SSRIs in women of reproductive age; a systematic review of local formularies.

BACKGROUND: Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of Selective Serotonin Reuptake Inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, post-partum haemorrhage (PPH) and Persistent Pulmonary Hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice. AIM: To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy and during breastfeeding. DESIGN & SETTING: Prescribing formularies in England and Wales. METHOD: A systematic keyword search of all Clinical Commissioning Group (CCG) and Integrated Care Board (ICB) websites in England and Local Health Board (LHB) websites in Wales was undertaken between December 2021-22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs. RESULTS: 74 prescribing formularies were reviewed. 14.9% (11/74) provided links to the Medicines and Healthcare Regulatory products Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (21/74) to guidance on PPH risk and 1.4% (1/74) to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy and during breastfeeding in 12.2% (9/74), 23% (17/74) and 21.6% (16/74) of formularies respectively. CONCLUSION: Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This may place babies at increased risk of unintentional SSRI exposure

The periodontally-involved root surface.

Recent years have seen much research on the periodontally-involved root surface. Many of these studies have produced results which suggest that plaque contaminants of the root surface are only superficially placed, and capable of being removed by gentle means. Further research has attested to the difficulties in rendering periodontally-involved root surfaces free of calculus deposits by instrumentation, yet clinical studies show that periodontal disease can be managed by root planing. It is concluded that root surface debridement is best assessed on the basis of the healing response and that it should aim to disrupt plaque on and remove plaque from the periodontally-involved root surface rather than to remove part of the root surface itself.link_to_subscribed_fulltex