The Pharmaceutical Journal
Vol 278 No 7455 p686
9 June 2007

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Managing the problem of depression in pregnancy more
More discoveries from the Mayan dynasties more
Genetic predisposition is unjustifiable basis for discrimination more
Brain teaser more

Managing the problem of depression in pregnancy

A discussion of the tricky problem of depression in women during pregnancy, from the Institute of Psychiatry at King’s College, London, appears in the 12 May issue of the BMJ. It points out that rates of depression are higher during the childbearing years than at any other time and vary from 7 to 15 per cent in economically developed countries to 19 to 25 per cent in less developed ones. The relapse rate in pregnant women with a history of recurrent mood disorder may be as high as 50 per cent.

Predisposition to such an effect is influenced by poverty, lack of education and sex inequality. Exposure to domestic violence adds to the risk, as do poor social support, adolescence and single status.

Most women welcome pregnancy, but it is a major physiological and psychological event and, added to other chronic stressors, may present an unmanageable situation. The biological changes during pregnancy directly affect mood, since sex steroids are increased and affect parts of the brain regulating it, while overactivity of the hypothalamic-pituitary-adrenal system increases.

Stopping maintenance medication may be an important contributory factor. The discontinuation of antidepressants after conception has been associated with relapse in some two thirds of women. The risk of suicide is low, but it may be a common cause of maternal deaths in the year after birth.

Antenatal depression may have a harmful influence upon the development of a child’s central nervous system. Moreover, unhealthy behaviours associated with depression, such as smoking, alcohol and other substance abuse, associated with poor attendance for obstetric care, add to the hazards. Behaviour that presents a health risk apparently has a strong effect on intrauterine growth, while psychological stress has more effect on preterm delivery.

Treating depression in pregnancy may involve psychotherapy for mild problems but, if the patients has a history of severe or recurrent depression, then treatment with antidepressants may be called for.

Paroxetine is suspected of being more liable to cause cardiac abnormalities than are other antidepressants. A serotonin withdrawal syndrome with hypotonia, irritability, excessive crying, sleeping difficulties and mild respiratory distress is more likely to occur with paroxetine than with other drugs of the same class.

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More discoveries from the Mayan dynasties

In the Guatemala jungle, west of the famous Mayan ruin of Tikal, archaeologists have found a 1,400-year old royal tomb containing a mass of artefacts, including figurines of superb quality, apparently representing a court assembly.

The circular arrangement in which the objects were discovered offers glimpses of the political and religious aspects of the Maya civilisation. A vaulted tomb within a pyramid that contained two dozen ceramic figurines also contained a child sacrifice covered with a jaguar pelt, a mosaic mask, 33 ceramic vessels and two carved heads of monkeys, which are usually associated with ancient scribes.

The finds indicate Mayan rulers who were artists and scholars as well as warrior kings. An outer circle of artefacts represents king, queen, ball player and other court members while an inner circle depicts creatures located between the real and the supernatural, including a frog, dwarves and a shaman with contorted face. The set-up suggests a creation myth.

Nothing like these figurines has been discovered since those found in the mid-20th century at La Venta, Mexico, an Olmec city dated a millennium before the classic period of the Maya. An Olmec statue was also found at the El Perú site now being examined. Two sculptural heads using imagery from Teotihuacán far to the north indicate a connection with a warlord in year 278 of the Christian era.

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Genetic predisposition is unjustifiable basis for discrimination

I note from an editorial in the 11 May issue of Science that the US House of Representatives has just passed legislation prohibiting health insurers from denying coverage to a healthy individual, or charging higher insurance premiums, solely because he or she possesses a genetic predisposition to develop a disease in the future. At the same time the law will prevent employers from making use of genetic information when deciding to hire, fire or promote employees.

If there is any fear that the abuse of personal genetic information might prevent some from receiving the insurance cover they seek or adversely affect their employment prospects, then the concerns of the public must be met. In a US survey in 2006, two-thirds of those questioned were worried about the security of information in respect of genetic testing.

Instances of genetic discrimination have already occurred in the US. In the 1970s many African-Americans were denied jobs, educational opportunities and insurance on the grounds that they posed a risk as carriers of sickle-cell anaemia. Some employees were given genetic tests for carpal tunnel syndrome without their knowledge.

Discrimination on genetic grounds is now recognised as both unjustifiable and illogical. Having a genetic predisposition to a disease does not mean that it will develop and having potentially bad genes is common. In other respects, suspicion has a crippling effect upon genetic research. Removing it would give researchers more freedom to study an important and engrossing phenomenon.

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And I quote…

Brain teaser
“Because we don’t understand the brain very well we’re constantly tempted to use the latest technology as a model for trying to understand it. In my childhood we were always assured that the brain was a telephone switchboard. (What else could it be?) And I was amused to see that Sherrington, the great British neuroscientist, thought that the brain worked like a telegraph system. Freud often compared the brain to hydraulic and electromagnetic systems. Leibniz compared it to a mill, and now, obviously, the metaphor is the digital computer.”
—John R. Searle, professor of the philosophy of mind and language, University of California, Berkeley (b.1932).