Pregnant women and psychotropic medications really don't mix

What I hate about this study is that we even have to study whether or not a pregnant woman should be given psychotropic medications during pregnancy. It disturbs me that this many studies surrounding this question are showing up in Pub Med. My common sense would tell me absolutely not, without even having to do the research. However, I guess there are some situations where it is more dangerous to have a pregnant woman's psychopathology left completely untreated for an entire 9 months. So, despite my personal feelings, I'll share the findings.

Pregnant mice were given fluoxetine (Prozac) throughout their pregnancy and kept on the medication until their pups were weaned. The pups were then given other medications and their responses to those medications were evaluated. The effects seemed to be more significant in the female offspring, who did not seem to have normal responses related to dopamine function. (Dopamine is important for impulse control, which influences potential for chemical dependencies and troubles such as addictions, gambling, shoplifting, and carbohydrate bingeing). The researchers also suggested that if this relationship existed in humans, daughters of women who took Prozac during pregnancy may not effectively respond to certain medications later in life. Two important classes of medications this might include are Parkinson's medications and antipsychotics, both of which attempt to correct problems in dopamine systems.

So, MY take on this is that given the fact that fish oil is such a powerful antidepressant and it is important to have enough of it during pregnancy for both mother and baby, perhaps we're learning that we should lean more in that direction on behalf of the two individuals involved in a pregnancy.

My CONCERN is that a drug company R and D person is likely to read the very same study and think, "Hmmm...if we get started right now, we can have a new drug ready for all those babies coming down the pike whose dopamine systems aren't responding to anything we can currently script."

We'll see which direction this information takes science. I sure hope it's the one involving fewer trips to the pharmacy in 20 years.

Favaro PN, Costa LC, Moreira EG. Maternal fluoxetine treatment decreases behavioral response to dopaminergic drugs in female pups. Neurotoxicol Teratol. 2008 Nov-Dec;30(6):487-94. Epub 2008 May 14.

Cigarettes and coffee for breakfast...why it's so easy to get stuck in that rut

My teaching assistant today comes from Star Wars. He is here with me, because I have lost track of the number of times, when trying to do a serious presentation about neurotransmitters, I have said, "R2D2" when I meant to say "DRD2". I will have to check the Universal Diagnostic and Statistical Manual to see if I meet the criteria for Intergalactical Dyslexia...

What R2D2 and I would like to tell you about his almost-namesake today, the DRD2 receptor, is that this subset of dopamine receptors is sensitive to how we eat. DRD2 is responsible for impulse control. People who have a disturbed DRD2 system are more prone to problems such as shoplifting, gambling, alcohol addiction, nicotine addiction, and binge eating. They also seem to have more intensive carbohydrate cravings.

Scientists recently reported that this receptor is especially sensitive to food restriction. That is, people who restrict their food intake seem to be more sensitive to the reinforcing effects (the effects that make you feel good and want to use) of several addictive substances, including opiates, nicotine, and psychostimulants.

(That is why R2D2 is a little wired today; he was running late and drank his coffee but skipped breakfast to be sure we got this posted.)

This particular study suggests that the same effect can be provoked when restricting food and using dopamine-promoting medications such as pramipexole (Mirapex). For anyone taking medications for Parkinson's disease or restless legs syndrome, this could be important information to discuss with a nutritionist.

One of the enhanced responses with food restriction is locomotion. And that makes me think of people who abuse some of these chemicals. They stimulate themselves, which suppresses their appetite, which enhances their stimulation and increases their physical activity. On an ongoing basis, (and people who abuse drugs tend to not only use them just once) that can create a calorie deficit which reinforces the positive effects of the drug use. And that can reinforce staying addicted.

Even if you're not using illicit drugs, maybe not eating and living on cigarettes and coffee is kind an offbeat, roundabout way to jumpstart the dopamine system into motion. I have had many, many clients who tell me they feel addicted to sugar, and when they simply don't eat it they feel better. Maybe this is one of the reasons for that relationship.

Just a little fun fact on this Friday that will hopefully give you something to think about.

R2D2 and I are now going to eat breakfast.

Collins GT, Calinski DM, Newman AH, Grundt P, Woods JH. Food restriction alters N'-propyl-4,5,6,7-tetrahydrobenzothiazole-2,6-diamine dihydrochloride (pramipexole)-induced yawning, hypothermia, and locomotor activity in rats: evidence for sensitization of dopamine D2 receptor-mediated effects. J Pharmacol Exp Ther. 2008 May;325(2):691-7.