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Dennis CL, Singla DR, Brown HK, Savel K, Clark CT, Grigoriadis S, Vigod SN. Postpartum Depression: A Clinical Review of Impact and Current Treatment Solutions. Drugs 2024:10.1007/s40265-024-02038-z. [PMID: 38811474 DOI: 10.1007/s40265-024-02038-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
Depression during the first year postpartum (postpartum depression) impacts millions of women and their families worldwide. In this narrative review, we provide a summary of postpartum depression, examining the etiology and consequences, pharmacological and psychological treatments, and potential mechanisms of change and current barriers to care. Psychological treatments are effective and preferred by many perinatal patients over medications, but they often remain inaccessible. Key potential mechanisms underlying their effectiveness include treatment variables (e.g., dosage and therapeutic alliance) and patient behaviors (e.g., activation and avoidance and emotional regulation). Among pharmacological treatments, the selective serotonin reuptake inhibitor (SSRI) sertraline is generally the first-line antidepressant medication recommended to women in the postpartum period due to its minimal passage into breastmilk and the corresponding decades of safety data. Importantly, most antidepressant drugs are considered compatible with breastfeeding. Neurosteroids are emerging as an effective treatment for postpartum depression, although currently this treatment is not widely available. Barriers to widespread access to treatment include those that are systematic (e.g., lack of specialist providers), provider-driven (e.g., lack of flexibility in treatment delivery), and patient-driven (e.g., stigma and lack of time for treatment engagement). We propose virtual care, task-sharing to non-specialist treatment providers, and collaborative care models as potential solutions to enhance the reach and scalability of effective treatments to address the growing burden of postpartum depression worldwide and its negative impact on families and society.
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Affiliation(s)
- Cindy-Lee Dennis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Rm 280, Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Daisy R Singla
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hilary K Brown
- Department of Health and Society, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
| | - Katarina Savel
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Crystal T Clark
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
| | - Sophie Grigoriadis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
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Deligiannidis KM, Bullock A, Nandy I, Dunbar J, Lasser R, Witte M, Leclair B, Wald J. Zuranolone Concentrations in the Breast Milk of Healthy, Lactating Individuals: Results From a Phase 1 Open-Label Study. J Clin Psychopharmacol 2024:00004714-990000000-00252. [PMID: 38739007 DOI: 10.1097/jcp.0000000000001873] [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: 05/14/2024]
Abstract
PURPOSE/BACKGROUND Zuranolone is a positive allosteric modulator of both synaptic and extrasynaptic γ-aminobutyric acid type A receptors and a neuroactive steroid approved as an oral, once-daily, 14-day treatment course for adults with postpartum depression in the United States. This study assessed zuranolone transfer into breast milk. METHODS/PROCEDURES Healthy, nonpregnant, lactating adult female participants received once-daily 30 mg zuranolone from day (D)1 through D5 in this phase 1 open-label study. The relative infant dose (RID; weight-adjusted proportion of the maternal dose in breast milk over 24 hours) for 30 mg zuranolone was assessed at D5. An RID for 50 mg zuranolone was estimated using a simulation approach across a range of infant ages and weights. FINDINGS/RESULTS Of 15 enrolled participants (mean age, 30.1 years), 14 completed the study. The mean RID for 30 mg zuranolone at D5 was 0.357%; the mean steady-state milk volume over D3 to D5 decreased from baseline by 8.3%. Overall unbound zuranolone in plasma was low (≤0.49%). Plasma concentrations peaked at D5 before decreasing in a biexponential manner. There was strong concordance between the temporal evolution of zuranolone concentrations in plasma and breast milk. The estimated mean RID for 50 mg zuranolone based on a milk intake of 200 mL/kg per day was 0.984%. All treatment-emergent adverse events reported by participants were mild, the most common being dizziness (n = 3). IMPLICATIONS/CONCLUSIONS Zuranolone transfer into the breast milk of healthy, nonpregnant, lactating adult female participants was low; the estimated RID for 50 mg zuranolone was <1%, well below the <10% threshold generally considered compatible with breastfeeding.
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Cantin C, Snelgrove-Clarke E, Gaudet L, Ross-White A. Characteristics of breastfeeding newborns in the first month of life with in utero selective serotonin reuptake inhibitor medication exposure: a scoping review protocol. JBI Evid Synth 2024; 22:144-152. [PMID: 37799099 DOI: 10.11124/jbies-23-00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE The objective of this scoping review is to understand the extent and type of evidence in relation to the characteristics of breastfeeding newborns in the first month of life who have been exposed in utero to selective serotonin reuptake inhibitor (SSRI) medications. INTRODUCTION SSRIs are the most commonly prescribed antidepressant medication in pregnancy. Up to 30% of newborns who are prenatally exposed to SSRIs demonstrate withdrawal signs. Poor neonatal adaptation syndrome represents a constellation of signs observed in these newborns. Little information has been studied regarding breastfeeding, as it relates to the impact of in utero SSRI exposure on the newborn. Parents have many questions regarding the safety of taking medications during pregnancy and breastfeeding. It is important for health care providers to collate evidence-based information and facilitate shared decision-making. We aim to identify the approaches researchers have used to investigate in utero SSRI exposure among breastfed newborns to determine knowledge gaps. INCLUSION CRITERIA Primary peer-reviewed studies will be considered for inclusion according to the following criteria: newborns, 31 days of age or less, with in utero SSRI exposure in any trimester of pregnancy, who were breastfed or received breast-milk feedings. METHODS MEDLINE, CINAHL, Embase, LactMed, the Maternity and Infant Care Database, and ClinicalTrials.gov databases will be searched. JBI methodology will be used. Abstracts will be assessed for eligibility and full texts will be retrieved if they meet the inclusion criteria. Two reviewers will independently extract the data from identified studies using a data extraction form and the results will be summarized descriptively and in tabular format. REVIEW REGISTRATION Open Science Framework osf.io/2bt39.
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Affiliation(s)
- Christina Cantin
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Erna Snelgrove-Clarke
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada
| | - Laura Gaudet
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Amanda Ross-White
- Queen's University Library, Queen's University, Kingston, ON, Canada
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Weingarten SJ, Osborne LM. Review of the Assessment and Management of Perinatal Mood and Anxiety Disorders. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:16-24. [PMID: 38694149 PMCID: PMC11058917 DOI: 10.1176/appi.focus.20230023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth. When poorly controlled, they are associated with worse obstetric outcomes, such as higher rates of preterm birth and unplanned cesarean delivery. They are also associated with suicide, a leading cause of perinatal maternal death. This article provides an overview of evidence-based recommendations for screening, assessment, and management of PMADs, including suicide risk assessment and management and pharmacological and nonpharmacological treatment options compatible with pregnancy and lactation. Although specialized reproductive psychiatrists can provide expert guidance for the management of PMADs, their scarcity means that most patients will not have access to this expert care and instead will seek guidance from general psychiatrists. This article provides a clinical guide for generalists that is based on the best current evidence, including recently released treatment guidelines.
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Affiliation(s)
- Sarah J Weingarten
- Department of Obstetrics and Gynecology (Weingarten, Osborne) and Department of Psychiatry (Osborne), Weill Cornell Medicine at NewYork-Presbyterian Hospital, New York, NY
| | - Lauren M Osborne
- Department of Obstetrics and Gynecology (Weingarten, Osborne) and Department of Psychiatry (Osborne), Weill Cornell Medicine at NewYork-Presbyterian Hospital, New York, NY
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Frankel LA, Sampige R, Pfeffer K, Zopatti KL. Depression During the Postpartum Period and Impacts on Parent-Child Relationships: A Narrative Review. J Genet Psychol 2024; 185:146-154. [PMID: 37978907 DOI: 10.1080/00221325.2023.2276264] [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: 05/25/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
Although controversy exists around labels for postpartum depression (PPD), focusing efforts on terms distracts the research community from better understanding the impact of depression on parent-infant relationships. The purpose of this article is to provide a narrative review of research related to how depression experienced in the postpartum period impacts parent-infant relationships. Our review indicates that PPD is pervasive, symptoms often appear during pregnancy, and it has the potential to negatively impact parent-infant relationships. Based on the recent review of literature, intervention efforts should focus on identification and treatment of PPD as early as possible to mitigate detrimental long-term impacts on parent-child relationships.
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Affiliation(s)
- Leslie Ann Frankel
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX, USA
| | - Ritu Sampige
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Katherine L Zopatti
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX, USA
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Harris M, Schiff DM, Saia K, Muftu S, Standish KR, Wachman EM. Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Breastfeed Med 2023; 18:715-733. [PMID: 37856658 PMCID: PMC10775244 DOI: 10.1089/bfm.2023.29256.abm] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments. Key Information: Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother-infant dyads. Recommendations: This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.
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Affiliation(s)
- Miriam Harris
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Davida M. Schiff
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Kelley Saia
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Serra Muftu
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Katherine R. Standish
- Department of Family Medicine, and Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Elisha M. Wachman
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Pediatrics, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
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Reddy DS, Mbilinyi RH, Estes E. Preclinical and clinical pharmacology of brexanolone (allopregnanolone) for postpartum depression: a landmark journey from concept to clinic in neurosteroid replacement therapy. Psychopharmacology (Berl) 2023; 240:1841-1863. [PMID: 37566239 PMCID: PMC10471722 DOI: 10.1007/s00213-023-06427-2] [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: 04/23/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023]
Abstract
This article describes the critical role of neurosteroids in postpartum depression (PPD) and outlines the landmark pharmacological journey of brexanolone as a first-in-class neurosteroid antidepressant with significant advantages over traditional antidepressants. PPD is a neuroendocrine disorder that affects about 20% of mothers after childbirth and is characterized by symptoms including persistent sadness, fatigue, dysphoria, as well as disturbances in cognition, emotion, appetite, and sleep. The main pathology behind PPD is the postpartum reduction of neurosteroids, referred to as neurosteroid withdrawal, a concept pioneered by our preclinical studies. We developed neurosteroid replacement therapy (NRT) as a rational approach for treating PPD and other conditions related to neurosteroid deficiency, unveiling the power of neurosteroids as novel anxiolytic-antidepressants. The neurosteroid, brexanolone (BX), is a progesterone-derived allopregnanolone that rapidly relieves anxiety and mood deficits by activating GABA-A receptors, making it a transformational treatment for PPD. In 2019, the FDA approved BX, an intravenous formulation of allopregnanolone, as an NRT to treat PPD. In clinical studies, BX significantly improved PPD symptoms within hours of administration, with tolerable side effects including headache, dizziness, and somnolence. We identified the molecular mechanism of BX in a neuronal PPD-like milieu. The mechanism of BX involves activation of both synaptic and extrasynaptic GABA-A receptors, which promote tonic inhibition and serve as a key target for PPD and related conditions. Neurosteroids offer several advantages over traditional antidepressants, including rapid onset, unique mechanism, and lack of tolerance upon repeated use. Some limitations of BX therapy include lack of aqueous solubility, limited accessibility, hospitalization for treatment, lack of oral product, and serious adverse events at high doses. However, the unmet need for synthetic neurosteroids to address this critical condition supersedes these limitations. Recently, we developed novel hydrophilic neurosteroids with a superior profile and improved drug delivery. Overall, approval of BX is a major milestone in the field of neurotherapeutics, paving the way for the development of novel synthetic neurosteroids to treat depression, epilepsy, and status epilepticus.
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Affiliation(s)
- Doodipala Samba Reddy
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan, TX, 77807, USA.
- Institute of Pharmacology and Neurotherapeutics, Texas A&M University Health Science Center, 8447 Riverside Pkwy, Bryan, TX, 77807, USA.
| | - Robert H Mbilinyi
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan, TX, 77807, USA
| | - Emily Estes
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan, TX, 77807, USA
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Real-world pharmacological treatment of patients with postpartum depression in China from 2016 to 2020: A cross-sectional analysis. Saudi Pharm J 2022; 30:1418-1425. [PMID: 36387336 PMCID: PMC9649344 DOI: 10.1016/j.jsps.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/13/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To determine the use and tendency of drugs for postpartum depression (PPD) in nine cities across China in 2016–2020 in order to provide a reference for drug use in the clinic. Methods The prescription data of drugs for PPD outpatients in nine cities (Beijing, Chengdu, Guangzhou, Harbin, Hangzhou, Shanghai, Shenyang, Tianjin and Zhengzhou) across China in 2016–2020 were extracted from the Hospital Prescription Analysis Cooperation Project database of the Hospital Pharmacy Professional Committee of Chinese Pharmaceutical Association. A cross-sectional analysis was then conducted of patient age, total prescription quantity, average prescription amount, defined daily doses (DDDs) of drugs, defined daily cost (DDC) of drugs and so on. Results In 2016–2020, more than half of PPD patients in these nine cities were distributed in first-tier cities (Beijing, Shanghai and Guangzhou), and were mainly aged 30–39 years. During the five-year period, the prescription quantity, total prescription amount and average prescription amount increased by 20.95%, 35.41% and 11.02%, respectively. In terms of prescription frequency and prescription amount, selective serotonin reuptake inhibitors (SSRIs) ranked first, followed by serotonin-norepinephrine reuptake inhibitors (SNRIs). With regard to DDDs, escitalopram, sertraline, paroxetine and venlafaxine ranked high, and sertraline was top year by year. The DDC of vortioxetine and milnacipran was greatest, while that of escitalopram, olanzapine and quetiapine declined sharply after being included in the China centralized drug-procurement program. Conclusion The number of PPD patients and the total prescription amount in the nine cities across China increased in 2016–2020. SSRIs and SNRIs were the main drugs for PPD treatment. Due to the national centralized drug-procurement policy, there has been a great reduction in the DDC, lightening the economic burden on patients.
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YILMAZ B, YAVUZ MY, BİLGE Ç, MECDİ KAYDIRAK M. Koronavirüs salgınında yaşanan korku ve postpartum depresyon ilişkisi: kesitsel bir çalışma. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.1061490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Amaç: Bu çalışmada 0-12 aylık bebeği olan kadınların Koronavirüs salgınında yaşadığı korkunun postpartum depresyon (PPD) ile ilişkisini incelemek amaçlandı.
Yöntem Kesitsel tanımlayıcı tipteki çalışma verileri 20 Mart-15 Haziran 2021 tarihleri arasında çevrim içi platformlarda toplandı. Çalışmaya 18-45 yaş aralığında, 0-12 aylık bebeği olan 206 kadın dahil edildi. Veriler katılımcı tanıtım formu, Edinburg Postpartum Depresyon Ölçeği (EPDÖ) ve Koronavirüs Korkusu Ölçeği (KKÖ) kullanılarak elde edildi.
Bulgular: Katılımcıların %81.1’inin Koronavirüs geçirmemiş olduğu gözlendi. Koronavirüs geçirenlerin %61.5’i bu süreçte bebeklerini emzirdiği tespit edildi. Katılımcıların %65.7’si Koronavirüse yakalandığını düşündüğünde kalp atışının hızlandığını, %70.9’u Koronavirüse yakalanmaktan duyduğu endişeden uykularının kaçtığını ve %75.2’si Koronavirüsü düşündüğünde ellerinin terlediğini bildirdi. Çalışma durumu, doğum sebebiyle çalışmaya ara verme ve salgın sebebiyle çalışmaya ara verme arasında KKÖ puanlarında istatistiksel açıdan anlamlı fark olduğu belirlendi. Katılımcıların %32.6’sı PPD açısından risk grubunda bulunmaktaydı. İşe tekrar başlamayı düşünen katılımcıların düşünmeyenlere göre daha düşük PPD riskinde oldukları belirlendi.
Sonuç: Çalışmada postpartum süreçte kadınların orta düzeyde Koronavirüs korkusuna sahip olduğu ve Koronavirüs korkusu ile PPD arasında pozitif bir ilişki olduğu belirlendi. Koronavirüs salgını sırasında anne sağlığı hizmetlerini iyileştirmek için Koronavirüs bilgisi ve doğum sonrası sağlık bilgisinin tanıtımının güçlendirilmesi, doğum sonrası kadınlara profesyonel danışmanlık hizmeti verilmesinin önemli olduğu düşünülmektedir.
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Affiliation(s)
- Büşra YILMAZ
- İSTANBUL ÜNİVERSİTESİ-CERRAHPAŞA, FLORENCE NİGHTİNGALE HEMŞİRELİK FAKÜLTESİ
| | | | - Çiğdem BİLGE
- Muğla Sıtkı Koçman Üniversitesi, Sağlık Bilimleri Fakültesi
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Kaydırak M, Yılmaz B, Demir A, Oskay Ü. The relationships between prenatal attachment, maternal anxiety, and postpartum depression: A longitudinal study. Perspect Psychiatr Care 2022; 58:715-723. [PMID: 33969497 DOI: 10.1111/ppc.12841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study aimed to evaluate the relationships between prenatal attachment, maternal anxiety, and postpartum depression. DESIGN AND METHODS This longitudinal study included 195 pregnant women in their third trimester. FINDINGS The level of postpartum depression in the sixth week was found to be significantly higher in women older than 31 years, high-risk pregnancies, primipara women, women having a living child outside of the newborn, and in women who experience problems after delivery. Our findings indicated that the level of anxiety and postpartum depression decreased significantly in the sixth postpartum week. Anxiety and depression levels decreased during the weeks following the postpartum period. Furthermore, no significant relationship emerged between prenatal attachment and postpartum depression. PRACTICE IMPLICATIONS Nurses should evaluate psychosocial health in the prenatal and postnatal periods.
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Affiliation(s)
- Meltem Kaydırak
- Department of Women's Health and Gynecological Nursing, Florence Nightingale Faculty of Nursing, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Büşra Yılmaz
- Department of Women's Health and Gynecological Nursing, Florence Nightingale Faculty of Nursing, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Aleynanur Demir
- Anesthesia and Reanimation Clinic, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Ümran Oskay
- Department of Women's Health and Gynecological Nursing, Florence Nightingale Faculty of Nursing, Istanbul University - Cerrahpasa, Istanbul, Turkey
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Darcy A, Beaudette A, Chiauzzi E, Daniels J, Goodwin K, Mariano TY, Wicks P, Robinson A. Anatomy of a Woebot® (WB001): agent guided CBT for women with postpartum depression. Expert Rev Med Devices 2022; 19:287-301. [PMID: 35748029 DOI: 10.1080/17434440.2022.2075726] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/05/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Postpartum Depression (PPD) is common, persistent, and stigmatized. There are insufficient trained professionals to deliver appropriate screening, diagnosis, and treatment. AREAS COVERED WB001 is a Software as a Medical Device (SaMD) based Agent-Guided Cognitive Behavioral Therapy (AGCBT) program for the treatment of PPD, for which Breakthrough Device Designation was recently granted by the US Food and Drug Administration. WB001 combines therapeutic alliance, human-centered design, machine learning techniques, and established principles from CBT and interpersonal therapy (IPT). We introduce AGCBT as a new model of service delivery, whilst describing Woebot, the agent technology that enables guidance through the replication of some elements of human relationships. The profile describes the device's design principles, enabling technology, risk handling, and efficacy data in PPD. EXPERT OPINION WB001 is a dynamic and personalized tool with which patients may establish a therapeutic bond. Woebot is designed to augment (rather than replace) human healthcare providers, unlocking the therapeutic potency associated with guidance, whilst retaining the scalability and agency that characterizes self-help approaches. WB001 has the potential to improve both the quality and the scalability of care through providing support to patients on waiting lists, in between clinical encounters, and enabling automation of measurement-based care.
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12
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Challenges in the Management of Breast Conditions During Lactation. Obstet Gynecol Clin North Am 2022; 49:35-55. [DOI: 10.1016/j.ogc.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Barry JM, Birnbaum AK, Jasin LR, Sherwin CM. Maternal Exposure and Neonatal Effects of Drugs of Abuse. J Clin Pharmacol 2021; 61 Suppl 2:S142-S155. [PMID: 34396555 DOI: 10.1002/jcph.1928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/17/2021] [Indexed: 11/08/2022]
Abstract
The public health crisis of pregnant women being exposed to drugs of abuse and of its impact on their unborn children continues to grow at an alarming rate globally. The state of pregnancy is unique, with physiological changes that can lead to changes in the way drugs are handled by the body in both pharmacokinetics and response. These changes place the pregnant woman, fetus, and newborn infant at risk, as many of these drugs can cross the placenta and into breast milk. The substances most commonly linked to harmful effects include alcohol, tobacco, cannabis, stimulants, and opioids. The pharmacological and toxicological changes caused by in utero exposure or breastfeeding exposure are difficult to study, and the full extent of the mechanisms involved are not fully understood. However, these changes can significantly affect the risks of substance abuse and influence optimal treatment of pregnant women with a substance use disorder. In addition, newborns who were exposed to drugs of abuse in utero can experience withdrawal syndromes. Pharmacological management in infants is used to guide and treat withdrawal symptoms, with the goal being to improve the infant's sleep, eating, and comfort. Several barriers may prevent pregnant women from seeking help for substance use, including stigma and interactions with the legal system. Understanding changes in pharmacology, including pharmacokinetic changes that happen during pregnancy, is essential for anticipating the extent of maternal exposure and neonatal adverse effects.
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Affiliation(s)
- Jessica M Barry
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minnesota, Minneapolis, USA
| | - Angela K Birnbaum
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minnesota, Minneapolis, USA
| | - Lisa R Jasin
- Neonatal Intensive Care Unit, Dayton Children's Hospital, Dayton, Ohio, USA
| | - Catherine M Sherwin
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minnesota, Minneapolis, USA.,Department of Pediatrics, Wright State University, Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, Ohio, USA
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Sethuraman B, Thomas S, Srinivasan K. Contemporary management of unipolar depression in the perinatal period. Expert Rev Neurother 2021; 21:643-656. [PMID: 33827361 DOI: 10.1080/14737175.2021.1914591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: There is increasing recognition that antenatal depression and postpartum depression are highly prevalent and have significant impact on maternal and child health.Areas Covered: In the initial part of the manuscript, the authors review the epidemiology of antenatal and postpartum depression and its impact on maternal and child health. The later part of the manuscript reviews the current status of the medical management and psychosocial interventions targeting perinatal depression.Expert Opinion: Perinatal depression is the focus of several studies with increasing interest in developing effective interventions. While several psychosocial interventions targeting maternal depressive symptoms during pregnancy and postpartum are available, more studies are needed to address the need for safe and efficacious strategies for the use of antidepressant medication during pregnancy and in the postpartum period.
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Affiliation(s)
| | - Susan Thomas
- Division of Mental Health and Neurosciences, St. John's Research Institute, Bangalore, India
| | - Krishnamachari Srinivasan
- Department of Psychiatry, St. John's Medical College & Head, Division of Mental Health and Neurosciences, St. John's Research Institute, Bangalore, India
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15
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Vanguri S, Rogers-McQuade H, Sriraman NK. ABM Clinical Protocol #14: Breastfeeding-Friendly Physician's Office-Optimizing Care for Infants and Children. Breastfeed Med 2021; 16:175-184. [PMID: 33599542 DOI: 10.1089/bfm.2021.29175.sjv] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Swathi Vanguri
- Department of Obstetrics and Gynecology, Crozer-Keystone Health System, Upland, Pennsylvania, USA
| | | | - Natasha K Sriraman
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA.,Division of General Academic Pediatrics, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA.,Division of Community Health & Research, Eastern Virginia Medical School, Norfolk, Virginia, USA
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16
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Lucas R, Zhang Y, Walsh SJ, Starkweather A, Young E. OXTR rs53576 Variation with Breast and Nipple Pain in Breastfeeding Women. Pain Manag Nurs 2020; 22:369-376. [PMID: 33303340 DOI: 10.1016/j.pmn.2020.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Thirty percent of women who seek professional breastfeeding support require assistance with ongoing breast and nipple pain and < 50% of women report resolution of their pain. It is unknown if there is a molecular risk for ongoing breast and nipple pain during breastfeeding. Aim -To evaluate associations among breast and nipple pain sensitivity and candidate pain sensitivity single-nucleotide polymorphisms [SNPs], (COMT rs6269, rs4633, rs4818, rs4680 and OXTR rs2254298, rs53576) in breastfeeding women. Design - A secondary analysis of a pilot randomized controlled trial of a pain self-management intervention conducted over 6 weeks postpartum. Setting and Participants - Sixty women were recruited from two hospital settings after birth. Methods - All participants underwent standardized mechanical somatosensory testing for an assessment of pain sensitivity and provided baseline buccal swabs for genetic analysis. At 1, 2, and 6 weeks postpartum, women self-reported breast and nipple pain severity using a visual analogue scale. Results - Women with the minor allele OXTR rs53576 reported 8.18-fold higher breast and nipple pain severity over time. For every 1-unit increase in Mechanical detection threshold and windup ratio, women reported 16.51-fold and 4.82-fold higher breast and nipple pain severity respectively. Six women with the OXTR rs2254298 minor allele reported allodynia. Conclusion - The presence of OXTR alleles in women with enhanced pain sensitivity suggests a phenotype of genetic risk for ongoing breast and nipple with potential for pain-associated breastfeeding cessation. Somatosensory testing identified women who reported higher breast and nipple pain during the first weeks of breastfeeding.
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Affiliation(s)
- Ruth Lucas
- University of Connecticut School of Nursing, Storrs, Connecticut.
| | - Yiming Zhang
- University of Connecticut School of Nursing, Storrs, Connecticut
| | - Stephen J Walsh
- University of Connecticut School of Nursing, Storrs, Connecticut
| | | | - Erin Young
- University of Connecticut School of Nursing, Storrs, Connecticut; University of Kansas Medical Center, Kansas City, Kansas
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17
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Qiu W, Duarte-Guterman P, Eid RS, Go KA, Lamers Y, Galea LA. Postpartum fluoxetine increased maternal inflammatory signalling and decreased tryptophan metabolism: Clues for efficacy. Neuropharmacology 2020; 175:108174. [DOI: 10.1016/j.neuropharm.2020.108174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
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18
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Hanley L. Medication Use During Lactation: Either a Potential Contributor to Premature Weaning or Evidence-based Support of the Mother/Child Couplet. Clin Ther 2020; 42:393-400. [PMID: 32113701 DOI: 10.1016/j.clinthera.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 01/23/2023]
Abstract
It is well established that breastfeeding improves the health of women, children, and populations. According to the 2018 Centers for Disease Control and Prevention Report Card, 83% of women initiated breastfeeding, but only 58% maintained breastfeeding at the 6-month mark, and 36% continued to 12 months. Reasons for cessation of breastfeeding are multifactorial and include issues surrounding safe use of medications while breastfeeding for acute or chronic conditions. There are a wide variety of resources that clinicians may consult to help decide if medications are compatible with breastfeeding. The resources have varying data and recommendations, which can make counseling challenging for the clinician. There are some resources that are updated regularly with the most current information about drug safety in lactation, as well as call centers that can answer questions from clinicians and patients. A case scenario is presented to help illustrate the many facets of how medication use can affect breastfeeding. Very few medications are absolutely contraindicated during lactation. Involving the woman and her family in a shared decision-making approach regarding medication use may help women feel more confident in the medication recommendations given and ultimately help women achieve their breastfeeding goals. (Clin Ther. 2020; 42:XXX-XXX)© 2020 Elsevier HS Journals, Inc.
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Affiliation(s)
- Lauren Hanley
- Obstetrics, Gynecology and Breastfeeding Medicine, MGH Lactation Clinic, Massachusetts General Hospital, 55 Fruit St, Founders 430, Boston, MA, 02114, USA.
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19
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Delaney SR, Malik PRV, Stefan C, Edginton AN, Colantonio DA, Ito S. Predicting Escitalopram Exposure to Breastfeeding Infants: Integrating Analytical and In Silico Techniques. Clin Pharmacokinet 2019; 57:1603-1611. [PMID: 29651785 DOI: 10.1007/s40262-018-0657-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Escitalopram is used for post-partum depression; however, there are limited pharmacokinetic data of escitalopram in milk and plasma of infants breastfed by women taking the drug. OBJECTIVE The objective of this study was to apply physiologically-based pharmacokinetic (PBPK) modelling to predict infant drug exposure (plasma area under the curve from time zero to infinity [AUC∞]) based on drug monitoring data of escitalopram in breast milk. METHODS Using a newly developed liquid chromatography-tandem mass spectrometry (LC-MS/MS) method, we quantified escitalopram concentrations in milk samples of 18 breastfeeding women with escitalopram therapy at steady state, collected at three to five time points. The escitalopram concentrations in breast milk were used with infant feeding parameters from the literature to simulate infant daily dose. We used PK-Sim® to develop an adult PBPK model for escitalopram and extrapolated it to a population of 1600 infants up to 12 months of age. An integration of the simulated infant daily dose and the virtual infants with variable physiological-pharmacological parameters was used to predict drug exposure (plasma AUC∞) distribution in the population of infants breastfed by women receiving escitalopram 20 mg/day. RESULTS Escitalopram concentrations in milk were 50 ± 17 ng/mL (mean ± standard deviation). The simulated infant plasma AUC∞ following escitalopram exposure through breast milk was low, with a median of 1.7% (range 0.5-5.9%) of the corresponding maternal plasma AUC∞, indicating no substantial exposure. CONCLUSIONS Infant exposure levels to escitalopram in breast milk are low. A PBPK modeling approach can be used to translate data on drug monitoring in milk into a population distribution of infant plasma levels for drug safety assessment.
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Affiliation(s)
- Sarah R Delaney
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Paul R V Malik
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | | | | | - David A Colantonio
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Shinya Ito
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada. .,Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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20
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Abstract
Postpartum depression (PPD) affects10% to 20% of women within the first year after birth and 25% beyond the first year. PPD, despite advances in diagnosis and treatment, remains underdiagnosed and misunderstood. Women do not always display signs of PPD while in care for delivery of the infant and may not discuss mood changes to their primary care provider at discharge and first post-delivery appointment. Identifying screening and treatment options for non-mental health providers was the purpose of this article.
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21
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Breastfeeding experiences and perspectives among women with postnatal depression: A qualitative evidence synthesis. Women Birth 2019; 33:231-239. [PMID: 31196830 DOI: 10.1016/j.wombi.2019.05.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies show that postnatal depression affects around 10-16% of women globally. It is associated with earlier cessation of breast feeding, which can negatively impact infants' long-term development. Mechanisms underpinning associations between mental health and women's decision to commence and continue to breastfeed are complex and poorly understood. AIM The aim of this review was to investigate breastfeeding experiences, perspectives, and support needs of women with postnatal depression. No previous reviews were identified which had addressed this aim. METHOD A systematic search was conducted of six databases to identify relevant qualitative studies. Six included studies were critically appraised and synthesised using thematic synthesis. FINDINGS Five themes were identified: (1) desire to breastfeed and be a 'good mother', (2) struggles with breastfeeding, (3) mixed experiences of support from healthcare professionals, (4) importance of practical and social support, (5) support for mental health and breastfeeding. Most women with postnatal depression expressed strong intentions to breastfeed, although some perceived 'failure' to breastfeed triggered their mental health problems. Practical and non-judgemental support for their mental health needs and for successful breastfeeding from healthcare professionals, family and friends are needed. CONCLUSION Most women with postnatal depression desired to breastfeed but experienced breastfeeding difficulties that could impact on their mental health. By offering women with postnatal depression tailored and timely support, healthcare professionals could help women minimize breastfeeding problems which could consequently impact on their mental well-being and ensure they and their infants have opportunity to benefit from the advantages that breastfeeding offers.
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22
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Flagg J, Busch DW. Utilizing a Risk Factor Approach to Identify Potential Breastfeeding Problems. Glob Pediatr Health 2019; 6:2333794X19847923. [PMID: 31106249 PMCID: PMC6501472 DOI: 10.1177/2333794x19847923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 03/30/2019] [Accepted: 03/31/2019] [Indexed: 12/02/2022] Open
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Abstract
Postpartum depression (PPD) is common, disabling, and treatable. The strongest risk factor is a history of mood or anxiety disorder, especially having active symptoms during pregnancy. As PPD is one of the most common complications of childbirth, it is vital to identify best treatments for optimal maternal, infant, and family outcomes. New understanding of PPD pathophysiology and emerging therapeutics offer the potential for new ways to add to current medications, somatic treatments, and evidence-based psychotherapy. The benefits and potential harms of treatment, including during breastfeeding, are presented.
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Affiliation(s)
- Donna E Stewart
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5G 2C4, Canada; .,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario M5G 2C4, Canada.,Toronto General Hospital Research Institute, Toronto, Ontario M5G 2C4, Canada.,University Health Network Centre for Mental Health, Toronto, Ontario M5G 2C4, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5G 2C4, Canada; .,Women's College Research Institute, Women's College Hospital, Toronto, Ontario M5G 2C4, Canada;
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Abstract
BACKGROUND: Perinatal depression (PD) screening has been defined for decades, but treatment remains ill-defined, with few mental health (MH) providers helping depressed women during this delicate time. The nurse practitioner (NP) is in a position to help women through PD with the use of a collaborative treatment model. AIMS: This DNP (doctor of nursing practice) inquiry investigated a stepped collaborative care model (CCM) to see whether the PD model improved time from referral to evaluation and decreased depression scores over a 6-month treatment period for women who came to an NP MH practice. METHOD: After obtaining approval from the institutional review board and the clients, the Edinburgh Postnatal Depression Scale was administered to 37 women at psychiatric evaluation and subsequent MH visits over a 6-month period. Time from referral to evaluation and depression scores were analyzed. RESULTS: The CCM met the goal of 30 days from referral to evaluation. Prenatal clients had a statistically significant decrease in depression scores, and postpartum client scores were clinically significant. CONCLUSION: A CCM among care providers facilitates prompt intake to treatment time within 1 month of identification of depression, and a decrease in depression scores in women measured by sequential depression screen scores. The study may provide ideas for evidence-based NP practice by use of the model to treat depression in this group of women.
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Affiliation(s)
- Mary M Rock
- 1 Mary M. Rock, DNP, CRNP-BC, FNP-C, CNS-PMH-BC, Geisinger Holy Spirit, Camp Hill, PA, USA
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26
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27
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Is There a Relationship Between Gestational Diabetes and Perinatal Depression? MCN Am J Matern Child Nurs 2018; 43:206-212. [PMID: 29958203 DOI: 10.1097/nmc.0000000000000439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Perinatal depression (PND) is one of the leading complications associated with childbirth. Early detection and treatment of depression, particularly during the perinatal period, is essential for the promotion of positive maternal-child outcomes. Gestational diabetes mellitus (GDM) has been suggested as a confounding factor associated with PND. Concerns associated with PND include interference with maternal-newborn bonding and long-term effects of neurobehavioral consequences. An exemplar case describing one woman's experience with GDM and her subsequent complications associated with PND is presented to discuss maternal depression and its plausible association with GDM. Recommendations include universal screening with the validated Edinburgh Postnatal Depression Scale screening tool during the early perinatal period to reduce incidence of maternal-newborn complications associated with PND and promote underpinnings for best practice.
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Cuomo A, Maina G, Neal SM, De Montis G, Rosso G, Scheggi S, Beccarini Crescenzi B, Bolognesi S, Goracci A, Coluccia A, Ferretti F, Fagiolini A. Using sertraline in postpartum and breastfeeding: balancing risks and benefits. Expert Opin Drug Saf 2018; 17:719-725. [PMID: 29927667 DOI: 10.1080/14740338.2018.1491546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The World Health Organization recommends newborns to be breastfed but this may be challenging if the mother needs to be treated for depression, since strong evidence to inform treatment choice is missing. AREAS COVERED We provide a critical review of the literature to guide clinicians who are considering sertraline for the management of depression during postpartum. EXPERT OPINION Sertraline is one of the safest antidepressants during breastfeeding. In most cases, women already taking sertraline should be advised to breastfeed and continue the medication. We recommend to begin with low doses and to slowly increase the dose up, with careful monitoring of the newborn for adverse effects (irritability, poor feeding, or uneasy sleep, especially if the child was born premature or had low weight at birth). The target dose should be the lowest effective. When feasible, child exposure to the medication may be reduced by avoiding breastfeeding at the time when the antidepressant milk concentration is at its peak. A decision to switch to sertraline from ongoing and effective treatment should be taken only after a scrupulous evaluation of the potential risks and benefits of switching versus continuing the ongoing medication while monitoring the infant carefully.
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Affiliation(s)
- Alessandro Cuomo
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| | - Giuseppe Maina
- b University of Torino , Department of Neuroscience (GM , GR )
| | - Stephen M Neal
- c The Department of Psychiatry , West Virginia School of Osteopathic Medicine (SMN)
| | - Graziella De Montis
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| | - Gianluca Rosso
- b University of Torino , Department of Neuroscience (GM , GR )
| | - Simona Scheggi
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| | - Bruno Beccarini Crescenzi
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| | - Simone Bolognesi
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| | - Arianna Goracci
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
| | - Anna Coluccia
- d University of Siena Department of Medical , Sugical and Neurological Sciences (AC2, FF)
| | - Fabio Ferretti
- d University of Siena Department of Medical , Sugical and Neurological Sciences (AC2, FF)
| | - Andrea Fagiolini
- a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF)
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Noble LM, Okogbule-Wonodi AC, Young MA. ABM Clinical Protocol #12: Transitioning the Breastfeeding Preterm Infant from the Neonatal Intensive Care Unit to Home, Revised 2018. Breastfeed Med 2018; 13:230-236. [PMID: 29717879 DOI: 10.1089/bfm.2018.29090.ljn] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols, free from commercial interest or influence, for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Lawrence M Noble
- 1 Department of Pediatrics, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Adora C Okogbule-Wonodi
- 2 Department of Pediatrics and Child Health, Howard University College of Medicine , Washington, District of Columbia
| | - Michal A Young
- 2 Department of Pediatrics and Child Health, Howard University College of Medicine , Washington, District of Columbia
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Abstract
Pregnancy is a complex and vulnerable period that presents a number of challenges to women, including the development of postpartum psychiatric disorders (PPDs). These disorders can include postpartum depression and anxiety, which are relatively common, and the rare but more severe postpartum psychosis. In addition, other PPDs can include obsessive-compulsive disorder, post-traumatic stress disorder and eating disorders. The aetiology of PPDs is a complex interaction of psychological, social and biological factors, in addition to genetic and environmental factors. The goals of treating postpartum mental illness are reducing maternal symptoms and supporting maternal-child and family functioning. Women and their families should receive psychoeducation about the illness, including evidence-based discussions about the risks and benefits of each treatment option. Developing effective strategies in global settings that allow the delivery of targeted therapies to women with different clinical phenotypes and severities of PPDs is essential.
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Affiliation(s)
- Natasha K Sriraman
- Division of General Academic Pediatrics, The Children's Hospital of the King's Daughters; Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA
| | - Do-Quyen Pham
- Division of Adolescent Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Reeti Kumar
- Division of Nephrology, Nationwide Children's Hospital, Columbus, OH
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Tabeshpour J, Sobhani F, Sadjadi SA, Hosseinzadeh H, Mohajeri SA, Rajabi O, Taherzadeh Z, Eslami S. A double-blind, randomized, placebo-controlled trial of saffron stigma (Crocus sativus L.) in mothers suffering from mild-to-moderate postpartum depression. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2017; 36:145-152. [PMID: 29157808 DOI: 10.1016/j.phymed.2017.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/27/2017] [Accepted: 10/05/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Numerous adverse effects of antidepressants as well as the attitudes of breastfeeding mothers, who prefer to consume herbal medicine rather than chemical drugs, encouraged us to assess the effects of saffron (Crocus sativus L.) on mothers suffering from mild-to-moderate postpartum depressive disorder. METHODS A double-blind, randomized, and placebo-controlled trial was conducted on 60 new mothers who had a maximum score of 29 on the Beck Depression Inventory-Second Edition (BDI-II). They were randomly assigned to the saffron (15 mg/Bid) or placebo group. The primary outcome was a change in the BDI-II scores 8 weeks after treatment compared to the baseline. The response and remission rates were considered to be secondary outcome measures. RESULTS Saffron had a more significant impact on the BDI-II scores than the placebo. The mean BDI-II scores decreased from 20.3 ± 5.7 to 8.4 ± 3.7 for the saffron group (p < .0001) and from 19.8 ± 3.2 to 15.1 ± 5.4 for the placebo group (p < .01). In the final assessment, 96% of the saffron group were in remission compared to 43% of the placebo group (p < .01). The complete response rates were 6% for the placebo group and 66% for the saffron group. CONCLUSION When administered to treat minor PPD in breastfeeding mothers, saffron had a more significant impact on the BDI-II than the placebo.
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Affiliation(s)
- Jamshid Tabeshpour
- Department of pharmacodynamy and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzaneh Sobhani
- Targeted Drug Delivery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Alireza Sadjadi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Hosseinzadeh
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ahmad Mohajeri
- Pharmaceutical research center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Omid Rajabi
- Department of Pharmaceutical Control, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zhila Taherzadeh
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Saeid Eslami
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Affiliation(s)
- Donna E Stewart
- From the University Health Network Centre for Mental Health (D.E.S.), the Toronto General Hospital Research Institute (D.E.S.), the Reproductive Life Stages Program, Women's Mental Health Program, and Women's College Hospital and Research Institute (S.V.), and the University of Toronto (D.E.S., S.V.) - all in Toronto
| | - Simone Vigod
- From the University Health Network Centre for Mental Health (D.E.S.), the Toronto General Hospital Research Institute (D.E.S.), the Reproductive Life Stages Program, Women's Mental Health Program, and Women's College Hospital and Research Institute (S.V.), and the University of Toronto (D.E.S., S.V.) - all in Toronto
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Affiliation(s)
- Philip O Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California , San Diego, La Jolla, California
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37
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Eidelman AI. When in Doubt, Breastfeeding Is the Default. Breastfeed Med 2015. [PMID: 26204123 DOI: 10.1089/bfm.2015.29003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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