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Cardaci V, Carminati M, Tondello M, Pecorino B, Serretti A, Zanardi R. Understanding and treating postpartum depression: a narrative review. Int Clin Psychopharmacol 2024:00004850-990000000-00143. [PMID: 38941162 DOI: 10.1097/yic.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Postpartum depression (PPD) is an increasingly prevalent but still poorly characterized disorder. Causal and modulating factors include hormones fluctuations, such as estrogen, progesterone, and allopregnolone, pathways imbalances, such as oxytocin and kynurenine, chronobiological factors, and brain imaging alterations. Treatment may differ from the traditional major depression management, while selective serotonin reuptake inhibitors such as sertraline are commonly used and suggested by guidelines, neurosteroids such as brexanolone and the more convenient zuranolone have been recently approved. Newer neurosteroids such as ganaxolone, valaxanolone, and lysaxanolone are currently under development, but also esketamine and psychedelics are promising potential treatments. Other somatic treatments including brain stimulation techniques and light therapy also showed benefit. PPD is therefore increasingly understood as, at least partially, independent from major depressive disorder. Specific and individualized treatments including pharmacological and non-pharmacological therapies are progressively being introduced in the routine clinical practice.
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Affiliation(s)
- Vincenzo Cardaci
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan
| | - Matteo Carminati
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan
| | - Mattia Tondello
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan
| | - Basilio Pecorino
- Department of Medicine and Surgery, Kore University of Enna, Enna
| | | | - Raffaella Zanardi
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan
- Department of Psychiatry, Mood Disorder Unit, IRCCS San Raffaele Hospital, Milan, Italy
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Martínez-García M, Jacobs EG, de Lange AMG, Carmona S. Advancing the neuroscience of human pregnancy. Nat Neurosci 2024; 27:805-807. [PMID: 38600168 DOI: 10.1038/s41593-024-01629-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Magdalena Martínez-García
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- University of California Santa Barbara, Santa Barbara, CA, USA.
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Emily G Jacobs
- University of California Santa Barbara, Santa Barbara, CA, USA
| | - Ann-Marie G de Lange
- Lausanne University Hospital (CHUV), Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
- University of Oslo, Oslo, Norway
- University of Oxford, Oxford, UK
| | - Susana Carmona
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Schalla MA, Stengel A. The role of stress in perinatal depression and anxiety - A systematic review. Front Neuroendocrinol 2024; 72:101117. [PMID: 38176543 DOI: 10.1016/j.yfrne.2023.101117] [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: 08/24/2023] [Revised: 11/29/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]
Abstract
Perinatal depression (PND) and anxiety affect around 20% of women, but available pharmacotherapy is not sufficiently effective in 20-60% of them, indicating a need for better understanding of these diseases. Since stress is a significant risk factor for PND, the aim was to examine the role of biological, environmental and psychological stress in PND and anxiety through a systematic literature search. Overall 210 studies were included, among which numerous rodent studies showed that perinatal stress induced depressive-like and anxious behavior, which was associated with HPA-axis alterations and morphological brain changes. Human studies indicated that the relationship between cortisol and perinatal depression/anxiety was not as clear and with many contradictions, although social and psychological stress were clearly positively associated with PND. Finally, oxytocin, synthetic neuroactive steroid and n-3 PUFA diet have been identified as potentially beneficial in the therapy of PND and anxiety, worth to be investigated in the future.
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Affiliation(s)
- M A Schalla
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; Department of Gynecology and Obstetrics, Helios Clinic, Rottweil, Germany
| | - A Stengel
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; German Center für Mental Health (DZPG), Site Tübingen, Germany.
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Gorman-Sandler E, Wood G, Cloude N, Frambes N, Brennen H, Robertson B, Hollis F. Mitochondrial might: powering the peripartum for risk and resilience. Front Behav Neurosci 2023; 17:1286811. [PMID: 38187925 PMCID: PMC10767224 DOI: 10.3389/fnbeh.2023.1286811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/01/2023] [Indexed: 01/09/2024] Open
Abstract
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.
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Affiliation(s)
- Erin Gorman-Sandler
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
- Columbia VA Healthcare System, Columbia, SC, United States
| | - Gabrielle Wood
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Nazharee Cloude
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Noelle Frambes
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Hannah Brennen
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Breanna Robertson
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Fiona Hollis
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
- Columbia VA Healthcare System, Columbia, SC, United States
- USC Institute for Cardiovascular Disease Research, Columbia, SC, United States
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Ling B, Zhu Y, Yan Z, Chen H, Xu H, Wang Q, Yu W, Wang W. Effect of single intravenous injection of esketamine on postpartum depression after labor analgesia and potential mechanisms: a randomized, double-blinded controlled trial. BMC Pharmacol Toxicol 2023; 24:66. [PMID: 37996953 PMCID: PMC10668401 DOI: 10.1186/s40360-023-00705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The study was designed to investigate effects of single intravenous injection of esketamine on the incidence of postpartum depression (PPD) after labor analgesia and explore the potential mechanisms. METHODS A total of 120 women who underwent labor analgesia by epidural analgesia pump were enrolled and divided into two groups randomly. Esketamine at a dose of 0.2 mg/kg was intravenously injected after fetal disengagement in the test group and placebo was administered in the control group. The occurrence of PPD and side effects after delivery were recorded. Some indicators related to stress and inflammation were measured before labor analgesia and at 24 h, 1 week, and 6 weeks after delivery in this study. Data were analyzed by independent t-test, repeated measures analysis of variance and Chi-square test in SPSS software (version 25.0). It was considered statistically significant since a p value less than 0.05. RESULTS The incidence of PPD was significantly decreased both for one week and six weeks after delivery by using of esketamine (3.4% vs. 15.3%, p = 0.004 and 5.2% vs. 18.6%, p = 0.006, respectively). There were also significant differences between the stress and inflammation-related indicators in different time points in this study, while the side effects for 48 h after delivery were similar between the two groups. CONCLUSIONS Single intravenous injection of esketamine after delivery in participants underwent labor analgesia can decrease the occurrence of postpartum depression for one week and six weeks after delivery, while the side effects were not increased. The antidepressant effects of esketamine may be related to the reduction of stress response and inflammation. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry on 5/30/2022 (CTRI registration number-ChiCTR2200060387). URL of registry: https://www.chictr.org.cn/bin/home .
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Affiliation(s)
- Bin Ling
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, CN-Jiangsu, No. 169 Hushan Road, Nanjing, 211100, China
| | - Yun Zhu
- Department of Anesthesiology, Nanjing Jiangning Hospital of Traditional Chinese Medicine, Nangjing, 211100, China
| | - Zelin Yan
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, CN-Jiangsu, No. 169 Hushan Road, Nanjing, 211100, China
| | - Hao Chen
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, CN-Jiangsu, No. 169 Hushan Road, Nanjing, 211100, China
| | - Hua Xu
- Department of Gynaecology and obstetrics, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, 211100, China
| | - Qi Wang
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, CN-Jiangsu, No. 169 Hushan Road, Nanjing, 211100, China
| | - Wanyou Yu
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, CN-Jiangsu, No. 169 Hushan Road, Nanjing, 211100, China
| | - Wei Wang
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, CN-Jiangsu, No. 169 Hushan Road, Nanjing, 211100, China.
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Liu QR, Zong QK, Ding LL, Dai HY, Sun Y, Dong YY, Ren ZY, Hashimoto K, Yang JJ. Effects of perioperative use of esketamine on postpartum depression risk in patients undergoing cesarean section: A randomized controlled trial. J Affect Disord 2023; 339:815-822. [PMID: 37482224 DOI: 10.1016/j.jad.2023.07.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/27/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Postpartum depression (PPD) is a prevalent public health issue. Although ketamine has prophylactic effects on PPD in women undergoing cesarean section, the effects of esketamine on PPD remain unclear. This trial aimed to evaluate the efficacy of perioperative esketamine infusion on PPD risk by assessing Edinburgh Postnatal Depression Scale (EPDS) scores and blood biomarkers. METHODS A total of 150 participants undergoing elective cesarean section were randomly allocated to receive either esketamine or normal saline. Since 27 participants were excluded due to consent withdrawal or loss to follow-up, 123 patients were included. The primary outcome was the prevalence of PPD risk. Secondary outcomes included the prevalence of postpartum anxiety (PPA) risk, levels of biomarkers, postoperative pain intensity, and cumulative sufentanil consumption. RESULTS The prevalence of PPD and PPA risk at 3 days, 42 days, 3 months, and 6 months postpartum did not differ between the two groups. Furthermore, EPDS scores, pain intensity at rest, and during coughing on postoperative days (POD) 1 and 2 did not differ between the two groups. Sufentanil consumption during 0-12 h, 12-24 h, 0-24 h, and 0-48 h postoperatively were significantly lower in the esketamine group compared to the control group. Blood biomarkers did not differ between the two groups on POD 3. LIMITATIONS The sample size was small. PPD risk was simply screened, not diagnosed. CONCLUSIONS Perioperative administration of esketamine did not decrease the incidence of PPD risk in women after elective cesarean section. However, esketamine reduced opioid consumption.
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Affiliation(s)
- Qing-Ren Liu
- Department of Anesthesiology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China
| | - Qian-Kun Zong
- Department of Anesthesiology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China
| | - Li-Li Ding
- Department of Anesthesiology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China
| | - Hong-Yan Dai
- Department of Obstetrics & Gynecology, Xishan People's Hospital of Wuxi City, Wuxi, 214105, China
| | - Yan Sun
- Department of Obstetrics & Gynecology, Xishan People's Hospital of Wuxi City, Wuxi, 214105, China
| | - Yong-Yan Dong
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Zhuo-Yu Ren
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba 260-8670, Japan.
| | - Jian-Jun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.
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