Even just 1% of pregnant moms taking antidepressants while pregnant is too much. I remember worrying about taking antideps when I was breastfeeding my twin boys. Granted, I had the post-partum depression from Hell, but I still worried about what I was putting into my body, and therefore into my sons'.

Sigh... Even when I was pregnant I worried about my asthma meds affecting my twins.

I think this is a frightening trend and one just has to wonder whether some of the babies born to these mothers are the ones that go on to have severe behavioral problems that may be neurologically based and end up on medications perpetuating the cycle. The babies may look normal at first but whether they really are or not we may never know. What a business model for pharma companies! You couldn't have made one up to create life long and intergenerational customers "better" than this.

Considering the hundreds of thousands of women who are pregnant at any given time, it is ridiculous for any agency/group to declare SSRIs such as Zoloft, Paxil etc safe for use during pregnancy.

THERE ARE NO LONG TERM STUDIES to prove the safety and efficacy. There are concrete things we do know: the first 3 months before pregnancy can affect a baby; the first trimester can; and anything the mother ingests after pregnancy ends up in breast milk.

Considering all people react differently to drugs: they are forgetting to include babies in that while considering this.

I've said it before and Levine says it in the article we've over time accepted the phrase "crack babies" and now it's simply "zoloft babies" or "paxil babies".

I find this alarming, and the stats to appear to increase with SSRI use and pregnancy right with the increase in SSRI rx and dx's.

Womens bodies are flooded with hormones during the entire 9+months of preganancy; after giving birth more hormonal shifts take place; the uterus is reducing back to normal size; the mother has a surge of hormones hit to produce milk to nurse a baby for up to a year...many women (including myself)remember exactly when the crying for no reason hits: a week or 10 days after giving birth--another big hormone shift.On top of that, recovering from all of this with sudden lack of sleep with a baby needing feeding every 2-3 hours, 24 hrs a day. Perfect formula for a doctor to call it depression.

Yes some women have it severe no matter what--severe PMS, severe post partum depression--but I fear the doctors are carelessly rx'ing SSRI's as if they are benign like lemon drops for a cough while pregnant.

Hormones cannot be treated with SSRI's.Women have to understand how hormones effect them, and until that happens, there will be many misdiagnoses of depression,bipolar etc-- overuse of SSRI's, for no reason. It's why some women still feel crappy on the SSRI--PMS still ruins their life; depression does; it should give pause for thought that there could be a reason for that.(SSRI's do not treat hormone imbalance!)
(and SSRI's DO cause birth defects in babies, such as holes in their hearts (PAXIL).

Google Thomas for S. 3175, a bill to "help" women with post partum depression (women from pregnancy to one year post birth). Then write your Senator against this bill, which has not yet been introduced into the Senate HELP Committee. It passed the House by a two thirds majority. I think you'll be hearing more about it here.

Kudos to Bruce Levine for covering in this article the real story of Melanie Stokes Blocker for whom the Mothers' Act was originally named. Melanie was a pharmaceutical sales rep who developed postpartum depression after her baby was born. Within 7 weeks she had been hospitalized three times and put on a cocktail of psych meds, including an antidepressant, an antipsychotic and a benzo. That wasn't working well so she had ECT. Then she jumped to her death from a 12th floor room. Man, if this isn't a supreme irony to have an act promoting more screening and treatment named after a woman whom I have no doubt died precisely because of her treatment I don't know what is. What are we coming to here?

Ironic that physicians warn pregnant woman not to smoke, drink, take aspirin, etc., yet write them prescriptions for antidepressants.

I suppose this ia all done in the name of "public health" which is fast becoming our country's National Religion!

It is nothing less than terrible to read that statistic. Medication should be a last resort for pregnancy. Therapy is the first line of treatment for any psychiatric issue short of suicidal/homicidal behaviors/psychosis/mania, or another issue I can't list off the top of my head that puts the mother or fetus at risk.

I still can't believe how many of my colleagues do not stop and ask a pregnant patient how they feel about the pregnancy and who are supports to them here and now. Kind of standard first line investigation questions, yet rarely asked.

By the way, I read some earlier postings and read the commentary about my alleged role in FS's request to re-examine the dialogue here. I will go on record as saying all I have asked is people show some responsibility and respect in their rebuttals and difference of opinion, or hopefully some support, in their comments, not just with me but with others. If you want to be heard and considered, it is quality and directness to what is read. And, while I have been guilty of excessive verbage in the past, say your peace in as few words as able. I don't read monologues any more; if I pontificate in the future, please tell me.

Interesting things happen in the summer, don't spend too much time watching the clouds float by!

TF, It's irresponsible of you to imply that therapy is or should be the first line of treatment for "psychiatric issues." If therapy worked, these women wouldn't be on drugs. Research indicates that pregnant women really are under more stress than usual during pregnancy for many reasons. Isolation and lack of exposure to others going through the same thing is the major cause of unhappiness in pregnant women, hence the best treatment for these women is free, pregnancy support groups. In addition to being free these groups don't create a record that could possibly be used against a woman if there's a custody battle in her future and don't, as therapy does, raise her family's health insurance premiums which places all members of the family at risk.

Try and be responsible TF. Need I remind you that by coming in here advertising that you are a doctor, passing yourself off as an expert, you are assuming legal liability for any harm you might cause in cavalierly giving medical advice and/or assigning diagnoses and recommending courses of treatment?

You know what, Sally? You would argue with me if I said penicillin treated strept throat simply because I said it as a doctor. Your hostility and unbrage is just rude. You are like this guy Supremacy Claus at Carlat's site. You say one responsible thing and think that gives you a free pass to bash and belittle with the next ten postings. I may be a doctor, but I am a person first, so you want to hold me to a higher standard to then make me your whipping boy, FORGET IT!

If you read all of what I wrote, and I doubt it, I'll write the one crucial sentence again, and hope in the future you read my posting fully and not just the every other sentence:

I still can't believe how many of my colleagues do not stop and ask a pregnant patient how she(my error with the 'they' pronoun prior)feels about the pregnancy and who are supports to her here and now.

So, who is being irresponsible here, Sally? Me, for raising what is a fairly valid concern among treating physicians who practice "first do no harm, & least to most invasive", or perhaps you, for whom I perceive to be a vindictive person who will deny what is a standard of care.

I would be grateful if you could share a bit of transparency with me and explain why fairly much every posting I make is so terrible and irresponsible based on your experiences as a clinician or patient, or perhaps both? Frankly, I am glad you wrote the above, as it reinforces my request to FS to clarify the mission of his blog if it will encourage providers like me to participate and then be slammed by people like you who feel hostility without accountability is acceptable.

If you know of these alleged free groups that women can access, please post away any and all info to sites that women would visit to benefit from this opportunity. Any in the Baltimore/Washington area would be of value to me specifically. And, I'll err with a moment of being hypocritical and be a bit hostile back:
what the hell am I advertising by noting I am a psychiatrist, and where is the liability in my general comments to a blog site that any reasonable and responsible reader would follow up with by first contacting his/her own physician/therapist before proceeding? Maybe if people do react to commentary sections like this as the gospel, that is a problem in and of itself. The internet is not a provider, it is a source of information. And, in the pursuit of healing oneself, it is not just the information but the source and level of reliability that should drive the response to it. I am one opinion in a sea of many; I just want to make sure people are aware of one avenue of treatment options. A patient should make choices based on trust, consistency, and reliability. Are you going to argue this point next?!

By the way, Stephany, thank you for your supportive comments in that posting dialogue. I sense you understand my interest in sites like FS's and Carlat's. I believe in the perspective that silence to hostile critics only validates their agenda. I will speak up when someone is going to challenge me, and if I am wrong, then I will acknowledge it and apologize for the mistake. This is a good site. I hope others with experience on either side of the desk will get involved and aid in improving a profession that has certainly lost its direction, but is not floridly evil, as some of the participants here would want the lesser traveled 10,000 readers to think otherwise.

By the way, if you want to see how the potential for evil can be pandemic, go to www.motherjones.com and read the article "Smoke and Mirrors" about how the welding trade has been victimized by the makers of manganese rods and how the makers of manganese products have controlled the alleged research to define if there is a legitimate risk factor to exposure to this product. Damming and disturbing stuff here!

Last comment: to phillip, if you can control the input in these rebuttal commentary sections, I would suggest considering a disclaimer under or above the poster's comments that you read the submission and posted it with something of the sort as "reader be warned". Perhaps a bit of censorship, but at least the poster gets the opportunity to say his/her piece, and the reader can decide if it is worth the reading. I am not an internet expert, but that is a middle ground position based on other sites I have been to.

Good times, good luck, good day.

TF,

The irony is so very thick.

First, you want a disclaimer for everyone excepting the profession that most resolutely demands one. Would only a psychiatrist would suggest such a thing? A true guffaw.

Then, "First do no harm". You really like to use this term seemingly as a shield from criticism. It's a mere platitude for the masses. It's a myth (or a lie) since you get to control and decide what harm is methinks. It's no different than lawyers pontificating on "THE LAW" as Rome burns. Complete and utter rubbish.

I haven't used the term "doctor" in ages. It's a title that entitles privileges that an egalitarian society should not accord. I refer to all people as simply Mr or Mrs/Ms. It's irrelevant to me whether you are a physician, psychiatrist, or pipe layer. No special considerations or respect are due nor should be expected. Such titles are also used as means of conveniently silencing criticism.

Personally, I should think that any medical advice from a qualified physician would come with a disclaimer. Professionals have obvious biases and liabilities. They have practices to maintain, patients to retain, staff to be paid, papers to publish, grant monies to be secured, CME's and symposiums to attend, and (lest we forget) a mark to leave on their profession if not history (Mr. Biederman et. al. come to mind here).

Bottom line: your profession (and you by proxy) are under some harsh scrutiny. We (survivors) find your profession complicit in the harm of too many people. Forgive us if your words are viewed with a certain jaundice. Given our first hand knowledge and experiences this should be unsurprising to a qualified therapist, no?

Issues Existing with Medicare and Medicaid (Missouri)

1. Medicaid
In 2005, Missouri experienced the most severe Medicaid cuts since the program began 30 years from then. Already, near 1 million Missourians are uninsured aside from this Medicaid situation. So Blount chops 100,000 dollars from Medicaid this year from those citizens who needed the medical resources the most. In addition, Blount had another 300,000 dollars robbed from Missouri’s Medicaid patients by having their medical benefits greatly reduced. Why? I heard it was to possibly to build more athletic stadiums in the state of Missouri. Furthermore, Blount created a ‘war room’ for corporate lobbyists to dispense gifts during the state’s legislative session for this egotistical psychopath to enjoy those obsequious to him, yet also seems to enjoy the suffering experienced by others, as illustrated with the Medicaid issue, which was the largest cut of any state in the history of the program for those in the most need of resources he cannot conceptualize or care about, as he should. Our administration seems to share similar traits as this man.
Limited income parents suffered the most with this atrocity, as more than 50,000 of them lost medical coverage for their families. And after Blount stated in 2007 that Missouri is now strong, prosperous, and vibrant regarding the state’s budget and the robust economy, he never repaired or acknowledged at all the damage he did to those suffering Missourians in 2005, and never indicated to do what he should have done, which having notable degrees of remorse, regret, and guilt. Remember that most on Medicaid in Missouri are children through what is called the SCHIP Medicaid program. There are also over 100 thousand children uninsured. If SCHIP does not expand as people wish, that number could easily reach 200,000 children.
In the U.S., the total cost of Medicaid is around 300 billion dollars a year. States have their own discretion on how their Medicaid programs are operated, and this is largely unexamined by the other contributor to Medicaid, the federal government, as it should be according to the laws involved with the proper administration of Medicad.
The joy he must experience in seeing or knowing of the suffering of others must continue to elate him, as the Missouri House of Representatives rejected a bill to expand Medicaid coverage greatly needed due to the actions of the governor those years ago recently, simply because he has the ability to do so.
Medicaid is also a necessity for those in need that are residents in the over 500 nursing homes in Missouri. The Nursing Home Inspectors already are accused of ignoring deficiencies in these nursing homes, which may include malnutrition and bed sores of the residents, and the inappropriate use of pharmaceuticals as well. Further unsettling is that such inspections with such reckless disregard normally take place only once a year. The inspectors should be monitored by the GAO because of safety issues in nursing homes that continue and appear unresolved, yet it seems to continue. For example, around 25 percent of Missouri nursing homes were found to have deficiencies recently that were authentic and concerning. The rest of the nation only has a rate of 15 percent. Also, the Nursing homes in the United States are only covered by Medicaid, as typically, nursing homes cost each patient over 5 thousand dollars a month without this much needed support.
Aside from the problems mentioned already with nursing homes, combined by the loneliness and desperation of those who stay at these facilities, the mental disease of dementia is a common disease as we get older and is seen in Nursing homes, and identified with those at these locations, yet are treated inappropriately, if at all, I understand. Basically, dementia is a disease of cognitive and brain dysfunction that usually is not reversible. If it’s the cortical kind of dementia, it is combined with Alzheimer’s disease. If it is the sub cortical kind, look for Parkinson’s disease to be experienced with these patients. Such patients are inappropriately prescribed and given inappropriate if not deadly medications, such as atypical anti-psychotics, which cause high rates of pneumonia and premature death in the elderly population who have dementia.
To complicate Missouri’s health care situation further, and because close to 90 percent of Missouri counties are rural, with most lacking hospitals, there is only one doctor for every 3500 or so residents in such counties in this state. There is something to help called a Certificate of Need, or CON. Issued by regulatory agencies, they authorize healthcare facility creation and expansion as determined by the perceived needs of any community. Only a small number of states seem to have a formal CON process to activate this system, such as the addition of new nursing facility beds. Missouri fortunately is a state that is entitled to this requirement if the providers have a 90 percent occupancy for 4 quarters. Created by the American Health Care Association, the last CON was called a Medicaid payment system clearinghouse. I’m not sure why this was involved with the CON program.
There are around 5 million people in Missouri are and have Medicaid. The state of Missouri pays 20 percent of that bill, with the government paying the rest. While the states manage Medicaid for their state, CMS monitors and regulates the states, but that does not mean that this DHHS division actually does this in a complete and beneficial method for the citizens of Missouri. In 1990, Medicaid came out with the drug rebate program, which helped many. The Missouri Healthnet Division is responsible for making the best of the MO Medicaid funds, with frequent drug utilization reviews to determine the level of access to covered pharmaceuticals, as they manage these funds.
With seniors, government health care programs pay for quite a bit. For example, Long Term Care (LOC) costs Missouri about 2 million dollars a year. About 10 million elderly U.S. residents are in LTC facilities. Only Medicaid pays for this service as well, as mentioned earlier. Homecare is one form of LTC, and preferable to many. The underfunding of Medicare for LTC has increased around 50 percent in less than a decade, which amounts to around 5 billion dollars per year. Missouri is one of the states with the greatest disparity between the actual cost of providing suitable medical care and Medicaid reimbursements. This, of course, is damaging for nursing facility residents who have also had their ‘allowable costs’ progressively lowered as well. The result of this decline means that each individual patient has a daily shortfall of over 20 dollars a day. Missouri ranks about 7 percent in the nation in reference to this type of neglect. Aside from decreased health care quality of the elderly, these people may become very sick and could result in their lifespan shortened due to lack of access of medical attention that may delay the progression of any existing diseases they may have. There are also skilled nursing facility patients, most of who rely on Medicaid to pay for their care and services. The state of Missouri decides what is allowed regarding their care.
To no one’s surprise for the most part, the federal government essentially is disregarding the humane responsibility they have to the citizens in this population in the United States with ensuring they have appropriate health care by allowing such flaws to continue to exist.
The Medicaid for children again is called SCHIP, and was created over 10 years ago. This program is facing funding shortfalls in many states, with Missouri topping the list thanks to the governor. Of course, Bush vetoed a bill for SCHIP expansion and reauthorization recently, and the House was unable to over-ride this veto and some other vetos Blunt has implemented for the benefit of the U.S. citizens. The cost for this SCHIP program for children is around 4 billion dollars a year, and residents are concerned about children not receiving medical attention due to the severe shortages that continue to exist with the state’s Medicaid funds. Some governors, however, appear to be void of such concern, and therefore clearly do not share the concern of their citizens.
2. Medicare
Medicare is primarily health insurance provided by our government for those over 65 years of age, along with other situations, such as those with disabilities. Medicare began the same year Medicaid did, and it was a decent program to implement. About 50 million people in the United States have Medicare, which costs around 300 billion dollars every year. Unfortunately, various market forces have infected Medicare for decades now. However, Medicare has become more confusing for the cardholders over the years. Most recently, a part D was added to assist with paying for prescription drugs. Part A covers hospital stays and f/u stays in skilled nursing facilities for up to 100 days. Part B covers preventative medical care, ancillary services, which include medical treatment received in a health care facility, which includes a doctor’s office, as well as covering for medical equipment, all determined as medically necessary by CMS, who administers not only Medicare components already mentioned, but also Medicaid, SCHIP, CLIA, and HIPPA. CMS also reports to Medicare about the utilization of Medicaid by the state.
Since Medicare is the insurance for this population, doctors and others are somewhat reliant on reimbursement from the program, just as they are with other forms of insurance. A few years ago, the Senate Finance Committee passed a spending cut package that dropped over 10 billion dollars from Medicare and Medicaid over the next five years after the package was activated. This was due to the federal government wanting to cut 35 billion from the federal budget. Yet at the same time, the Senators agreed to boost doctors’ Medicare payments by over 10 billion dollars over 5 years that replaced a scheduled 5 percent or so cut that physician groups understandably were opposed to upon becoming aware of it. Furthermore, Medicare randomly assigned the members to a plan they may be completely unaware about until they are denied healthcare at a clinic, perhaps.
Then there is the issue of Medicare Fraud, which the CMS freely admits knowledge of, yet prosecutions seem rare, yet lucrative to the prosecutors with settlement agreements, which averages about a billion dollars a year from the wrongdoers and the settlements they pay. Also, when CMS spoke on this last year, the DHHS announced a pilot program to catch such people who rob taxpayers by over-billing Medicare in the amount of several billions of dollars every year.
There is an issue of doctors having their Medicare reimbursements cut by the Senate Finance Committee. Doctors are reimbursed by Medicare by a list of codes provided to them by CMS to illustrate to doctors that they have the discretion on what the doctor is allowed to collect from Medicare. Late last year, a closed meeting was held to discuss reversing a scheduled reduction in physician fees exceeding 10 percent that was planned to take place at the start of 2008. A one year moratorium regarding this cut was suggested. Physicians were included with many others scheduled for Medicare reductions. Finally in the summer of 2008, a veto-proof passage of a Medicare reform bill halted any Medicare reductions to physicians until at least 2009. At the same time, a Medicare Improvements for Patients and Providers act was passed- designed ultimately to improve Medicare and ensure the health of those on this program. 90 percent of doctors see Medicare patients. It appears the will of the people was acknowledged with the passage of this act. Because seeing Medicare patients is no longer affordable to doctors because of reimbursement issues with Medicare. And Medicare does have its share of flaws, such as the Medicare Advantage, designed as a solution to the shortfalls of the Medicare program. About 20 percent signed up for Medicare Advantage Medicare that was marketed aggressively to seniors regarding this element of their Medicare, yet was passed by congress and signed by the president. Now, regulations are being considered by the administration to limit their Medicare entitlements in other ways because of their mistake. Medicare Advantage cuts could deprive seniors of needed pharmaceuticals for the restoration of their health or to delay the progression of an existing disease they may have.
Then there are other cuts that are now in effect with Medicare reimbursement reductions, but were intended to begin shortly after the passing of the Balanced Budget act of 1997, which capped medical therapy for Medicare pts. at a maximum reimbursement of 1500 dollars per session for outpatient services that was initially suppose to be activated in 1999. Thanks to three moratoriums that were allowed after 1999 that provided an extension of the caps requirement until 2005, when the caps were mandated, yet were placed with what was called an ‘exceptions processes. This permits certain types of therapy to exceed the cap limit if the Medicare patient meets certain diagnostic and clinical criteria determined by their relevant health care provider. This process was authorized by the Deficit Reduction act of 2005. The process exception existed though a couple of more acts that were passed and activated until June of 2008. And the therapy sessions max out at a little over 1800 dollars a session at this time of implementation of the caps for services with the exceptions process expired at this point as well.
The intention of both Medicare and Medicaid was to assist others in medical need who are unable to obtain such needs due to their condition or their income. A few bad apples, from doctors to government officials, have contaminated the intent of these programs and health care to those who need it the most is being taken away from them, even though they have done nothing wrong.

Yeah, I’d say that our Health Care System a crisis.

“Compassion is the basis of all morality.” --- Arthur Schopenhauer

Dan Abshear

i just wanted to say thank you to the person talking about anti depressants with pregnancy i am now recieving therapy and dont care if i sound completely stupid i had to say thank u....u saved me and my child from a dumb decision