Good point. We also can’t forget rhadomyolysis.

Yes there are a number of toxicities with both classes of drugs (and others) that may be synergistic. Other ones might include suicide, violence, and akathesia and hepatotoxicity with selected agents such as Zyprexa and Cymbalta. As opposed to the hepatotoxicity many of these toxicities may involve the serotonergic systems or the intracellular systems they effect.

Things like akathesia, lactation and gynecomastia, and to a lessor extent tardive dyskinesia are less serious in my eyes as they don’t result in death.

Now do you think the additional studies of antipsychotics with antidepressants for depression were powered or sufficiently long to pick up on synergistic toxicities?

Salmon

Another condition that is rarely discussed in regards to ssri’s and antipsychotics, is neuroleptic malignant syndrome, a potentially painful death. IBS cant begin to compare to that of NMS

This is a critical piece of information that is lacking. We know that withdrawal can last MUCH longer than the advertised “few weeks”, which would make an assumption that the drugs physiological effect is long lasting.
Using that rationale that effect could still be acting on the fetus long after stopping the drug.
Not having a control group of “never medicated Mom’s” and their fetal cardiac outcomes makes the situation incomplete research at best.

Then there’s the “did the depression cause the IBS, or did the IBS cause the depression” argument, which is still ongoing. We could also throw in the “did the depression medication cause the IBS?”

Depression also causes issues that doctors refer to “irritable bowel syndrome”, which is a professional way of saying “we have no idea what’s up with your digestive system”

So by your statement if medicine can’t figure out the cause they assign a mental health diagnosis? Do they tell their patients that they are being treated with a random drug for a situation with an unknown cause?

So total numbers would be 13,000 instead of 130,000 for just SIDS alone. Still over 25 years they add up and are several fold more than the deaths due to Vioxx and COX-2 inhibitors, and as with COX-2 the deaths do not include the much greater numbers of injured but not killed.

Salmon

The quote above does not discuss whether the mothers had gone back on drugs and were breast feeding. Even if this is not the case assuming that SSRIs work via raising serotonin and this increase in serotonin causes PAH via receptors unrelated to receptors responsible for alleviating depression, isn’t it possible that normal increases in serotonin in response to depression may also cause similar cardiac toxicities but at a lower level.

Thus we shouldn’t discount the importance of additional risks due to drug induced toxicities simply because there may be an elevated but lessor risk without drugs.

Other things we need to consider include absolute risks and the total incidence in a population like the US where there are 5 million births per year.

The incidence of deaths due to SIDS has gone from 9 in 1000 births prior to the introduction of SSRIs to 35 in 1000 births today. With 5 million births per year in the US we now have ~130,000 excess infant deaths PER YEAR in the US due to SIDS alone. (This of course doesn’t include deaths due to other causes but with similar underlying mechanims which doubles the incidence). Consequently I have wonder how many deaths have occurred over the years that are due to SSRIs or antipsychotics over and above any due to the underlying disease.

Salmon

They are blaming the disease, not the person. Big difference.

This raises the possibility that the risks were related to the mother’s depression itself, rather than antidepressant use, according to the researchers.”

It was this quote from the Reuters article that brought it to mind, Nathan. I don’t like the idea of blaming the person over the medication, especially when “depressed women not on medication” wasn’t a category. And the “mothers who’d stopped using” isn’t good enough for me unless they prove there were no residual effects from the meds. How long before they got pregnant did they stop using? A week? month? year?

Also I would have to question how many of the women were actually diagnosed as clinically depressed since off-label prescribing is so rampant for these drugs. Granted, this particular study only required the women be on the drugs, but if they’re going to extrapolate the information it’s negligent to assume that’s why they were all taking the medication.

And to your last point - I’d like to believe there are still people out there who’ve chosen to deal with their depression through diet, exercise and *therapy* rather than taking a pill.