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Jonas W.,University of Toronto | Jonas W.,Karolinska Institutet | Mileva-Seitz V.,Erasmus Medical Center | Girard A.W.,Emory University | And 7 more authors.
Genes, Brain and Behavior | Year: 2013

Mothers vary in duration of breastfeeding. These individual differences are related to a variety of demographic and individual maternal factors including maternal hormones, mood and early experiences. However, little is known about the role of genetic factors. We studied single-nucleotide polymorphisms (SNPs) in the OXT peptide gene (rs2740210; rs4813627) and the OXT receptor gene (OXTR rs237885) in two samples of mothers from the Maternal adversity, Vulnerability and Neurodevelopment study (MAVAN), a multicenter (Hamilton and Montreal, Canada) study following mothers and their children from pregnancy until 7years of age. Data from the Hamilton site was the primary sample (n=201) and data from Montreal was the replication sample (n=151). Breastfeeding duration, maternal mood (measured by the CES-D scale) and early life adversity (measured by the CTQ scale) were established during 12months postpartum. In our primary sample, polymorphisms in OXT rs2740210, but not the other SNPs, interacted with early life adversity to predict variation in breastfeeding duration (overall F8,125=2.361, P=0.021; interaction effect b=-8.12, t=-2.3, P=0.023) and depression (overall F8,118=5.751, P≤0.001; interaction effect b=6.06, t=3.13, P=0.002). A moderated mediation model showed that higher levels of depression mediated the inverse relation of high levels of early life adversity to breastfeeding duration, but only in women possessing the CC genotype [effect a′=-3.3401, 95% confidence interval (CI)=-7.9466 to -0.0015] of the OXT SNP and not in women with the AA/AC genotype (a′=-1.2942, ns). The latter findings (moderated mediation model) were replicated in our Montreal sample (a′=-0.277, 95% CI=-0.7987 to -0.0348 for CC; a′=-0.1820, ns for AA/AC). © 2013 John Wiley & Sons Ltd and International Behavioural and Neural Genetics Society. Source

Steiner M.,Womens Health Concerns Clinic | Steiner M.,McMaster University | Li T.,Womens Health Concerns Clinic
CNS Drugs | Year: 2013

Premenstrual dysphoria (PMD) affects 3-8 % of women in their reproductive years worldwide. This paper summarizes the studies establishing the efficacy of continuous, luteal phase, and symptom-onset dosing of selective serotonin reuptake inhibitors (SSRIs) and dual serotonin and norepinephrine reuptake inhibitors (SNRIs) in treating women with PMD. The evidence indicates that for some women, symptom-onset dosing with escitalopram, fluoxetine, and paroxetine controlled release (CR) is as effective as continuous or luteal phase dosing. The wide range of clinical efficacy of SSRIs/SNRIs suggests that they exert their therapeutic effect through multiple pathways. This paper offers a few alternative mechanisms of action to explain the rapid response to SSRIs/SNRIs in women with PMD. © 2013 Springer International Publishing Switzerland. Source

Soares C.N.,Womens Health Concerns Clinic | Soares C.N.,McMaster University
Drugs and Aging | Year: 2013

Epidemiologic and clinic data have unequivocally supported the notion that women experience more psychiatric problems at some point in their lives compared with men, particularly mood and anxiety symptoms and sleep problems. It is also known that, for some women, such increased risk might be associated with reproductive cycle events such as the postpartum period or the menopausal transition. These periods are not only marked by substantial hormone variations but also quite often accompanied by stressful events and changes in personal, family and professional responsibilities. The complexity of these reproductive-related 'windows of vulnerability' poses a challenge to physicians and other professionals dedicated to women's health across the lifespan. The menopausal transition and early postmenopausal years constitute a characteristic example; during this period in life, dynamic changes in sex hormones and reproductive function co-occur with modifications in metabolism, sexuality, lifestyle behaviours and overall health, sometimes affecting a woman's quality of life and overall functioning. For most women, however, this transition has little or no significant impact on their mental wellness. A prior depressive episode - particularly if related to reproductive events - is the strongest predictor of mood symptoms or depression during menopausal years. Also, the presence and severity of vasomotor symptoms and other health-related issues appear to modulate the risk for depression in midlife women. Mechanistically, estrogen plays an important modulatory role in mood and cognitive regulation, hence the effects noted when midlife women are exposed to significant estrogen fluctuations or to estrogen-based therapies (use or withdrawal). Transdermal estradiol, as well as serotonergic and noradrenergic antidepressants, have shown efficacy in the management of depression in this population. Other evidence-based treatment options (hormonal, pharmacological, behavioural) are available to clinicians and health professionals who care for this population. © 2013 Springer International Publishing Switzerland. Source

Steiner M.,Womens Health Concerns Clinic | Steiner M.,McMaster University | Steiner M.,University of Toronto
Acta Physiologica | Year: 2011

The comorbidity of cardiovascular disease (CVD) and depression/anxiety disorders is well established, but the mechanisms are not well understood. This paper will review the epidemiological and biological evidence for the role of depression in CVD, as well as the pathophysiological process underlying both depression and CVD. The focus will be on the roles of serotonin, platelets, and the immune system, with an emphasis on the relevance of sex differences in both depression/anxiety and CVD as they pertain to women. © 2011 The Author. Acta Physiologica © 2011 Scandinavian Physiological Society. Source

Grigoriadis S.,Sunnybrook Health science Center | Grigoriadis S.,Sunnybrook Research Institute | VonderPorten E.H.,Sunnybrook Health science Center | Mamisashvili L.,Sunnybrook Health science Center | And 7 more authors.
BMJ (Online) | Year: 2014

Objective: To examine the risk for persistent pulmonary hypertension of the newborn associated with antenatal exposure to antidepressants. Design: Systematic review and meta-analysis. Data sources: Embase, Medline, PsycINFO, and CINAHL from inception to 30 December 2012. Eligibility: English language studies reporting persistent pulmonary hypertension of the newborn associated with exposure to antidepressants. Two independent reviewers extracted data and assessed the quality of each article. Results: Of the 3077 abstracts reviewed, 738 papers were retrieved and seven included. All seven studies were above our quality threshold. Quantitative analysis was only possible for selective serotonin reuptake inhibitors (SSRIs). Although exposure to SSRIs in early pregnancy was not associated with persistent pulmonary hypertension of the newborn (odds ratio 1.23, 95% confidence interval 0.58 to 2.60; P=0.58), exposure in late pregnancy was (2.50, 1.32 to 4.73; P=0.005). Effects were not significant for any of the moderator variables examined, including study design, congenital malformations, and meconium aspiration. It was not possible to assess for the effect of caesarean section, body mass index, or preterm delivery. The absolute risk difference for development of persistent pulmonary hypertension of the newborn after exposure to SSRIs in late pregnancy was 2.9 to 3.5 per 1000 infants; therefore an estimated 286 to 351 women would need to be treated with an SSRI in late pregnancy to result in an average of one additional case of persistent pulmonary hypertension of the newborn. Conclusions: The risk of persistent pulmonary hypertension of the newborn seems to be increased for infants exposed to SSRIs in late pregnancy, independent of the potential moderator variables examined. A significant relation for exposure to SSRIs in early pregnancy was not evident. Although the statistical association was significant, clinically the absolute risk of persistent pulmonary hypertension of the newborn remained low even in the context of late exposure to SSRIs. Source

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