Children of depressed mothers who stop taking antidepressants before pregnancy have IQs and rates of behavioral problems similar to those of children of mothers who take serotonin reuptake inhibitors or venlafaxine, a serotonin-norepinephrine inhibitor, during pregnancy. Nulman et al. (p. 1165) tested children at age 3–6 and report that IQs are lower in these children than in children of nondepressed mothers, and behavioral problems are somewhat more common (figure). However, neither difference is related to prenatal antidepressant dose or duration. The child’s IQ is influenced by the mother’s IQ and child’s sex. Behavioral problems are associated with the severity of the mother’s depression not only during gestation but also during early childhood. The editorial by Steiner (p. 1130) summarizes evidence that untreated depression is a larger threat to offspring than antidepressants, but he recommends medication during pregnancy only if the indication is compelling.

Skin picking consumes hours a day for some individuals, causing disfigurement and interfering with social or work life. Grant et al. (CME, p. 1143) note that skin picking disorder has a prevalence of 1%–5% and can arise at any age, often after the onset of a dermatological condition. Although it has similarities to obsessive-compulsive disorder and body dysmorphic disorder, it is distinguished by a personal or family history of grooming disorders and a lack of preoccupation with appearance. A dermatologist should determine whether the patient has an underlying skin condition and whether medical treatment is needed. Skin picking disorder can be treated with cognitive-behavioral therapy, particularly habit reversal and acceptance-enhanced behavior therapy. Naltrexone and N-acetylcysteine, a glutamatergic agent, have shown promise in case reports. Clinical trials of selective serotonin reuptake inhibitors have had mixed results.