Review of NVP and HG and Early Pharmacotherapeutic Intervention
ABSTRACT NVP occurs in 50-90% of pregnancies, making it a common medical condition in pregnancy. Women present differently with any combination of signs and symptoms. It is appropriate to take the pregnancy-related versus nonpregnancy-related approach when determining the cause of nausea and vomiting but other causes should be considered. The most common etiologies for NVP include the hormonal changes associated with pregnancy, the physiologic changes in the gastrointestinal tract, and a genetic predisposition. Up to 10% of women will require pharmacotherapy to treat the symptoms of NVP despite conservative measures. ACOG currently recommends that a combination of oral pyridoxine hydrochloride and doxylamine succinate be used as first-line treatment for NVP if pyridoxine monotherapy does not relieve symptoms. A review of NVP and early pharmacotherapeutic management is presented due to the fact that NVP is largely undertreated, and investigations into the safe and effective pharmacotherapies available to treat NVP are lacking.
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ABSTRACT: The efficacy of antidepressant treatment of major depression remains a matter of controversy. A review of acute treatment studies suggests that for relatively more severe episodes of major depression, antidepressants are superior to treatment in the "placebo group;" however, there are numerous methodological confounds in the available literature. (Some recent, preliminary evidence suggests that antidepressants may also be of benefit in some less severely depressed populations).There is moderately strong evidence that, compared with placebo, maintenance antidepressant treatment reduces six-month relapse rates in major depression; however, it is less clear that antidepressants prevent actual recurrence of depression in the longer term. There is evidence of both over-use and under-use of antidepressant treatment, and there appears to be a "mismatch" between diagnosis and optimal treatment of depression in some clinical settings. Better designed studies are needed to resolve these uncertainties and to investigate such putative conditions as "oppositional tolerance" to long-term antidepressant treatment. The author advocates a conservative approach to antidepressant treatment, as well as a substantially extended "tapering" period when antidepressants are discontinued.Innovations in Clinical Neuroscience 05/2012; 9(5-6):31-40.
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ABSTRACT: Hyperemesis gravidarum occurs in 0.3 to 10 percent of pregnant women, with a 0.8 percent hospital admission rate. While older theories supported the psychosocial model as a cause for hyperemesis gravidarum, more recent studies have shown significant data to support a biological etiology. Hyperemesis gravidarum has serious complications including include increased risk for miscarriage, low birth weight infants, dehydration, Wernicke's encephalopathy, secondary depression, and negative attitudes toward a consecutive pregnancy. Because of these life-threatening complications and complexity of the disease, it is important to treat both somatic and psychosocial causes of hyperemesis gravidarum to provide the best care for the patient. This paper presents a case of a woman with anxiety symptoms who was experiencing severe nausea and vomiting since Week 2 of pregnancy, with minimal reduction of these symptoms on standard medications utilized in hyperemesis gravidarum. The patient had marked reduction of nausea and vomiting with adjunctive gabapentin. After a brief review of relevant neurogastroenterology, we discuss a possible mechanism for the added gabapentin.Innovations in Clinical Neuroscience 11/2012; 9(11-12):31-8.
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ABSTRACT: Nearly all pregnant women experience nausea and vomiting of pregnancy (NVP) to some degree, yet its effects on quality of life (QOL) have not been studied extensively. The National Voice of Pregnancy survey was undertaken to increase understanding about the symptoms of NVP and their impact on QOL in women in the United States. In all, 621 currently or recently pregnant women completed an online survey about their NVP experiences. Their responses indicated that NVP can occur at any time of day or night and can have negative effects on eating, sleeping, and ability to handle domestic and occupational responsibilities. Relationships with spouse, family, friends, and coworkers can also be adversely affected. The effects of NVP are greater in women with moderate or severe symptoms, but women with mild NVP are also affected. These findings are consistent with previous studies conducted in various countries. Women sometimes fail to discuss NVP with their health care providers, and QOL issues rarely come up if it is discussed. Most women try dietary and other lifestyle modifications first to control their symptoms. Safe and effective medications are also available to help ease the symptoms of NVP and thereby improve QOL.Obstetrical and Gynecological Survey 01/2013; 68:S1-S10. DOI:10.1097/OGX.0b013e3182a8784d · 2.36 Impact Factor