ABSTRACT
The use of antidepressant medications during pregnancy has stimulated much professional and public debate. As a consequence, considerable data on the reproductive safety of antidepressants has been generated that exceeds the available information for most, if not all, other classes of medications that may be used in the perinatal period. Despite progress to date, definitive conclusions are limited by the methodological issues inherent to clinical research involving illness versus treatment effects in pregnancy. A notable shortcoming is the limited discussion of statistically significant (a mathematical determination) versus clinically significant (incorporation of incidence and effect sizes into practical relevance). Research emphasises completing an individualised 'risk-benefit' assessment, which is a laudable goal but falls short in providing succinct practical guidelines that includes the key educational points for patients. In this chapter, we focus on areas in which the preponderance of data are consistent, and there is concordance with the preclinical literature to generate a practical approach for antidepressant use in pregnancy.
Subject(s)
Antidepressive Agents, Tricyclic/therapeutic use , Depression/drug therapy , Pregnancy Complications/drug therapy , Selective Serotonin Reuptake Inhibitors/therapeutic use , Abnormalities, Drug-Induced/etiology , Antidepressive Agents, Tricyclic/adverse effects , Birth Weight/drug effects , Female , Gestational Age , Humans , Infant, Newborn , Maternal-Fetal Exchange , Persistent Fetal Circulation Syndrome/chemically induced , Pregnancy , Pregnancy Complications/psychology , Prenatal Exposure Delayed Effects/chemically induced , Respiratory Distress Syndrome, Newborn/chemically induced , Selective Serotonin Reuptake Inhibitors/adverse effectsABSTRACT
The highly doped electrodes of a vertical silicon nanogap device have been bridged by a 5.85 nm long molecular wire, which was synthesized in situ by grafting 4-ethynylbenzaldehyde via C-Si links to the top and bottom electrodes and thereafter by coupling an amino-terminated fluorene unit to the aldehyde groups of the activated electrode surfaces. The number of bridging molecules is constrained by relying on surface roughness to match the 5.85 nm length with an electrode gap that is nominally 1 nm wider and may be controlled by varying the reaction time: the device current increases from ≤1 pA at 1 V following the initial grafting step to 10-100 nA at 1 V when reacted for 5-15 min with the amino-terminated linker and 10 µA when reacted for 16-53 h. It is the first time that both ends of a molecular wire have been directly grafted to silicon electrodes, and these molecule-induced changes are reversible. The bridges detach when the device is rinsed with dilute acid solution, which breaks the imine links of the in situ formed wire and causes the current to revert to the subpicoampere leakage value of the 4-ethynylbenzaldehyde-grafted nanogap structure.
