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Zhao FY, Li L, Xu P, Zhang WJ, Kennedy GA, Zheng Z, Wang YM, Yue LP, Ho YS, Fu QQ, Conduit R. Inadequate Evidence for Acupuncture as an Alternative or Adjunct to Antidepressants/Psychotherapy for Postpartum Depression: A Bayesian Systematic Review and Network Meta-Analysis. Neuropsychiatr Dis Treat 2024; 20:1741-1755. [PMID: 39323936 PMCID: PMC11423827 DOI: 10.2147/ndt.s484387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 09/13/2024] [Indexed: 09/27/2024] Open
Abstract
Background Acupuncture is popular in the treatment of mental illness. This study determined its feasibility and role in managing postpartum depression (PPD) using a network meta-analysis. Methods We systematically searched seven databases up to May 2024 for randomized controlled trials (RCTs) appraising acupuncture's efficacy and safety against waitlist-control, placebo, standard control, or as an add-on treatment. Cochrane criteria were followed. Results Thirteen studies encompassing 872 participants underwent analysis. Both pairwise and network meta-analysis indicated that acupuncture, psychotherapy, and antidepressants were comparable in clinical efficacy rate and in reducing Hamilton Depression Scale and Edinburgh Postnatal Depression Scale scores. Acupuncture and psychotherapy also effectively mitigated concurrent anxiety symptoms. Combining acupuncture with antidepressants augmented therapeutic efficacy and reduced reported gastrointestinal adverse effects associated with antidepressant use. Acupuncture combined with psychotherapy offered similar benefits with superior safety profile. However, the quality of evidence ranged from very low to low due to significant risks of bias and limited sample sizes. The efficacy of psychotherapy and the combination of acupuncture and psychotherapy might be underestimated, as most RCTs used supportive therapy or individual counseling as positive controls instead of recommended approaches like interpersonal psychotherapy (IPT) or cognitive behavioral therapy (CBT) per PPD guidelines. Conclusion Current evidence precludes strong recommendations of administering acupuncture in PPD. Rigorous RCTs are essential to validate promising outcomes observed in comparisons between acupuncture, antidepressants, and their combined application. It remains inconclusive whether acupuncture's antidepressive effect is specific or non-specific. Given that psychotherapy is a recommended first-line treatment, investigating the potential efficacy enhancement of combining acupuncture with IPT/CBT is paramount to ascertain the preferred therapeutic approach for PPD.
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Affiliation(s)
- Fei-Yi Zhao
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, 201209, People's Republic of China
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People's Republic of China
| | - Li Li
- Shanghai Changning Center for Disease Control and Prevention, Shanghai, 200335, People's Republic of China
| | - Peijie Xu
- School of Computing Technologies, RMIT University, Melbourne, VIC, 3000, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People's Republic of China
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
| | - Yan-Mei Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People's Republic of China
| | - Li-Ping Yue
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, 201209, People's Republic of China
| | - Yuen-Shan Ho
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, People's Republic of China
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People's Republic of China
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
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Yi F, Ahn S. Effects of postpartum fatigue, parenting stress, and family support on postpartum depression in Chinese first-time mothers: a cross-sectional study. WOMEN'S HEALTH NURSING (SEOUL, KOREA) 2024; 30:226-237. [PMID: 39385549 PMCID: PMC11467248 DOI: 10.4069/whn.2024.09.02.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 09/02/2024] [Accepted: 09/02/2024] [Indexed: 10/12/2024]
Abstract
PURPOSE This study aimed to explore the levels of postpartum fatigue, parenting stress, family support, and postpartum depression (PPD) experienced by first-time Chinese mothers and to investigate their impact on PPD. METHODS This cross-sectional survey involved 150 primigravida women attending postnatal checkups in Hebi City, Henan Province, China. Demographic data and information on environmental variables (living conditions, family relationships), postpartum fatigue, parenting stress, family support (expected vs. actual level), and PPD were collected. RESULTS The average age of the women was 26.25 years (SD, ±3.90), with 78.7% at risk for PPD (score ≥10). Significant correlations were found between PPD and postpartum fatigue (r=.63, p<.001), parenting stress (r=.59, p<.001), and family support (r=.40, p<.001). In model 1, which examined the influence of women's demographic variables on PPD, significant factors included a poor relationship with parents (β=.24, p=.001), a poor relationship with parents-in-law (β=.18, p=.029), and a poor relationship with the husband (β=.20, p=.013). When the three research variables were incorporated into model 2, the factors contributing to a higher level of PPD included a poor relationship with parents-in-law (β=.14, p=.033), increased postpartum fatigue (β=.37, p<.001), increased parenting stress (β=.33, p<.001), and less family support than expected (β=.12, p=.048). CONCLUSION The most critical factors influencing PPD include postpartum fatigue, parenting stress, poor relationships with parents-in-law, and low family support among Chinese primiparas. To mitigate PPD levels, healthcare professionals should screen mothers for depression in outpatient clinics and offer education and counseling to both mothers and their families or companions regarding PPD.
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Affiliation(s)
- Feiyan Yi
- College of Nursing, Chungnam National University, Seoul, Korea
| | - Sukhee Ahn
- College of Nursing, Chungnam National University, Seoul, Korea
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Li S, Zhou W, Li P, Lin R. Effects of ketamine and esketamine on preventing postpartum depression after cesarean delivery: A meta-analysis. J Affect Disord 2024; 351:720-728. [PMID: 38286233 DOI: 10.1016/j.jad.2024.01.202] [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] [Received: 11/12/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Ketamine and esketamine has been suggested to have potential efficacy in preventing postpartum depression (PPD) recent years. The aim of this meta-analysis was to evaluate the effectiveness of ketamine and esketamine on PPD after cesarean delivery. METHODS We systematically searched PubMed, Embase, and the Cochrane Library for studies investigating the efficacy of ketamine and esketamine in preventing PPD. The primary outcomes of this study were risk ratios (RRs) and EPDS scores (Edinburgh Postnatal Depression Scale) in relation to PPD after ketamine and esketamine. The second outcomes were the postoperative adverse events. RESULTS Thirteen randomized controlled trials (RCTs) and one retrospective study including 2916 patients were analyzed, including six on the use of ketamine and eight on the use of esketamine. The risk ratios and EPDS scores of PPD were significantly decreased in the ketamine/esketamine group compared to those in the control group in one week and four weeks postoperative periods. Subgroup analyses showed that high dosage, administrated in patient controlled intravenous analgesia (PCIA) method and only esketamine exhibited a significant reduction in the incidence and EPDS scores of PPD in one week and four week postoperative. However, the incidences of postoperative adverse events, such as dizziness, diplopia, hallucination, and headache were significantly higher in the ketamine/esketamine group than that in the control group. CONCLUSION Ketamine and esketamine appear to be effective in preventing PPD in the one week and four week postoperative periods after cesarean delivery with moderate certainty of evidence. But they can also lead to some short-term complications too. Future high-quality studies are needed to confirm the efficacy of ketamine and esketamine in different countries.
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Affiliation(s)
- Shuying Li
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key laboratory of Birth Deficits and related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Wenqin Zhou
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key laboratory of Birth Deficits and related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Ping Li
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key laboratory of Birth Deficits and related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
| | - Rongqian Lin
- Department of Clinical Medicine, Sichuan University, Chengdu, Sichuan, China
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Wang W, Ling B, Chen Q, Xu H, Lv J, Yu W. Effect of pre-administration of esketamine intraoperatively on postpartum depression after cesarean section: A randomized, double-blinded controlled trial. Medicine (Baltimore) 2023; 102:e33086. [PMID: 36862862 PMCID: PMC9981392 DOI: 10.1097/md.0000000000033086] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND To evaluate the effect of pre-administration of esketamine intraoperatively on the occurrence of postpartum depression after cesarean section under combined spinal-epidural anesthesia. METHODS A total of 120 women aged 24 to 36 years undergoing cesarean section by spinal-epidural anesthesia with American Society of Anesthesiologists physical status II were enrolled. According to the intraoperative use of esketamine, all participants were randomly divided into 2 groups: test group (group E) and control group (group C). Esketamine was administered intravenously at a dose of 0.2 mg/kg after the infant was delivered in group E and equal volume of normal saline was given in group C. The incidence of postpartum depression was recorded at 1 week and 6 weeks after the operation. The occurrence of adverse reactions such as postpartum bleeding, nausea and vomiting, drowsiness, and nightmares were also recorded at 48 hours after surgery. RESULTS Compared with group C, the incidence of postpartum depression was significantly lower at 1 week and 6 weeks after surgery in group E (P < .01). There was no significant difference of the adverse effects at 48 hours after the operation between the 2 groups. CONCLUSION Intravenous infusion of 0.2 mg/kg esketamine in women during cesarean section can significantly reduce the incidence of postpartum depression at 1 week and 6 weeks after surgery without increasing related adverse effects.
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Affiliation(s)
- Wei Wang
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Bin Ling
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Qian Chen
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Hua Xu
- Department of Gynaecology and obstetrics, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Jie Lv
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
- * Correspondence: Jie Lv, Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, No. 168 Gushan Road, CN-Jiangsu, Nanjing 211100, China (e-mail: )
| | - Wanyou Yu
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
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Meng J, Du J, Diao X, Zou Y. Effects of an evidence-based nursing intervention on prevention of anxiety and depression in the postpartum period. Stress Health 2022; 38:435-442. [PMID: 34633141 DOI: 10.1002/smi.3104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/05/2021] [Accepted: 09/07/2021] [Indexed: 01/10/2023]
Abstract
Postpartum depression has been one of the most common psychological disorders in patients during postpartum period. The constant anxiety and depression during this period seriously affect the physiological and psychological health of both the mother and infant. Evidence-based nursing has been widely applied in clinical practice and has achieved remarkable results. However, the effect of evidence-based nursing on postpartum depression remains unclear. Pregnant women who were not diagnosed with postpartum depression during hospitalisation (Edinburgh Postpartum Depression Scale [EPDS] ≤ 13 points) but prone to postpartum depression (EPDS scores of 9-13) were recruited into the study. They were randomly divided into the Intervention group (N = 60) and Control group (N = 60). Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), EPDS and Pittsburgh Sleep Quality Index (PSQI) were used to investigate the psychological outcomes of puerperae during and after the 6-week intervention. Both the intention-to-treat and per-protocol analyses showed that 6 weeks of evidence-based nursing intervention significantly reduced the incidence of postpartum depression. The application of the evidence-based nursing also improved the patients' satisfaction degree and effectively alleviated their anxiety according to both the intention-to-treat and per-protocol analyses. Evidence-based nursing intervention had positive effects against anxiety and depression in the postpartum period.
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Affiliation(s)
- Jun Meng
- Maternity School, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
| | - Junying Du
- Children's Health Clinic, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
| | - Xiaoli Diao
- Department of Obstetrics, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
| | - Yingxia Zou
- Children's Health Clinic, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
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Muresan D, Voidăzan S, Salcudean A, Bodo C, Grecu I. Bioresonance, an alternative therapy for mild and moderate depression. Exp Ther Med 2022; 23:264. [PMID: 35251330 PMCID: PMC8892610 DOI: 10.3892/etm.2022.11190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022] Open
Abstract
Depression is a negative emotional state that may persist for short or long periods of time with varying severity. The aim of the present study was to evaluate the method by which bioresonance therapy can improve the severity of recurrent depressive disorder with moderate and mild episodes experienced by patients. Bioresonance therapy is a method of energy treatment that processes the electromagnetic information of the human body using a sensitive Mora Nova device using electrodes. In addition, this improvement was compared with the one obtained by applying monotherapy with selective serotonin reuptake inhibitors. The study included two groups of patients suffering from depression. The first group received bioresonance treatment for five weeks. The second group received either newly introduced or on-going pharmacological treatment with selective serotonin reuptake inhibitor antidepressants, as monotherapy, for five weeks. An outcome measurement of severity was performed. Results revealed that, the score improvement on the Hamilton Scale, used for assessing depression and comprising 17 items, showed a mean of 3.1 [standard deviation (SD), 1.28] for the bioresonance group one and a mean of 2.2 (SD, 0.61) for the second group. The difference between the two data series was statistically significant (P<0.0001, Student's t-test). As the bioresonance therapy outcome was higher than the selective serotonin reuptake inhibitor medication outcome, it can be concluded that bioresonance can reduce the severity of the patients facing recurrent depressive disorder with moderate and mild episodes. Furthermore, the reduction in severity for the bioresonance group compared with the antidepressant medication group was statistically significant.
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Affiliation(s)
- Daniela Muresan
- Doctoral School of Medicine and Pharmacy, Department of Medicine, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Septimiu Voidăzan
- Department of Epidemiology, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Andreea Salcudean
- Department of Ethics and Social Sciences, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Cristina Bodo
- Psychiatric Clinic No. 2, Mures County Hospital, 540142 Targu Mures, Romania
| | - Iosif Grecu
- Senior Psychiatrist Psychiatric Clinic No. 1, ‘George Emil Palade’ University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
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Predicting women with depressive symptoms postpartum with machine learning methods. Sci Rep 2021; 11:7877. [PMID: 33846362 PMCID: PMC8041863 DOI: 10.1038/s41598-021-86368-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/15/2021] [Indexed: 11/09/2022] Open
Abstract
Postpartum depression (PPD) is a detrimental health condition that affects 12% of new mothers. Despite negative effects on mothers’ and children’s health, many women do not receive adequate care. Preventive interventions are cost-efficient among high-risk women, but our ability to identify these is poor. We leveraged the power of clinical, demographic, and psychometric data to assess if machine learning methods can make accurate predictions of postpartum depression. Data were obtained from a population-based prospective cohort study in Uppsala, Sweden, collected between 2009 and 2018 (BASIC study, n = 4313). Sub-analyses among women without previous depression were performed. The extremely randomized trees method provided robust performance with highest accuracy and well-balanced sensitivity and specificity (accuracy 73%, sensitivity 72%, specificity 75%, positive predictive value 33%, negative predictive value 94%, area under the curve 81%). Among women without earlier mental health issues, the accuracy was 64%. The variables setting women at most risk for PPD were depression and anxiety during pregnancy, as well as variables related to resilience and personality. Future clinical models that could be implemented directly after delivery might consider including these variables in order to identify women at high risk for postpartum depression to facilitate individualized follow-up and cost-effectiveness.
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Abstract
Enhanced recovery after cesarean (ERAC) delivery is an evidence-based, multi-disciplinary approach throughout pre-, intra-, post-operative period. The ultimate goal of ERAC is to enhance recovery and improve the maternal and neonatal outcomes. This review highlights the role of anesthesiologist in ERAC protocols. This review provided a general introduction of ERAC including the purposes and the essential elements of ERAC protocols. The tool used for evaluating the quality of ERAC (ObsQoR-11) was discussed. The role of anesthesiologist in ERAC should cover the areas including management of peri-operative hypotension, prevention and treatment of intra- and post-operative nausea and vomiting, prevention of hypothermia and multi-modal peri-operative pain management, and active pre-operative management of unplanned conversion of labor analgesia to cesarean delivery anesthesia. Although some concerns still remain, ERAC implementation should not be delayed. Regular assessment and process improvement should be imbedded into the protocol. Further high-quality studies are warranted to demonstrate the effectiveness and efficacy of the ERAC protocol.
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Moore Simas TA, Huang MY, Packnett ER, Zimmerman NM, Moynihan M, Eldar-Lissai A. Matched cohort study of healthcare resource utilization and costs in young children of mothers with postpartum depression in the United States. J Med Econ 2020; 23:174-183. [PMID: 31597499 DOI: 10.1080/13696998.2019.1679157] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: To assess healthcare resource utilization (HRU) and costs in children of mothers with and without postpartum depression (PPD).Methods: Administrative claims data from the IBM Watson Health MarketScan Databases (2010-2016) were used. Women with live births (index date = delivery date) were identified and linked to their newborns. The mother-child pairs were divided into PPD and non-PPD exposure cohorts based on claims for depression, mood or adjustment disorders, or anxiety identified in the mother between 15 and 365 days after delivery. Mother-child pairs with PPD exposure were propensity score matched 1:3 to mother-child pairs without PPD exposure. Children were required to have 24 months of continuous health plan enrolment following delivery. Additional comparisons were performed between mother-child pairs with and without preterm delivery.Results: Overall, 33,314 mother-child pairs with PPD exposure were propensity score matched to 102,364 mother-child pairs without PPD exposure. During the 24-month follow-up period, HRU across most service categories was significantly higher among children in the PPD exposure cohort than non-PPD exposure cohort. Among outpatient services, the percentages of children with a physician specialist service (68% versus 64%), early-intervention screening (40% versus 37%), and an emergency room visit (48% versus 42%) were greater in children of mothers with PPD (all p < .001). Furthermore, children of mothers with PPD incurred 12% higher total healthcare costs in the first 24 months of life compared to children of mothers without PPD ($24,572 versus $21,946; p < .001). After excluding mothers with preterm delivery, the proportion of children with ER visits, physician specialist services, and outpatient pharmacy claims was significantly higher in the PPD exposure cohort than non-PPD exposure cohort (all p < .001).Conclusion: The results of this analysis suggest that HRU and costs over the first 24 months of life in children of mothers with PPD exceeded that of children of mothers without evidence of PPD.
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Affiliation(s)
- Tiffany A Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry and Population & Quantitative Health Sciences, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - Ming-Yi Huang
- Health Economics Outcomes Research, Sage Therapeutics, Inc, Cambridge, MA, USA
| | | | | | | | - Adi Eldar-Lissai
- Health Economics Outcomes Research, Sage Therapeutics, Inc, Cambridge, MA, USA
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A systematic review of acupuncture and Chinese herbal medicine for postpartum depression. Complement Ther Clin Pract 2018; 33:85-92. [DOI: 10.1016/j.ctcp.2018.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/09/2018] [Accepted: 08/27/2018] [Indexed: 12/19/2022]
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