1
|
Dubreucq J, Kamperman AM, Al-Maach N, Bramer WM, Pacheco F, Ganho-Avila A, Lambregtse-van den Berg M. Examining the evidence on complementary and alternative therapies to treat peripartum depression in pregnant or postpartum women: study protocol for an umbrella review of systematic reviews and meta-analyses. BMJ Open 2022; 12:e057327. [PMID: 36410814 PMCID: PMC9680168 DOI: 10.1136/bmjopen-2021-057327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Complementary and alternative therapies (CATs) refer to a diverse range of approaches that can be used as add-on or an alternative to conventional therapies. While a number of individual studies and systematic reviews (SRs) or meta-analyses (MAs) have investigated the effectiveness of specific types of CATs to treat depressive symptoms at specific moments of the perinatal period, an overarching synthesis of the literature is currently lacking. We will conduct an umbrella review of SRs and MAs to assess to which extent CATs are associated with depressive symptoms reduction during pregnancy or after childbirth. METHODS AND ANALYSIS We will search a broad set of electronic databases (MEDLINE via Ovid, Embase.com, CINAHL via EBSCOhost, PsycINFO via Ovid, AMED and Google Scholar). We will include SRs with or without MAs meeting the following criteria: (1) the review should focus mostly on individual studies reporting a randomised controlled design; (2) diagnosis should be made during pregnancy or during the post partum using a clinical interview according to DSM or ICD criteria; (3) the reviewed intervention should start during pregnancy or in the first postpartum year and meet the criteria for being considered as CAT. The main outcome will be depressive symptoms reduction during pregnancy or after childbirth. Secondary outcomes will include the remission of depression according to DSM criteria and intervention acceptability. Overlap between reviews will be described, quantified and discussed. We will rate the quality of the included SRs or MAs using the AMSTAR-2 tool. MAs will be performed by using the data from the individual RCT studies included in the SRs or MAs. Sensitivity analyses restricted to studies with a low-moderate risk of bias will be realised. Publication bias will be examined visually by using a funnel plot, and formally using the Egger's test and test of excess significance. ETHICS AND DISSEMINATION We intend to publish the results of the umbrella review in an international peer-reviewed journal. Oral presentations in congresses and internal diffusion through the Rise up-PPD European COST Action network are also planned. PROSPERO REGISTRATION NUMBER CRD42021229260.
Collapse
Affiliation(s)
- Julien Dubreucq
- Child & Adolescent Psychiatry, Insitute of Cognitive Neuroscience (CNRS 5229), University Lyon 1 & University Hospital Saint Etienne, Saint Etienne, France
- Department of Child and Adolescent Psychiatry, Erasmus MC, Rotterdam, Netherlands
| | - Astrid M Kamperman
- Department of Child and Adolescent Psychiatry, Erasmus MC, Rotterdam, Netherlands
| | - Nadia Al-Maach
- Department of Child and Adolescent Psychiatry, Erasmus MC, Rotterdam, Netherlands
| | | | - Francisca Pacheco
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Ana Ganho-Avila
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | | |
Collapse
|
2
|
Treatment of Peripartum Depression with Antidepressants and Other Psychotropic Medications: A Synthesis of Clinical Practice Guidelines in Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041973. [PMID: 35206159 PMCID: PMC8872607 DOI: 10.3390/ijerph19041973] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023]
Abstract
This study examined (1) the availability and content of national CPGs for treatment of peripartum depression, including comorbid anxiety, with antidepressants and other psychotropics across Europe and (2) antidepressant and other psychotropic utilization data as an indicator of prescribers' compliance to the guidelines. We conducted a search using Medline and the Guidelines International Network database, combined with direct e-mail contact with national Riseup-PPD COST ACTION members and researchers within psychiatry. Of the 48 European countries examined, we screened 41 records and included 14 of them for full-text evaluation. After exclusion of ineligible and duplicate records, we included 12 CPGs. Multiple CPGs recommend antidepressant initiation or continuation based on maternal disease severity, non-response to first-line non-pharmacological interventions, and after risk-benefit assessment. Advice on treatment of comorbid anxiety is largely missing or unspecific. Antidepressant dispensing data suggest general prescribers' compliance with the preferred substances of the CPG, although country-specific differences were noted. To conclude, there is an urgent need for harmonized, up-to-date CPGs for pharmacological management of peripartum depression and comorbid anxiety in Europe. The recommendations need to be informed by the latest available evidence so that healthcare providers and women can make informed, evidence-based decisions about treatment choices.
Collapse
|
3
|
Branquinho M, Rodriguez-Muñoz MDLF, Maia BR, Marques M, Matos M, Osma J, Moreno-Peral P, Conejo-Cerón S, Fonseca A, Vousoura E. Effectiveness of psychological interventions in the treatment of perinatal depression: A systematic review of systematic reviews and meta-analyses. J Affect Disord 2021; 291:294-306. [PMID: 34062397 DOI: 10.1016/j.jad.2021.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Perinatal depression is a high prevalent mental health problem with serious consequences. Evidence about effective psychological interventions in treating perinatal depression has been increasing, but it lacks a comprehensive synthesis of findings. METHODS A systematic review of systematic reviews and meta-analyses concerning the effectiveness of psychological interventions in treating perinatal depression (depression during pregnancy and the first 12 months postpartum) in adult women was conducted. The electronic databases MEDLINE (PubMed), PsycINFO, The Cochrane Library, Web of Science and Prospero were searched, on May 2020, using a combination of keywords. Data were independently extracted by two authors and a synthesis of the results was presented. Methodological quality was independently assessed by two authors, using AMSTAR-2. RESULTS Seven systematic reviews were included and reported, overall, the effectiveness of psychological interventions in decreasing depressive symptoms in women in the perinatal period, both short and long-term. CBT was found to be the most effective intervention, regardless of the treatment format. LIMITATIONS Grey literature was not searched, and some studies may overlap among the included systematic reviews. These (the included reviews) were rated with low methodological quality, which weakens the evidence of the reported results. CONCLUSIONS CBT is currently the most evidence-based psychological intervention, provided in different delivery formats (individual, group, face-to-face or Internet-based). Further studies, including systematic reviews, with other types of psychological interventions (e.g., third-wave CBT) and with higher quality are needed.
Collapse
Affiliation(s)
- Mariana Branquinho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Coimbra, Portugal
| | | | - Berta Rodrigues Maia
- Universidade Católica Portuguesa, Faculty of Philosophy and Social Sciences, Centre for Philosophical and Humanistic Studies, Portugal
| | - Mariana Marques
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Coimbra, Portugal; Coimbra Hospital and Universitary Centre (CHUC), Portugal; Institute of Psychological Medicine (IPM), Coimbra, Portugal
| | - Marcela Matos
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Coimbra, Portugal
| | - Jorge Osma
- Universidad de Zaragoza and Instituto de Investigación Sanitaria de Aragón, Spain
| | | | | | - Ana Fonseca
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Coimbra, Portugal
| | - Eleni Vousoura
- Department of Psychiatry, Eginition Hospital, University of Athens, Greece
| |
Collapse
|
4
|
Bais B, Kamperman AM, Bijma HH, Hoogendijk WJ, Souman JL, Knijff E, Lambregtse-van den Berg MP. Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial. BMJ Open 2020; 10:e038030. [PMID: 33115894 PMCID: PMC7594358 DOI: 10.1136/bmjopen-2020-038030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Approximately 11%-13% of pregnant women suffer from depression. Bright light therapy (BLT) is a promising treatment, combining direct availability, sufficient efficacy, low costs and high safety for both mother and child. Here, we examined the effects of BLT on depression during pregnancy. DESIGN Randomised, double-blind controlled trial. SETTING Primary and secondary care in The Netherlands, from November 2016 to March 2019. PARTICIPANTS 67 pregnant women (12-32 weeks gestational age) with a DSM-5 diagnosis of depressive disorder (Diagnostic and Statistical Manual of Mental Disorders). INTERVENTIONS Participants were randomly allocated to treatment with either BLT (9000 lux, 5000 K) or dim red light therapy (DRLT, 100 lux, 2700 K), which is considered placebo. For 6 weeks, both groups were treated daily at home for 30 min on awakening. Follow-up took place weekly during the intervention, after 6 weeks of therapy, 3 and 10 weeks after treatment and 2 months postpartum. PRIMARY AND SECONDARY OUTCOME MEASURES Depressive symptoms were measured primarily with the Structured Interview Guide for the Hamilton Depression Scale-Seasonal Affective Disorder. Secondary measures were the Hamilton Rating Scale for Depression and the Edinburgh Postnatal Depression Scale. Changes in rating scale scores of these questionnaires over time were analysed using generalised linear mixed models. RESULTS Median depression scores decreased by 40.6%-53.1% in the BLT group and by 50.9%-66.7% in the DRLT group. We found no statistically significant difference in symptom change scores between BLT and DRLT. Sensitivity and post-hoc analyses did not change our findings. CONCLUSIONS Depressive symptoms of pregnant women with depression improved in both treatment arms. More research is necessary to determine whether these responses represent true treatment effects, non-specific treatment responses, placebo effects or a combination hereof. TRIAL REGISTRATION NUMBER NTR5476.
Collapse
Affiliation(s)
- Babette Bais
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Astrid M Kamperman
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Hilmar H Bijma
- Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Witte Jg Hoogendijk
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Jan L Souman
- Lighting Applications, Signify NV, Eindhoven, Noord-Brabant, The Netherlands
| | - Esther Knijff
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Mijke P Lambregtse-van den Berg
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
- Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| |
Collapse
|
5
|
Molenaar NM, Bais B, Lambregtse-van den Berg MP, Mulder CL, Howell EA, Fox NS, Rommel AS, Bergink V, Kamperman AM. The international prevalence of antidepressant use before, during, and after pregnancy: A systematic review and meta-analysis of timing, type of prescriptions and geographical variability. J Affect Disord 2020; 264:82-89. [PMID: 31846905 DOI: 10.1016/j.jad.2019.12.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Antidepressant use during pregnancy has increased over the last decades, while safety has been under debate. Our aim was to measure the international prevalence of antidepressant use before, during, and after pregnancy and examine timing, type of prescriptions and geographic variability. METHODS We searched Embase, Medline Ovid, Web of Science, Cochrane Central and Google Scholar from their inception until February 19, 2019. We determined pooled prevalence estimates of antidepressants before, during, and after pregnancy, as well as stratified according to substantive variables. RESULTS We identified 40 cohorts from 15 countries, together reporting on 14,072,251 pregnancies. Included studies had a low risk of bias, often reporting on large representative cohorts. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly used antidepressants during pregnancy, with an international prevalence estimate of 3.0% (95%CI 2.3;3.7). While Europe and Australasia had pooled prevalence estimates of 1.6% and 1.3% respectively, Northern America had a prevalence estimate of 5.5% (Q-value = 126.19; df = 2; p-value<0.01). Highest SSRI prevalence rates were found for sertraline (1.10%), followed by citalopram and fluoxetine (0.77% and 0.76% respectively) (Q-value = 121.25; df = 5; p-value<0.01). Qualitative analysis indicated an increase in antidepressant use over subsequent calendar years. LIMITATIONS Substantial heterogeneity remained unaccounted for throughout the analyses, even after accounting for hypothetical contributors. CONCLUSIONS This meta-analysis revealed substantial regional differences in antidepressant use around pregnancy, which could be due to variability in prescription behavior, healthcare seeking behavior and organization of healthcare. There is an urgent need for evidence on effectiveness, benefit, and harm of antidepressants during pregnancy to guide clinical practice.
Collapse
Affiliation(s)
- Nina M Molenaar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States; Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Babette Bais
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mijke P Lambregtse-van den Berg
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Sophia's Children Hospital, Rotterdam, the Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands; Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Elizabeth A Howell
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States; Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, United States; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Nathan S Fox
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Anna-Sophie Rommel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States; Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, United States; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Astrid M Kamperman
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands; Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
6
|
Molenaar NM, Lambregtse-van den Berg MP, Bonsel GJ. Dispensing patterns of selective serotonin reuptake inhibitors before, during and after pregnancy: a 16-year population-based cohort study from the Netherlands. Arch Womens Ment Health 2020; 23:71-79. [PMID: 30762147 PMCID: PMC6987060 DOI: 10.1007/s00737-019-0951-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/31/2019] [Indexed: 02/02/2023]
Abstract
Management of mental illness in the perinatal period with antidepressants is controversial, since evidence emerged on potential harmful effects to the unborn child. However, over time, the dispensing of antidepressants in the perinatal period has increased. We examined perinatal dispensing patterns over time and the role of a recently issued guideline in this regard. We identified a 16-year cohort of 153,952 Dutch pregnancies with a delivery date between January 1999 and December 2014. Data included exposure to selective serotonin reuptake inhibitors (SSRIs) related to phases of pregnancy (preconception, pregnancy and delivery, post-delivery). The chi-square test for trends was used. With standard logistic regression, we explored the influence of patient characteristics on continuation of SSRIs during pregnancy. A persistent significant rise of dispensing rates in all phases was observed, with the largest increase during pregnancy (from 0.8% in 1999/2000 to 2.1% in 2013/2014, chi-square for trend = 141.735, p < 0.001). A substantial change of practice in terms of the SSRI used (less paroxetine) and the policy towards continuation into pregnancy (more continuation over time) was visible. Concomitant use of psycholeptics halved the probability of continuation of SSRIs (OR 0.50, 95%CI 0.43-0.55, p < 0.01). Dispensing rates of SSRIs steadily increased last 16 years, especially during pregnancy, caused by an increase in the proportion of women continuing their medication during pregnancy. In view of the demonstrated impact of uncertainty regarding effectiveness and safety of SSRIs in pregnancy, future research should involve more detailed outcome research of SSRIs as it is, and research into viable alternatives.
Collapse
Affiliation(s)
- Nina Maren Molenaar
- The Department of Psychiatry, Erasmus MC, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Mijke Pietertje Lambregtse-van den Berg
- The Department of Psychiatry, Erasmus MC, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
- The Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Gouke Jacobus Bonsel
- The Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
- Division Women and Baby, UMC Utrecht, Utrecht, The Netherlands
| |
Collapse
|
7
|
Güngör BB, Öztürk N, Atar AÖ, Aydın N. Comparison of the groups treated with mirtazapine and selective serotonine reuptake inhibitors with respect to birth outcomes and severity of psychiatric disorder. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1673936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Buket Belkız Güngör
- Psychiatry, University of Health Sciences Istanbul Mazhar Osman Bakırkoy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Nalan Öztürk
- Psychiatry, University of Health Sciences Istanbul Mazhar Osman Bakırkoy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ayça Öngel Atar
- Psychiatry, University of Health Sciences Istanbul Mazhar Osman Bakırkoy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Nazan Aydın
- Humanities and Social Sciences Faculty, Üsküdar University, Psychology, Istanbul, Turkey
| |
Collapse
|
8
|
Milosavljević MN, Janković SV, Janković SM, Djurić J, Protrka Z, Arsenijević S, Folić M, Stojadinović D, Dimitrijević A. Effects of selective serotonin reuptake inhibitors on motility of isolated fallopian tube. Clin Exp Pharmacol Physiol 2019; 46:780-787. [DOI: 10.1111/1440-1681.13118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/16/2019] [Accepted: 05/31/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Miloš N. Milosavljević
- Department of Pharmacy Faculty of Medical Sciences University of Kragujevac Kragujevac Serbia
| | - Snezana V. Janković
- Department of Pharmacology and toxicology Faculty of Medical Sciences University of Kragujevac Kragujevac Serbia
| | - Slobodan M. Janković
- Department of Pharmacology and toxicology Faculty of Medical Sciences University of Kragujevac Kragujevac Serbia
| | - Janko Djurić
- Department of Gynecology and obstetrics Faculty of Medical Sciences University of Kragujevac Kragujevac Serbia
| | - Zoran Protrka
- Department of Gynecology and obstetrics Faculty of Medical Sciences University of Kragujevac Kragujevac Serbia
| | - Slobodan Arsenijević
- Department of Gynecology and obstetrics Faculty of Medical Sciences University of Kragujevac Kragujevac Serbia
| | - Marko Folić
- Department of Pharmacy Faculty of Medical Sciences University of Kragujevac Kragujevac Serbia
| | - Dobrivoje Stojadinović
- Department of Anatomy Faculty of Medical Sciences University of Kragujevac Kragujevac Serbia
| | - Aleksandra Dimitrijević
- Department of Gynecology and obstetrics Faculty of Medical Sciences University of Kragujevac Kragujevac Serbia
| |
Collapse
|
9
|
Molenaar NM, Brouwer ME, Kamperman AM, Burger H, Williams AD, Hoogendijk WJG, Bockting CLH, Lambregtse-van den Berg MP. Recurrence of depression in the perinatal period: Clinical features and associated vulnerability markers in an observational cohort. PLoS One 2019; 14:e0212964. [PMID: 30794709 PMCID: PMC6386367 DOI: 10.1371/journal.pone.0212964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/12/2019] [Indexed: 01/08/2023] Open
Abstract
Objective Antidepressant medication is commonly used for the prevention of depression recurrence in the perinatal period, yet it is unknown what vulnerability markers may play a role in recurrence. The objective of the current study was to provide a descriptive overview of the associated characteristics of women who experienced a perinatal recurrence of depression despite ongoing antidepressant use, and further, to identify clinically measurable vulnerability markers associated with recurrence. Methods Eighty-five pregnant women with a history of depression who used antidepressants (e.g. Selective Serotonin Reuptake Inhibitors or Serotonin and Noradrenaline Reuptake Inhibitors) at the start of the study were included. Clinical features, including information on psychiatric history and antidepressant use, were collected throughout the perinatal period (in this study defined as the period between 12 weeks of pregnancy untill three months postpartum). The clinical features of women experiencing recurrence of depression were described in detail. To identify vulnerability markers associated with recurrence of depression, we performed exploratory univariable logistic regression analyses. Results Eight women (9.4%) experienced a recurrence of depression; two during pregnancy and six in the first 12 weeks postpartum. All women with recurrence of depression had first onset of depression during childhood or adolescence and had at least 2 psychiatric co-morbidities. Identification of vulnerability markers associated with recurrence of depression yielded associations with depressive symptoms around 16 weeks of pregnancy (OR 1.28, 95%CI 1.08–1.52), number of psychiatric co-morbidities (OR 1.89, 95%CI 1.16–3.09) and duration of antidepressant use (OR 1.01, 95%CI 1.00–1.02). Conclusion Implementing adequate risk assessment in pregnant women who use antidepressants can help identify predictors for recurrence of depression in future studies and thus ultimately lead to improved care.
Collapse
Affiliation(s)
- Nina M. Molenaar
- The Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Marlies E. Brouwer
- The Department of Psychiatry, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
- The Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Astrid M. Kamperman
- The Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Huibert Burger
- The Department of Psychiatry, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
- The Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alishia D. Williams
- Faculty of Science, School of Psychology, The University of New South Wales, Sydney, Australia
| | | | - Claudi L. H. Bockting
- The Department of Psychiatry, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mijke P. Lambregtse-van den Berg
- The Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
- The Department of Child and Adolescent Psychiatry, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
10
|
O'Connor E, Senger CA, Henninger ML, Coppola E, Gaynes BN. Interventions to Prevent Perinatal Depression: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 321:588-601. [PMID: 30747970 DOI: 10.1001/jama.2018.20865] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Depression during pregnancy and the postpartum period is relatively common and can have adverse effects on both mother and child. OBJECTIVE To systematically review benefits and harms of primary care-relevant interventions to prevent perinatal depression, a major or minor depressive episode during pregnancy or up to 1 year after childbirth, to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMED (for publisher-supplied records only), PsycINFO, and the Cochrane Central Register of Controlled Trials; surveillance through December 5, 2018. STUDY SELECTION Randomized clinical trials (RCTs) and nonrandomized controlled intervention studies of interventions (eg, behavior-based, antidepressants, dietary supplements) to prevent perinatal depression in general populations of pregnant and postpartum individuals or in those at increased risk of perinatal depression. Large cohort studies were considered for harms of antidepressant use only. DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed abstracts and full-text articles and quality rated included studies. Random-effects meta-analysis was used to estimate the benefits of the interventions. MAIN OUTCOMES AND MEASURES Depression status; depression symptoms; maternal, infant, and child health outcomes. RESULTS Fifty studies (N = 22 385) that met inclusion criteria were identified. Counseling interventions were the most widely studied interventions. Compared with controls, counseling interventions were associated with a lower likelihood of onset of perinatal depression (pooled risk ratio [RR], 0.61 [95% CI, 0.47-0.78]; 17 RCTs [n = 3094]; I2 = 39.0%). The absolute difference in the risk of perinatal depression ranged from 1.3% greater reduction in the control group to 31.8% greater reduction in the intervention group. Health system interventions showed a benefit in 3 studies (n = 5321) and had a pooled effect size similar to that of the counseling interventions, but the pooled effect was not statistically significant using a method appropriate for pooling a small number of studies (restricted maximum likelihood RR, 0.58 [95% CI, 0.22-1.53]; n = 4738; I2 = 66.3%; absolute risk reduction range, -3.1% to -13.1%). None of the behavior-based interventions reported on harms directly. A smaller percentage of participants prescribed sertraline had a depression recurrence compared with those prescribed placebo (7% vs 50%, P = .04) at 20 weeks postpartum in 1 very small RCT (n = 22 analyzed) but with an increased risk of adverse effects to the mother. CONCLUSIONS AND RELEVANCE Counseling interventions can be effective in preventing perinatal depression, although most evidence was limited to women at increased risk for perinatal depression. A variety of other intervention approaches provided some evidence of effectiveness but lacked a robust evidence base and need further research.
Collapse
Affiliation(s)
- Elizabeth O'Connor
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Caitlyn A Senger
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Michelle L Henninger
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Erin Coppola
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | | |
Collapse
|
11
|
Yamamoto-Sasaki M, Yoshida S, Takeuchi M, Tanaka-Mizuno S, Ogawa Y, Furukawa TA, Kawakami K. Association between antidepressant use during pregnancy and autism spectrum disorder in children: a retrospective cohort study based on Japanese claims data. Matern Health Neonatol Perinatol 2019; 5:1. [PMID: 30652008 PMCID: PMC6327597 DOI: 10.1186/s40748-018-0096-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/17/2018] [Indexed: 12/17/2022] Open
Abstract
Background Studies using data from Western countries have raised concerns that treating pregnant women with antidepressants may increase the risk of autism spectrum disorders (ASDs) in their offspring. However, to date, the studies are inconclusive. We therefore examined the association between antidepressant use and ASD using claims data collected in Japan. Methods This retrospective cohort study was based on claims data from mothers and their children from January 2005 to July 2014, obtained from the Japan Medical Data Center. The information from mothers and children was linked using the family identification code. Information on antidepressant prescriptions during pregnancy was extracted from the database. To collect information on ASD, children for whom data were available 24 months or more after birth were followed up from birth through July 2014 or up until their withdrawal from the database. To ensure appropriate diagnosis of ASD, mother-child pairs where the children's data did not cover the 24 months after birth or pairs where children had a diagnosis of ASD within only 23 months after birth were excluded from the study cohort. We used logistic regression analyses to evaluate the association between antidepressant use during pregnancy and the children's ASD diagnosis. All statistical analyses were performed using IBM SPSS (Statistical Package for the Social Sciences) Statistics ver. 21.0. Results Of the 53,864 eligible mother-child pairs, 26,925 met the study criteria. Crude analysis showed that the ASD prevalence in children was significantly higher with any antidepressant use than with non-use (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.08, 4.95). However, when the analysis was adjusted for the confounding effect of maternal depression during pregnancy, statistical significance was lost (OR, 0.76; CI, 0.27, 2.18). Conclusions After adjustment for confounders, we found no significant association between antidepressant use during pregnancy and ASD in children in Japan. This result provides additional evidence to support the idea that antidepressant use during pregnancy itself is not associated with an increase in ASD in children. In addition, this represents the first evidence based on Asian data.
Collapse
Affiliation(s)
- Madoka Yamamoto-Sasaki
- 1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho Sakyo-ku, Kyoto, 606-8501 Japan
| | - Satomi Yoshida
- 1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho Sakyo-ku, Kyoto, 606-8501 Japan
| | - Masato Takeuchi
- 1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho Sakyo-ku, Kyoto, 606-8501 Japan
| | - Sachiko Tanaka-Mizuno
- 2Department of Medical Statistics, Shiga University of Medical Science, Setatsukinowacho Otsu, Shiga, 520-2121 Japan
| | - Yusuke Ogawa
- 3Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho Sakyo-ku, Kyoto, 606-8501 Japan
| | - Toshiaki A Furukawa
- 4Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho Sakyo-ku, Kyoto, 606-8501 Japan
| | - Koji Kawakami
- 1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho Sakyo-ku, Kyoto, 606-8501 Japan
| |
Collapse
|