Antidepressants are one of the most commonly prescribed medications among women, with around 15% of all women taking an antidepressant, and one of the most commonly prescribed groups of these medications are SSRIs.  SSRIs are generally used to treat depression and anxiety, and while it’s generally thought that the risks of taking these medications during pregnancy are for the most part rather low, it turns out that these medications may make having a successful pregnancy harder.  Here’s a quick overview.

What are SSRIs, and how do they work?  SSRI stands for selective serotonin reuptake inhibitor, and includes medicines like citalopram (Celexa), fluoxetine (Prozac), ecitalopram (Lexapro), sertraline (Zoloft), and paroxetine (Paxil).  These medications work by increasing the level of serotonin in the brain.  Serotonin is a chemical messenger used by the cells in the brain for communication.

How would this affect my ability to become pregnant?  We've known for awhile that SSRIs can decrease libido, but a recent study by Dr. Sjaarda, et al presented at the American Society of Reproductive Medicine, suggests that using any SSRI while trying to conceive decreases the chances of becoming pregnant in a single menstrual cycle by 23%.  Additionally, patients specifically taking fluoxetine (Prozac) had an increased risk of pregnancy loss (34% vs 24%) compared with patients who weren’t taking Prozac.

So, should I stop my SSRI right away if I’m trying to conceive?  Absolutely not!  The decision of whether or not to continue a medication should always be discussed with your provider BEFORE stopping.  Not only should these medications generally be tapered prior to stopping, but everyone has a very individual health history, and the level of need for these medications can vary significantly from person to person.  Pregnancy at the cost of good mental health probably isn’t going to be worth it.

All medications have their both their benefits and their side effects.  For some, those benefits far outweigh the potential side effects, and quite frankly, safe day-to-day functioning may not be possible without a given medication.  For others with more mild symptoms, especially if the cause of those symptoms was temporary, their depression might be controlled with nonmedicinal options such as therapy, exercise, good social support, meditation or other coping strategies.  In those cases, gradually tapering an SSRI prior to pregnancy may be a good option, or if taking fluoxetine, another medication in the SSRI group may be a better option.  That being said, these decisions should always be made in conjunction with your healthcare provider, and if any severe depression symptoms develop during weaning these medications, it is always advised to go directly to the ER for help.  For all of those trying to conceive and taking SSRIs, we hope that you are able to make the best decision for you, and, hopefully, your growing family 😊
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Dr. Nick

I get this question all the time.  So, as we age, the ovaries produce less estrogen, progesterone, and testosterone.  Hormone production across the board decreases.  Why does this happen?  A woman is born with a finite number of eggs which are in the ovaries.  As time goes by, most of these eggs are released for ovulation in hopes to achieve a pregnancy.  During this process the ovaries produce estrogen, progesterone and testosterone.  As the number of eggs diminishes, there are no more left to ovulate, and without this process hormones are not produced.  This is why the production of hormones significantly decreases with menopause. 

With this decrease in hormone production, women approaching menopause can experience the following changes- insomnia, mood swings, hot flashes, vaginal dryness, changes in libido, weight gain, changes in hair/skin, the list goes on and on.  For some women, these symptoms can be really severe and negatively affect their quality of life.  For others, they barely notice the difference. 

So, do I need any extra lab tests or hormones checked to confirm this?  The answer is most likely no.  If you are approaching menopause and having symptoms consistent with menopause, then you are probably in menopause.  If you were to check hormones- they would all be low because your ovaries have now decreased production of them as you approach the menopause.  There are no guidelines that recommend this testing, and often insurance does not cover routine hormone testing.  So, you could easily be out $500 for a blood test.

Will checking hormones help guide my provider to providing me the right dose of hormones?  The answer to this as well is no.  We titrate the dose until your symptoms are better.  Some women require only a small amount of hormone replacement and some require a larger dose to help with their hot flashes and other menopausal symptoms.  If you are 55, your hormones across the board will most likely be low, and knowing this does not help me determine what dose of hormone replacement is best for you. 

If you are approaching menopause and have noticed severe hot flashes, moodiness or other symptoms, talk to your provider about options.  It is important to know both the risks and benefits of hormone replacement therapy as well as the best option for you.
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Dr. Pam

Every winter I get lots of questions from patients about skin changes, and while some of them are definitely pregnancy related, a lot of the more annoying skin conditions actually start with the weather.  So, when the snow starts falling, here are a few tips to keep your skin from flaking.

1.  Healthy skin starts from the inside out.  Drinking extra water, even when you’re not as thirsty because of the cold, is an important first step to maintaining good skin health.  Fish oil and flaxseed oil both provide omega fatty acids that can be beneficial in severe conditions, too.
2. Stay warm, but not too warm.  While it’s tempting to crank the heat on a cold day, anything above 72 begins to zap the moisture from the air and can in turn dry out your skin.  If you really must turn the heat higher, then consider investing in a humidifier to offset the moisture loss from the heat.
3. The same goes for showers and baths, too.  Warm (not hot) water is best for keeping the moisture in your skin, and time in the water should be limited to less than 10 minutes.
4. As soon as you get out of the shower, moisturize while the skin is still damp, and be sure to use a heavy-duty moisturizer rather than simply a lotion during the winter months.
5. Limit exfoliants, toners, astringents, and scented skin products during the winter.  Even if they don’t usually cause skin sensitivity, the more fragile state of your skin during the winter can allow problems to develop.
6. Be wary of scented detergents and those with dyes, too.  Exposure to even small amounts of these chemicals left in clothes can potentially result in irritated skin.  That being said, don’t forget to wash new clothes before wearing as excess dye left in new clothes can also cause skin issues.
7. Warm clothes can sometimes be an issue as well.  For those with sensitive skin, wool can lead to rather profound itching, and other types of heavy clothes are often made of more coarse materials.  Be sure to layer with lighter, more comfortable clothes protecting you from the rougher texture of your winter garments.  Heavy clothes also tend to hold moisture longer than lighter layers, so if you do end up with snow falling into your jacket or boots, try to change as soon as possible as wet clothes can be even more irritating to skin than dry ones, and in turn, make you that much itchier.
8. Don’t forget your sunscreen!  Even on bleary days, UV damage is quite possible (as anyone who’s ever come home from a ski trip with goggle outlines can attest).  A combination of moisturizer and sunscreen can limit the number of skin products needed during the winter.
9. Lastly, at the end of the day, don’t forget to gently wash your face before bed to rinse of any accumulated products, oil and grime accumulated during the day.  A gentle nighttime moisturizer is a good investment in protecting your skin before bed.

Skin dryness and itchiness is a very common problem during the winter, and some irritation over the colder months may not be avoidable.  Still, a good skin care regimen for winter weather can go a long way toward making things better.  In turn, that healthy skin allows for even more enjoyment of peaceful, snowy days, whether you’re carving turns on the ski hill or admiring the snowfall while enjoying hot chocolate and a book by a crackling fire 😊

​Dr. Nick