or opinion
2. and a self-reinforcing delusion is one that creates conditions that reinforce that false belief or opinion.
October 14, 2011 the Canadian Psychiatric Association [CPA] presented their 61st Annual Conference where they rolled out a soon-to-be published tool that, they claimed, may help ease the decision-making process for physicians and patients alike.
Sophie Grigoriadis, MD, PhD, from Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada, presented preliminary data from a pilot test of an "urgently needed" tool to help clinicians assist pregnant patients who have moderate to severe depression make more informed treatment decisions.
Informed treatment decisions?
"Conflicting information about antidepressant medications in pregnancy has made it difficult for clinicians to figure out how to treat these women. What we're trying to do is help them cut through some of the confusion by summarizing the literature in a way that will make it easier apply to clinical practice," Dr. Grigoriadis told Medscape Medical News.
And what exactly was that help in summarizing literature?
There were conflicting reports about antidepressant use in pregnant women. In addition, evidence was also published highlighting the risks associated with discontinuing antidepressant medication, and specifically highlighting the increased risk for depression relapse in women.
In the end we need to understand that patients are at risk no matter what decision they make. They are at risk because they are exposed to depression, and they are at risk because they may be exposed to antidepressant medication.
Fair enough, although I would err on the side of caution when treating a pregnant mother with antidepressant treatment, the risk of malformations in the fetus would far outweigh any benefit.
Grigoriadis continued with:
The investigators looked at more than 38,000 abstracts and 821 scientific papers. Of these, 187 articles were selected for inclusion in the tool and underwent a quality assessment by 2 independent reviewers, based on a number of predetermined criteria, and received a final quality rating: high, moderate, low, or very low.
Not surprisingly, she said, almost none of the papers garnered a high rating because very few were randomized controlled trials. Most, she added, were deemed to be of moderate or low quality.
In the face of FDA warnings, she added, one of the finer points about antidepressant medications that is often lost is that these drugs still confer minimal risk to the offspring.
"Depending on the number of studies, the results change slightly, but what we're seeing is that these drugs are not hugely teratogenic, and I think people may feel more comfortable regarding that when they understand that these are not huge effect sizes. You have to consider that 3% to 4% of women can have a baby with a congenital malformation just by chance alone, and people need to understand that," she said.
Not hugely teratogenic?
How huge does it have to be?
Sagar Parikh, MD, FRCPC, a psychiatrist and researcher with the University Health Network in Toronto, who was not involved in the development of the tool, said it will definitely help fill a clinical gap.
He concluded: "There are clearly some studies that show some harm from some medications, but studies like the Paxil study are difficult to interpret on a case-by-case basis. Even from a societal perspective, it is difficult to interpret. If I told you 100 children in Canada were hospitalized at birth because of their mothers were on Paxil, but that the drug prevented 300 women with depression from being hospitalized because they were on Paxil, how do we weigh that? And right now, no one knows how to approach this dilemma."
Ah, no one knows.
Pretty much like a game of Russian roulette then, huh?
The CPA could always ask the pharmaceutical companies that manufacture these drugs if they are teratogenic, or maybe even approach Health Canada and ask them.
It's simple really but would, of course, throw a spanner in the works of this latest tool rolled out by psychiatry.
I applaud the Ying and Yang arguments but the debate about whether or not antidepressant medication can cause birth defects is a no-brainer - See Kilker Vs GlaxoSmithKline
Or, if you can stomach it, watch this short video:
The study was supported by the Canadian Institutes of Health Research. Dr. Grigoriadis reports she is on the advisory board of Servier Canada. Dr. Parikh reports he has financial/research relationships with Mensante, AstraZeneca Canada Inc, Bristol-Myers Squibb Inc, CANMAT, Eli Lilly Canada Inc, Lundbeck Canada Inc, and Pfizer Canada Inc.
Say's it all really.
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