Postpartum depression: aetiology, pathogenesis and the role of nutrients and dietary supplements in prevention and management

Zuranolone, a neuroactive drug, used in the treatment of postpartum depression by modulation of GABAA receptors

BACKGROUND

Postpartum depression [PPD] is a prevalent and debilitating mood disorder that affects mothers in the weeks to months after childbirth. Zuranolone (Zurzuvae) is a novel pharmaceutical agent that was approved by the US FDA on 4 August 2023 for the management of PPD. This review article provides a comprehensive overview of zuranolone, focusing on its dosing, chemistry, mechanism of action, clinical trials, adverse drug reaction, and overall conclusion regarding its utility in the management of PPD. It also discusses the recommended dosing strategies to achieve optimal efficacy while minimizing adverse effects as the dosage regimen of zuranolone is critical for its therapeutic application. Moreover, it gives insights into neurobiological pathways involved in PPD.

METHODOLOGY

Data from randomized controlled trials and observational studies was collected to provide a comprehensive understanding of zuranolone in the management and treatment of PPD.

CONCLUSION

Zuranolone represents a promising therapeutic option for women suffering from postpartum depression. However, ongoing research and post-marketing surveillance are essential to further elucidate its long-term safety and efficacy. The integration of zuranolone into clinical practice may significantly improve the quality of life for mothers facing the challenges of postpartum depression.

Association between of vitamin B12 status during pregnancy and probable postpartum depression: the ECLIPSES study

BACKGROUND

B12 vitamin is essential for the functioning of the nervous system and the production of mood-related neurotransmitters. However, information on its association with postpartum depression (PPD) is limited.

OBJECTIVE

To examine the effect of serum vitamin B12 levels during pregnancy on PPD, in healthy pregnant women from the Mediterranean region of Catalonia, Spain.

METHOD

This longitudinal study included a subsample of women at 54 days (7.7 weeks) postpartum (n = 336), who participated in the ECLIPSES Study conducted out in Tarragona, Spain. Maternal concentrations of vitamin B12 were determined in the first and third trimester of pregnancy and sociodemographic, nutritional, and psychological data were collected. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

The prevalence of probable PPD was 21%. After adjusting for sociodemographic, lifestyle, biochemical parameters, and postpartum characteristics the regression model showed a negative association between EPDS scores and the highest quartile of serum vitamin B12 (first quartile (reference) vs. fourth quartile), (β = -1.267, 95% CI = -2.461, -0.073, p = 0.038).

CONCLUSION

Maintaining a normal-high level of vitamin B12 during early pregnancy can contributes to preventing PPD.

Association of Perinatal Depressive Symptoms with Breastfeeding

Objective

Perinatal depression (PND) refers to depressive symptoms that occur in women during pregnancy and/or postpartum and is a common perinatal mental health problem. It is unclear whether early breastfeeding behavior is associated with PND symptoms in China. Therefore, this study aimed to investigate the association between PND symptoms and breastfeeding patterns for infants based on a large cohort.

Methods

A prospective study was conducted in a community cohort from March 2021 to December 2022. In this study, maternal depressive symptoms were assessed using the Edinburgh postnatal depression scale (EPDS). The assessments were carried out 1 week before and 1 month after delivery. The socio-demographic information of the mothers, their intention to breastfeed, and their feeding status were investigated one-on-one by the hospital's trained medical staff through self-designed questionnaires. The maternity information and physical examination results were obtained through the healthcare records of the patients.

Results

A total of 442 pregnant women were included in the study, and the total detection rate of PND was 29.41%, among which the detection rate of mild PND was 24.66%, and the detection rate of severe depression was 4.75%. About 61.99% of the mothers had exclusive breastfeeding within 1 hour after delivery, and 83.71% had exclusive breastfeeding within 24 hours after delivery. The proportion of mothers with PND symptoms and those without PND symptoms who exclusively breastfed for the first time after delivery was 71.54% and 91.67%, respectively. The median duration of exclusive breastfeeding for mothers without depressive symptoms was 3(1,5) months, while the median duration of exclusive breastfeeding for mothers with depressive symptoms was 2(1,3) months, indicating that the duration of exclusive breastfeeding for mothers without depressive symptoms was longer (P < 0.05).

Conclusion

There was an association between perinatal depressive symptoms and exclusive breastfeeding. Addressing perinatal depressive symptoms may extend the duration of exclusive breastfeeding.

Nourishing the Mind: How Food Security Influences Mental Wellbeing

Food insecurity is a significant public health problem worldwide and critical to mental health. There is a complex relationship between food security and mental health. We carried out a narrative review study aiming to address how food insecurity impacts mental wellbeing by focusing on the mental health repercussions of food insecurity, recognizing its pivotal role in attaining Sustainable Development Goals 2 (on hunger) and 3 (on enhancing global wellbeing). A comprehensive search was conducted on PubMed and Google Scholar, incorporating Google searches for pertinent reports and policy documents. To address these questions, we emphasized and elucidated the interconnectedness between food security and mental health. The review shows that food security and mental health share a profound relationship influenced by multifaceted factors like socioeconomic conditions, access to nutritious food, and societal inequalities. We then provide recommendations for integrating food security into mental health strategies based on the insights and conclusions drawn. Strategies ranging from sustainable farming practices to urban agriculture initiatives and digital mental health services demonstrate avenues for enhancing food safety and mental wellbeing. This highlights the need for collaborative interdisciplinary efforts and systemic reforms to address these interconnected challenges.

Mitochondrial might: powering the peripartum for risk and resilience

The peripartum period, characterized by dynamic hormonal shifts and physiological adaptations, has been recognized as a potentially vulnerable period for the development of mood disorders such as postpartum depression (PPD). Stress is a well-established risk factor for developing PPD and is known to modulate mitochondrial function. While primarily known for their role in energy production, mitochondria also influence processes such as stress regulation, steroid hormone synthesis, glucocorticoid response, GABA metabolism, and immune modulation - all of which are crucial for healthy pregnancy and relevant to PPD pathology. While mitochondrial function has been implicated in other psychiatric illnesses, its role in peripartum stress and mental health remains largely unexplored, especially in relation to the brain. In this review, we first provide an overview of mitochondrial involvement in processes implicated in peripartum mood disorders, underscoring their potential role in mediating pathology. We then discuss clinical and preclinical studies of mitochondria in the context of peripartum stress and mental health, emphasizing the need for better understanding of this relationship. Finally, we propose mitochondria as biological mediators of resilience to peripartum mood disorders.

Biomarkers of Postpartum Depression: A Narrative Review

Postpartum depression (PPD) is a disorder that impairs the formation of the relationship between mother and child, and reduces the quality of life for affected women to a functionally significant degree. Studying markers associated with PPD can help in early detection, prevention, or monitoring treatment. The purpose of this paper is to review biomarkers linked to PPD and to present selected theories on the pathogenesis of the disease based on data from biomarker studies. The complex etiology of the disorder reduces the specificity and sensitivity of markers, but they remain a valuable source of information to help clinicians. The biggest challenge of the future will be to translate high-tech methods for detecting markers associated with postpartum depression into more readily available and less costly ones. Population-based studies are needed to test the utility of potential PPD markers.

Metformin in Gestational Diabetes Mellitus: To Use or Not to Use, That Is the Question

In recent years, there has been a dramatic increase in the number of pregnancies complicated by gestational diabetes mellitus (GDM). GDM occurs when maternal insulin resistance develops and/or progresses during gestation, and it is not compensated by a rise in maternal insulin secretion. If not properly managed, this condition can cause serious short-term and long-term problems for both mother and child. Lifestyle changes are the first line of treatment for GDM, but if ineffective, insulin injections are the recommended pharmacological treatment choice. Some guidance authorities and scientific societies have proposed the use of metformin as an alternative pharmacological option for treating GDM, but there is not yet a unanimous consensus on this. Although the use of metformin appears to be safe for the mother, concerns remain about its long-term metabolic effects on the child that is exposed in utero to the drug, given that metformin, contrary to insulin, crosses the placenta. This review article describes the existing lines of evidence about the use of metformin in pregnancies complicated by GDM, in order to clarify its potential benefits and limits, and to help clinicians make decisions about who could benefit most from this drug treatment.