Visualizations
Reddit: after all this years?
Ramen in the US is climbing...too...
Give birth or don't
With South Korea falling below 0.7 not for the first time, despite stimulation measures, the world is not lagging behind too much:
And the reason is:
Jobs vs unemployed in US
CRISPS and sides
Zoomers discovering off-target effects
CRISPR is introducing off-target effects, with some modifications reducing them (nice overview by our friends P and C)
Prime editing aims to reduce off-target effects to zero, in super-dumb terms:
nCas9 cuts the DNA strand in two
A short sequence to start/prime reverse transcriptase (RNA → DNA) attaches, RT template including the edited part follows
RT synthesizes the DNA
Cell incorporates the new DNA into the sequence
Postpartum…
Psychosis!
Closely related to bipolar + hormones:
Reduction of estradion and progesterone →
Imbalance in dopaminergic and glutamatergic signalling →
Et voila, psychotic depression!
(Allopregnagolone is crawling nearby)
Lithium is the gold management standard, yet should be considered carefully because of sleep disruptions
Lamotrigine readily passes to the milk, about 14% of relative lithium dose passes
Valproic acid can be used during breastfeeding despite not being used in pregnancy
Dehydration → more chance of lithium toxicity for the kid
So it’s lithium all the way + managing hydration + benzodiazepines symptomatically (not an advocate of antipsychotics, but they’re mentioned - quetiapine looks the most bening here as well as helping with sleep disturbances)
Depression and breastfeeding!
All the medications pass into breast milk, most are compatible
The choice of medication/breastfeed-not should be made depending on mother’s condition
Sertraline showed >placebo (possibly because of its additional effect of allopregnagolone synthesis stimulation?); but then sertraline=nortryptiline and nortryptiline=placebo. So, by logic laws, sertraline>=placebo?..
Venlafaxine and Fluoxetine don’t meet safety criteria of <10% relative dosage in breast milk
Usual advice if already on treatment: maintain but limit exposure (like, lower the dosage?)
Breast is not a drug reservoir! The substances of <200 Da weight get into the milk when feeding, with up to 1000 Da possible.
Lipid solubility is also a thing: a drug has to be somewhat lipid-soluble to pass into breast milk
Depression and allopregnagolone!
Brexanolone is FDA-approved, but:
Has to be IVed over 60 hours (!!!), limiting its applicability
Patients have to be monitored for hypoxia and sleepiness → wut…
Zuranolone is taken orally, and doesn’t have as much side effects
Y U NO etifoxine, which raises allopregnagolone? Not approved for breastfeeding as there’s not enough data, but still preferable to SSRIs I presume
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