Management of postpartum depression

Perioperative esketamine administration for prevention of postpartum depression after the cesarean section: A systematic review and meta-analysis

BACKGROUND

Postpartum Depression (PPD) exerts a substantial negative effect on maternal well-being post-delivery, particularly among Cesarean Section (C/S) recipients. In this study, we aimed to review the efficacy of perioperative esketamine, the S-enantiomer of ketamine, in preventing PPD incidence and depressive symptoms as measured with the Edinburgh Postnatal Depression Scale (EPDS) after C/S.

METHODS

A systematic search for relevant articles was conducted in Scopus, PubMed, Web of Sciences, and PsycINFO until April 6, 2024. Meta-analyses were conducted using random-effect models to compare the PPD incidence and EPDS scores via log odds ratio and Hedge's g, respectively, during the first week post-C/S and at 42 days post-C/S in the esketamine and control group.

RESULTS

Fourteen studies, including 12 randomized controlled trials and 2 retrospective cohorts, were reviewed. Our meta-analyses found lower PPD incidence during the first week (log odds ratio: -0.956 [95 % confidence interval: -1.420, -0.491]) and at day 42 post-C/S (log odds ratio: -0.989 [95 % confidence interval: -1.707, -0.272]) among patients administered esketamine compared to controls. Additionally, EPDS scores for the esketamine group were significantly lower than controls during the first week (Hedge's g: -0.682 [95 % confidence interval: -1.088, -0.276]) and at day 42 post-C/S (Hedge's g: -0.614 [95 % confidence interval: -1.098, -0.129]).

LIMITATIONS

Presence of various concomitant medications and heterogeneous study designs.

CONCLUSION

Our review highlights the potential impact of esketamine in PPD prevention, as well as in alleviating depressive symptoms post-C/S, regardless of PPD occurrence, therefore suggesting the benefits of adding esketamine to peri-C/S analgesic regimen.

Understanding and treating postpartum depression: a narrative review

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.

Postpartum Depression: Etiology, Treatment, and Consequences for Maternal Care

Postpartum depression (PPD) is a disabling condition that has recently shown an increase in prevalence, becoming an essential public health problem. This study is a qualitative review summarizing the most frequent risk factors associated with PPD, evaluating molecular aspects of PPD and current approaches to detect and prevent PPD. The most prevalent risk factors were detected in the areas of economic and social factors, obstetrical history, lifestyle, and history of mental illness. Research on the genetic basis for PPD has taken place in recent years to identify the genes responsible for establishing targeted therapeutic methods and understanding its pathogenesis. The most frequently studied candidate gene was the serotonin transporter gene (SERT) associated with PPD. Among biological studies, antidepressants and psychological interventions provided the most evidence of successful intervention. The obstetrician can serve an essential role in screening for and treating PPD. Postpartum women with risk factors should be screened using the Edinburgh Postnatal Depression Scale (EPDS), but, at the moment, there are no prevention programs in Europe. In conclusion, data from this review increase concerns among this vulnerable population and can be used to design a screening tool for high-risk pregnant women and create a prevention program.

Diagnosis of peripartum depression disorder: A state-of-the-art approach from the COST Action Riseup-PPD

BACKGROUND

Peripartum depression (PPD) is a major depression disorder (MDD) episode with onset during pregnancy or within four weeks after childbirth, as defined in DSM-5. However, research suggests that PPD may be a distinct diagnosis. The goal of this study was to summarize the similarities and differences between PPD and MDD by synthesizing the current research on PPD diagnosis concerning different clinical features and give directions for improving diagnosis of PPD in clinical practice.

METHODS

To lay the groundwork for this narrative review, several databases were searched using general search phrases on PPD and its components of clinical diagnosis.

RESULTS

When compared to MDD, peripartum depression exhibits several distinct characteristics. PPD manifests with a variety of symptoms, i.e., more anxiety, psychomotor symptoms, obsessive thoughts, impaired concentration, fatigue and loss of energy, but less sad mood and suicidal ideation, compared to MDD. Although PPD and MDD prevalence rates are comparable, there are greater cross-cultural variances for PPD. Additionally, PPD has some distinct risk factors and mechanisms such as distinct ovarian tissue expression, premenstrual syndrome, unintended pregnancy, and obstetric complications.

CONCLUSION

There is a need for more in-depth research comparing MDD with depression during pregnancy and the entire postpartum year. The diagnostic criteria should be modified, particularly with (i) addition of specific symptoms (i.e., anxiety), (ii) onset specifier extending to the first year following childbirth, (iii) and change the peripartum onset specifier to either "pregnancy onset" or "postpartum onset". Diagnostic criteria for PPD are further discussed.

Investigating Factors Associated with the Development of Postnatal Depression After Cesarean Delivery: A Validation Cohort Study

Purpose

This study aimed to validate a proposed association model previously published to determine the clinical relevance of pre-operative determinants in the development of PND after Cesarean delivery (CD).

Patients and Methods

Parturients undergoing elective CD under neuraxial anesthesia were recruited for a prospective cohort study between Oct 2021 and Oct 2022 at KK Women's and Children's Hospital, Singapore. Predelivery pain, psychological and mechanical temporal summation, and demographic data were recorded. A follow-up survey was conducted at 6 to 10 weeks after CD. The primary outcome was the incidence of PND, defined as an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10.

Results

A total of 180 patients were recruited for validation. PND 6 to 10 weeks post-delivery occurred in 18.9% of recruited parturients. Multivariate regression analyses showed that higher pre-operative CSI scores (p=0.0156), higher anxiety levels about upcoming surgery (p=0.0429), increased pre-operative pain scores on movement (p=0.0110), and higher pre-operative HADS subscale scores on anxiety (p=0.0041) were independently associated with the development of PND weeks post-CD. Lower anticipation of pain medication needs (p=0.0038) was independently associated with the development of PND post-CD. The area under curve (AUC) of this multivariable model (training cohort), internal cross validation (training cohort) and external cross validation (validation cohort) were 0.818 (95% CI, 0.746 to 0.889), 0.785 (95% CI, 0.707 to 0.864) and 0.604 (95% CI, 0.497 to 0.710) respectively.

Conclusion

The proposed model performed well in a local population. Further refinement is necessary to test the proposed model in populations with social and cultural differences.

Celecoxib in Treatment of Postpartum Depression: A Case Report

Postpartum depression (PPD) impairs mother-infant interaction and has negative effects on the child's emotional, behavioral, and cognitive skills. There is considerable evidence to suggest that inflammation plays a role in the pathogenesis of depression. Controlled trials indicate that celecoxib has antidepressant effects in patients with major depressive disorder. A 34-year-old woman with mild to moderate PPD received a celecoxib capsule twice a day. This treatment has not been reported in previous studies and is novel in clinical practice. The patient was assessed using the Hamilton Depression Rating Scale (HDRS). Moreover, levels of brain-derived neurotrophic factor (BDNF) and inflammatory cytokines were measured at baseline and at the end of celecoxib therapy. This case suggests that celecoxib can improve depressive symptoms in patients with mild to moderate PPD. No adverse effects occurred during follow-up.

The effect of crocin versus sertraline in treatment of mild to moderate postpartum depression: a double-blind, randomized clinical trial

Postpartum depression (PPD) is one of the most common conditions among women. This study aimed to investigate the effect of crocin compared to sertraline in women with mild to moderate PPD. This trial study was performed on women with PPD. Patients in two groups received crocin (15 mg) and sertraline (50 mg) daily for 3 months, respectively. Patients have assessed by Beck's Depression Inventory-II (BDI-II) and Beck's Anxiety Inventory (BAI) at 0-12 weeks. A total of 64 patients were examined. The mean of the BDI-II score in the crocin group decreased after 3 months from 20.75 to 4.93 (P = 0.0001). In the sertraline group, the mean score of BDI-II decreased after 3 months from 21.06 to 2.37 (P = 0.0001). The mean of the BAI score in the crocin group decreased significantly after 3 months from 13.75 to 4.06 (P = 0.0001) and in the sertraline group from 12.9 to 2.71 (P = 0.0001). No significant difference was observed between crocin and sertraline after the clinical trial (P = 0.5). No severe side effects were observed during the study in the two groups. The results of this study showed that crocin (15 mg daily) could be useful in treating PPD. Furthermore, this study showed that crocin, with far fewer side effects than chemical drugs, can be widely used in PPD, but due to the small sample size further studies are necessary to confirm such efficiency.

Effect of transcranial direct current stimulation on postpartum depression: A study protocol for a randomized controlled trial

Postpartum depression (PPD) is a complex combination of physiological, emotional, and behavioral alterations associated with postpartum chemical, social, and psychological variations. It does harm to the relationship between family members that could potentially last for years. However, standard depression treatments are not ideal for PPD, and the outcomes of these treatments are debatable. Transcranial direct current stimulation (tDCS) is an emerging technology that could provide patients with PPD with a safe and non-pharmacological treatment. tDCS can relieve depression by directly stimulating the prefrontal cortex through the excitatory effect of the anode. It may also ease depression indirectly by promoting the production and release of the neurotransmitter GABA. The mechanism of tDCS makes it an ideal therapeutic approach to treat PPD, although it has not been widely used, and its effect has not been evaluated systematically and effectively. A double-blind, randomized controlled trial will be conducted involving 240 tDCS-naive patients with PPD, who will be randomly divided into two groups. One group will receive routine clinical treatment and care with active tDCS, and the other group will receive routine clinical treatment and care with sham tDCS. Each group of patients will receive a 3-week intervention during which they will receive 20 min of active or sham tDCS 6 days per week. The Montgomery-Åsberg Depression Rating Scale will be administered before the intervention as a baseline and on each weekend throughout the intervention phase. Before and after the intervention, the Perceived Stress Scale and the Positive and Negative Affect Schedule will be evaluated. Side effects and abnormal reactions will be recorded during each treatment. As antidepressants are banned in the study, the results will not be affected by drugs and will therefore be more accurate. Nonetheless, this experiment will be conducted in a single center as a small sample experiment. Therefore, future studies are required to confirm the effectiveness of tDCS in treating PPD.

Effects of goal-oriented nursing intervention on postpartum depression

This retrospective study aimed to explore the effects of goal-oriented nursing intervention (GONI) on postpartum depression (PPD). We retrospectively analyzed the medical records of 72 women with PPD. They were allocated to a treatment group (n = 36, exercise plus GONI) or a control group (n = 36, exercise). Patients in both groups received a total of 3 months of treatment. Outcomes included the 17-item Hamilton Rating Scale for Depression (HAMD-17) total score, HAMD-17 response rate (≥50% score reduction), HAMD-17 remission rate (score ≤ 7), and adverse events. Outcomes were analyzed before and after 3-month of treatment. After treatment, patients in the treatment group achieved more effective outcomes in the HADM-17 total score (P < .01), HADM-17 response rate (P < .01), HADM-17 remission rate (P < .01) than those in the control group. Regarding safety, the medical records of both the groups did not report any adverse events. The results of this study showed that GONI and exercise had more effects in patients with PPD. Further prospective studies are required to validate our findings.

The Use of Cannabis and Its Effects on Postpartum Depression

Cannabis use and depression management have been studied, with a preponderance of exacerbating effects, but there are few studies on postpartum depression (PPD). Depression affects a significant number of women, with a portion of it manifesting as PPD in childbearing women in the United States each year. The pharmacologic management approaches have disadvantages such as side effects, cost-benefit ratio, contraindications, use reluctance, medication adherence, and stigmatization in patients. Anecdotal claims of medical cannabis' therapeutic benefits have led to widespread legalization in several regions, making cannabis and its extracts a possible alternative. Cannabis is widely used during pregnancy and in general. Even though substance use disorders exacerbating depression symptoms have been reported, there are increasing reports and evidence about the therapeutic benefit of dose-dependent cannabis or its extracts in some depression symptoms, such as acute psychosocial stress relief, its purported anxiolytic effect, appetite, and sleep quality, thus stimulating more interest that may be inferred to depression. PPD marijuana use is unclear. This paper reviewed works of literature that claimed cannabis' therapeutic benefit in treating depression and, by extension, PPD. Our findings show the link between cannabis and PPD has not been fully explored. Self-reported studies link marijuana uses to positive mood, anxiety relief, sleep regulation, nausea and vomiting reduction, and appetite stimulation-all PPD symptoms. Others opposed postpartum marijuana use.

Profiles of women with postpartum depressive symptoms: A latent profile analysis using the Edinburgh Postnatal Depression Scale factors

OBJECTIVES

To examine the multidimensionality of symptoms assessed with the Edinburgh Postnatal Depression Scale (EPDS) and to identify and characterize the profiles of women with Postpartum Depression (PPD) symptoms.

METHODS

A sample of 487 Portuguese postpartum women with clinically relevant depressive symptoms participated in this cross-sectional online study. Confirmatory factor analysis was conducted to analyze the factor structure of the EPDS. A latent profile analysis based on the EPDS factors was conducted. Differences in sociodemographic characteristics and risk factors between profiles were explored.

RESULTS

Three EPDS factors were confirmed: depression, anxiety, and anhedonia. Based on these dimensions, three profiles with different symptom severities were found: mild anxious-depressive symptoms; severe PPD symptoms; and moderate anxious-depressive symptoms.

CONCLUSION

Identifying profiles of women with PPD symptoms according to the EPDS factors allows to understand the distinct paths of development of PPD and can inform the development of tailored interventions.

Development of neuroactive steroids for the treatment of postpartum depression

Postpartum depression (PPD) is a common major depressive episode surrounding childbirth, with estimated rates ranging from 5.5% to 23.5% of all live births across Europe and the USA based on the presence of key symptoms. PPD has been associated with significant impairments in both maternal functioning and mother-infant attachment, and these impairments can have lasting effects on the emotional and cognitive development of children. Although the precise pathophysiology of PPD is unknown, preclinical findings suggest that large fluctuations in neurosteroid hormone levels can induce physiological plasticity in the expression of functional GABA_A receptors during pregnancy and the postpartum period, and that deficits in this plasticity may underpin a biological mechanism that contributes to the manifestation of depressive symptoms. Here, we review the controlled clinical trials to date that have assessed the efficacy of pharmacological treatments for PPD, including oestradiol, selective serotonin reuptake inhibitors, brexanolone (an iv formulation of allopregnanolone) and an investigational neuroactive steroid and GABA_A positive allosteric modulator, zuranolone. Coupled with the GABAergic deficits implicated in major depressive disorder, these findings highlight not only the potential role of GABA_A receptor plasticity in the pathophysiology of PPD, but also the novel therapeutic approach of using positive allosteric modulators targeting GABAergic transmission to treat women affected by PPD.

Oxytocin effects on the cognition of women with postpartum depression: A randomized, placebo-controlled clinical trial

BACKGROUND

One of the most common mental disorders in the perinatal period is postpartum depression (PPD), which is associated with impaired emotional functioning due to alterations in different cognitive aspects including thought and facial emotion recognition (FER). Emotional impairments may affect the interaction and care offered to infants and their later development and therefore interventions with potential to minimize impairments associated with PPD are opportune. Oxytocin (OXT) was shown to have therapeutic properties associated with the promotion of affiliative and pro-social behaviors in different mental disorders. Few studies have assessed its therapeutic potential in PPD.

OBJECTIVES

To assess the effects of the acute administration of intranasal OXT (24 IU) on FER of baby faces and negative thoughts after delivery in mothers with and without PPD.

METHODS

We conducted a randomized double-blind, placebo-controlled trial with a crossover design involving mothers with PPD (N = 20) and without PPD (N = 35) in the puerperium. Participants completed a static task of FER of baby faces and a questionnaire of post-natal negative thoughts.

RESULTS

Mothers with PPD had increased scores of negative thoughts about motherhood/infants, but no impairments in FER, when compared to healthy mothers. OXT had no effects on the rates of correct judgments or response times in the FER task, but was associated with response biases to facial happiness and the reduction of negative thoughts in mothers with PPD.

DISCUSSION/CONCLUSION

OXT may have positive effects on maternal affiliative behavior, maternal care, and mother-infant interactions as suggested by changes found in different cognitive aspects, thus minimizing the deleterious effects of PPD on child development.

Postpartum Depression Screening for Mothers of Babies in the Neonatal Intensive Care Unit

BACKGROUND

Postpartum depression (PPD) is a prevalent, yet underidentified, problem among mothers with babies in the Neonatal Intensive Care Unit (NICU). Postpartum depression can result in immediate and long-term consequences for mother and baby. Screening, followed by early intervention, is critical for improvement and resolution. The purpose of the project was to initiate early screening for PPD among a high-risk population to identify and refer for early treatment.

METHODS

A screening and referral protocol was implemented using the Edinburgh Postnatal Depression Scale (EPDS), with consults as indicated to an onsite licensed professional clinical counselor. The nurse on the care team was responsible for initiating the screening after 2 weeks postpartum and placing a mental health referral as needed. Retrospective medical record reviews were conducted to determine whether timely screening was implemented among eligible mothers, and if referrals were made for those at-risk based on EPDS score.

RESULTS

Twenty-four percent of women screened were at increased risk for PPD based on their EPDS score, approximately double that of the general population (12.5%). All women with a positive screen had a referral placed and were seen by the licensed professional clinical counselor within 3 days.

CLINICAL IMPLICATIONS

This project recognizes the importance of an interdisciplinary care approach and highlights the need for early identification and treatment for PPD among mothers with babies in the NICU. The project can guide future initiatives to increase the use of screening in the inpatient setting, to detect PPD during its early and more treatable stages.

Effectiveness of Telehealth Interventions for Women With Postpartum Depression: Systematic Review and Meta-analysis

BACKGROUND

Postpartum depression (PPD) is a prevalent mental health problem with serious adverse consequences for affected women and their infants. Clinical trials have found that telehealth interventions for women with PPD result in increased accessibility and improved treatment effectiveness. However, no comprehensive synthesis of evidence from clinical trials by systematic review has been conducted.

OBJECTIVE

The aim of this study is to evaluate the effectiveness of telehealth interventions in reducing depressive symptoms and anxiety in women with PPD. To enhance the homogeneity and interpretability of the findings, this systematic review focuses on PPD measured by the Edinburgh Postnatal Depression Scale (EPDS).

METHODS

PubMed, The Cochrane Library, CINAHL, PsycINFO, CNKI, and Wanfang were electronically searched to identify randomized controlled trials (RCTs) on the effectiveness of telehealth interventions for women with PPD from inception to February 28, 2021. Data extraction and quality assessment were performed independently by two researchers. The quality of included studies was assessed using the Cochrane risk-of-bias tool, and meta-analysis was performed using RevMan 5.4 software.

RESULTS

Following the search, 9 RCTs with a total of 1958 women with PPD were included. The EPDS (mean difference=-2.99, 95% CI -4.52 to -1.46; P<.001) and anxiety (standardized mean difference=-0.39, 95% CI -0.67 to -0.12; P=.005) scores were significantly lower in the telehealth group compared with the control group. Significant subgroup differences were found in depressive symptoms according to the severity of PPD, telehealth technology, specific therapy, and follow-up time (P<.001).

CONCLUSIONS

Telehealth interventions could effectively reduce the symptoms of depression and anxiety in women with PPD. However, better designed and more rigorous large-scale RCTs targeting specific therapies are needed to further explore the potential of telehealth interventions for PPD.

TRIAL REGISTRATION

PROSPERO CRD42021258541; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258541.

A Systematic Review of the Efficacy of Repetitive Transcranial Magnetic Stimulation Treatment for Women with Postpartum Depression

Transcranial Magnetic Stimulation (TMS) has a strong evidence base for the treatment of major depressive disorder (MDD), however, there is minimal research investigating the treatment of depression within the postpartum period. This systematic review aims to systematically examine the efficacy and safety of TMS when treating postpartum depression (PPD). Databases Ovid Medline, PsycINFO, EMBASE and PubMed were searched from inception to May 2021, to identify peer-reviewed papers assessing the administration of TMS for PPD treatment. Data were systematically extracted and evaluated regarding clinical psychiatric outcomes, social-relational outcomes, neuropsychological testing, and side effects. This systematic review included one randomised controlled trial, two open-label studies, two conference papers, and two case studies, providing data on 60 participants. TMS appears well tolerated, with no reported major adverse side effects. While the studies reported a general reduction in PPD symptoms, the poor quality of the evidence available indicates that TMS for PPD is unable to be currently recommended. However, the substantial evidence for TMS in the treatment of MDD and the differential response to antidepressant medication in PPD indicates that further research into TMS for PPD is warranted.

Supporting Breastfeeding in 2021 and Beyond-Lessons from the Pandemic

The COVID-19 pandemic has affected maternal and infant health globally both directly from infection with the SARS-CoV-2 virus and indirectly from changes in health care resulting from social, economic, and health care policies unique to each country. The developing countries have to share the disproportionate burden on maternal and infant health. In this review, we discuss the uncertainties resulting from SARS-CoV-2 infection in pregnancy, vertical transmission of the virus, and its effects on breastfeeding of the newborn. The problems of families and communities caring for mothers with COVID-19 and its impact on breastfeeding in newborns are discussed. The challenges posed by the pandemic have forced us to think and devise innovative solutions, including telemedicine help for antenatal counseling, breastfeeding education, and lactation support. Optimal utilization of resources and technology to find creative solutions at the individual and the community level will help in facilitating maternal-infant bonding soon after birth. Appropriate health care policies to support pregnant and lactating mothers will go a long way in meeting healthy child development goals.

A potential role for insulin treatment during pregnancy in reducing postpartum psychological distress in maternal obesity: an administrative population health study

BACKGROUND

Studies have found an association between obesity and an increased risk for peripartum depression, which has also been linked to decreased placental lactogen levels. In addition, women with obesity treated for gestational diabetes with insulin were found to have increased levels of placental lactogen. Treatment options exist for perinatal and postpartum depression however they pose a risk to the developing offspring. Thus, prevention as well as markers for early identification of peripartum depression are needed. Therefore, our study objective is to identify the association between insulin treatment in pregnancy and the risk of postpartum psychological distress (abbreviated here as PPD) among cohorts of women with and without obesity.

METHODS

Administrative health data (2002/03-2018/19) were used to identify a cohort of women (age 15+ years) who gave birth (N = 250,746) and had no pre-existing mood/anxiety disorders or diabetes (N = 222,863 excluded). Women were then divided into two groups: lean (N = 17,975) and with obesity (N = 9908), which was identified by a recorded maternal weight of > 38 to < 65.6 kg and ≥ 85 to < 186 kg (respectively). The risk of PPD within one year after delivery with and without insulin treatment was assessed by Poisson regression analysis. Models were adjusted for maternal age group (at pregnancy start date) and area-level income (at delivery).

RESULTS

The unadjusted risk of PPD was higher in the obesity group (8.56%; 95% CI 8.00-9.15) than in the lean group (6.93%; 95% CI 6.56-7.33). When no insulin treatment was given during pregnancy, mothers with obesity had a significantly higher risk of PPD than the lean group (aRR 1.27; 95% CI 1.17-1.39; p < 0.0001). However, when women with obesity and insulin treatment were compared to the lean group with no insulin treatment, no significant difference in the risk of PPD was observed between the groups (aRR 1.30; 95% CI 0.83-2.02; p = 0.248).

CONCLUSION

This is the first study to demonstrate a positive association between insulin treatment in pregnancy among women with obesity and reduced PPD rates, suggesting insulin as a possible preventative measure. However, the biological mechanism behind the observed positive effect of insulin on PPD rates remains to be investigated.

Brexanolone, a GABAA Modulator, in the Treatment of Postpartum Depression in Adults: A Comprehensive Review

Postpartum depression (PPD) is one of the three major categories on the spectrum of postpartum psychiatric syndromes. Postpartum psychiatric syndromes are classified as either postpartum blues, postpartum depression, or postpartum psychosis. Postpartum depression is important to recognize clinically because of the effect it can have on the mother-child bond. The neurosteroid allopregnanolone, a progesterone derivative, is important for its role in positively modulating GABA_A receptors. GABA-mediated signaling has been previously implicated in major depressive disorder. Allopregnanolone-mediated signaling has been identified as an important therapeutic target. Treatment with an allopregnanolone-analog, brexanolone, has been shown to improve depression scores in trials for the treatment of PPD. Brexanolone is a positive allosteric modulator of GABA_A and is the first drug approved by the FDA to treat postpartum depression. Brexanolone enhances the inhibitory effects of GABA_A, restores dysfunctional GABA_A transmembrane channels, and mimics a naturally produced progesterone metabolite that fluctuates during pregnancy and postpartum. One open-label study and two phase two studies have some significant reduction in HAM-D scores after treatment and that the effect was still there 30 days post-treatment. Per the data reported, intravenous infusion of brexanolone could be efficacious and safe for the treatment of women suffering from postpartum depression.

Postpartum depression burden and associated factors in mothers of infants at an urban primary health center in Delhi, India

OBJECTIVE

Postpartum depression is a nonpsychotic mental health condition that impairs both the immediate and long-term health of both the mother and her child.

MATERIALS AND METHODS

We conducted a cross-sectional study from January to June 2019 at a primary care clinic in Delhi, India, to estimate the burden of postpartum depression in women having an infant child. The Hindi version of the Edinburgh Postnatal Depression Scale was used to screen for the depression in the participants. Data were analyzed with IBM SPSS software version 25. P <0.05 was considered statistically significant.

RESULTS

A total of 210 women were screened, and 61 (29%) were detected with postpartum depression. On multivariate analysis, women reporting low and medium levels of perceived social support had significantly higher odds of having postpartum depression. However, depressive symptoms were not associated with the sex and age of the infant or even the sex composition of the women's other children.

CONCLUSION

Postpartum depression represents a major public health challenge in India. Regular, mandatory screening for postpartum depression is needed at primary health facilities in resource-constrained settings for an extended period postchildbirth.

Efficacy and safety of repetitive transcranial magnetic stimulation for peripartum depression: A meta-analysis of randomized controlled trials

This study aims to summarize and systematically review the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for women with peripartum depression (PPD). Several databases (Wanfang, CNKI, VIP, CBM, PubMed, Embase, Cochrane Library, PsyINFO, Web of Science, and Clinical trial) were searched from inception until April 12, 2020. In total, ten randomized controlled trials (RCTs) met the eligibility criteria and were included in this systematic review. We calculated the combined effect size (standardized mean difference [SMD] and odds ratio [OR]) for the corresponding effects models. The aggregated result of 10 trials indicated a significant benefit of rTMS on PPD, and the aggregated result of remission showed significantly positive effects of Test group VS. Control group. In terms of treatment adverse effects, the aggregated result showed no statistical significance of headache and dry mouth between the two groups. The results of the meta-analysis suggest that rTMS is an effective and safe intervention for PPD. Owing to poor methodological quality among the included studies, high-quality multicenter RCTs are needed to further verify the effects of this treatment.

The epidemiology of postnatal depression in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Postnatal depression is among the common mental health problems that occur during the postnatal period. However, it is left undiagnosed in low- and middle-income countries including Ethiopia. Therefore, this systematic review and meta-analysis aimed to systematically summarize the available evidence on the epidemiology of postnatal depression in Ethiopia and suggest recommendations for future clinical practice.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to conduct this systematic review and meta-analysis. We searched PubMed, SCOPUS, EMBASE and Google Scholar databases for the relevant articles that assessed the prevalence of postnatal depression in Ethiopia. We used a random-effect model to conduct a meta-analysis. We conducted a subgroup and sensitivity analysis to explore the source of heterogeneity. Cochrane Q- and the I²-test were used to check the heterogeneity of the included studies. The presence of publication bias was also checked by visual inspection of symmetry and Egger's test.

RESULTS

The pooled estimated prevalence of postnatal depression in Ethiopia was 20.1% (95% CI 12.7-30.2). The pooled prevalence of postnatal depression in the studies that were conducted in community settings and used the Patient Health Questionnaire to assess postnatal depression [16.6% (95% CI 8.90-28.99)] was lower than the prevalence in studies based in institutions and that used the Edinburgh Postnatal Depression Scale [23.2% (95% CI 14.50-28.5)]. Further, in a leave-one-out sensitivity analysis the prevalence of postnatal depression ranges between 15.4% and 25.4%. Unplanned pregnancy [AOR = 3.46, 95% CI (2.37-5.04)], age between 15-24 years [AOR = 1.72, 95% CI (1.11-2.68)], marital problems [AOR = 3.07, 95% CI (2.36-3.99)], experiencing the death of infant [AOR = 3.41, 95% CI (1.91-6.09)] and history of substance use [AOR = 3.47, 95% CI (2.17-5.56)] were associated with the increased odds of postnatal depression in Ethiopia.

CONCLUSION

The prevalence of postnatal depression in Ethiopia was high. Therefore, the concerned body should give due attention to improve reproductive health services through early detection of risk factors of postnatal depression.

Long-term effects of pre-gestational stress and perinatal venlafaxine treatment on neurobehavioral development of female offspring

Preclinical studies suggest that stress-related disorders even prior gestation can cause long-term changes at the level of neurobehavioral adaptations. Therefore, it is critical to consider undergoing antidepressant therapy which could reverse the negative consequences in the offspring. Venlafaxine is widely used in clinical practice; however insufficient amount of well-controlled studies verified the safety of venlafaxine therapy during gestation and lactation. The aim of this work was to investigate the effects of perinatal venlafaxine therapy on selected neurobehavioral variables in mothers and their female offspring using a model of maternal adversity. Pre-gestational stressed and non-stressed Wistar rat dams were treated with either venlafaxine (10 mg/kg/day) or vehicle during pregnancy and lactation. We have shown that pre-gestational stress decreased the number of pups with a significant reduction in the number of males but not females. Furthermore, we found that offspring of stressed and treated mothers exhibited anxiogenic behavior in juvenile and adolescent age. However, during adulthood pre-gestational stress significantly increased anxiety-like behavior of female, with venlafaxine treatment normalizing the state to control levels. Additionally, we found that even maternal stress prior gestation can have long-term impact on adult number of hippocampal immature neurons of the female offspring. A number of questions related to the best treatment options for maternal depression still remains, however present data may provide greater insight into the possible outcomes associated with perinatal venlafaxine therapy.

Use of Traditional Chinese Medicine for Patients Diagnosed with Postpartum Depression: A Nationwide Population-Based Study

Postpartum depression (PPD) is one of most common postnatal complications, affecting approximately 10%-15% of women after childbirth annually. Traditional Chinese medicine (TCM) has been gaining popularity as the choice of treatment for PPD in Taiwan. Hence, our aim was to analyze the utilization of TCM among PPD patients in Taiwan. A cross-sectional study was conducted using a random sample of one million beneficiaries selected from the Taiwanese National Health Insurance Research Database. We identified patients with PPD who had received either TCM treatment or non-TCM treatment from the database during 2000-2012. Multivariate logistic regression analysis was used to identify the factors associated with the use of TCM. A total of 653 patients with PPD were enrolled. The majority of patients with PPD were 26-30 years old, lived in a highly urbanized area of Taipei, had a monthly income <20,000 NT$, and were private enterprise employees. Around 52.7% of PPD patients had the motivation to seek TCM services. Younger women, who resided in central and southern Taiwan and who had used TCM one year before PPD diagnosis, were more likely to use TCM services. PPD patients who underwent TCM treatment had a lower overall medical expenditure than non-TCM users. Most TCM users chose simple Chinese herbal medicine. The coexisting factors that made PPD patients to seek TCM services were respiratory or oral infections. We demonstrated the characteristics of those that seek TCM for PPD, which may provide useful insights to health care providers towards resource allocation.

The prevalence of peripartum depression and its relationship to mode of delivery and other factors among mothers in Ixopo, Kwazulu-Natal, South Africa

Peripartum depression is a common mental health condition among mothers, occurring between 4 and 6 weeks post-delivery. This study sought to evaluate the influence that mode of delivery and other related factors have on the development of peripartum depression. The study was carried out in Ixopo, in the KwaZulu-Natal province of South Africa. All women whose infants had been delivered within 4–6 weeks of the study were included until the sample size of 276 was reached. A demographic questionnaire and an Edinburgh postnatal depression scale were administered. Mothers with Edinburgh postnatal depression scale scores of ⩾10 were considered to be suffering from peripartum depression, and peripartum depression was ruled out in those with a score of <10. A total of 110 mothers had Edinburgh postnatal depression scale score ⩾10, thus presenting a prevalence of 39.9%. Of these, 51 (46.4%) had undergone normal vaginal delivery and 59 had a Caesarean section (53.6%). Of the latter group, 23 had elective Caesarean section and 36 had emergency Caesarean section. Logistic regression showed no significant association between peripartum depression and mode of delivery ( p = .074); women who had delivered their child by emergency Caesarean section were three times more likely to develop peripartum depression compared to those who had delivered via normal vaginal delivery (odds ratio: 2.733, confidence interval: 1.002–7.452). Unemployment was found to have a statistically significant association with peripartum depression ( p = .003) and single motherhood was not associated ( p = .425). Emergency Caesarean sections and unemployment were shown to be risk factors for peripartum depression.

A Case of Major Depressive Disorder With Peripartum Onset With Heralding Symptoms

This report describes a case of major depressive disorder with peripartum onset in a 24-year-old African-American female who was admitted to the inpatient psychiatric facility after a suicide attempt. The patient demonstrated what we will describe as heralding symptoms during the birth of her second child, but her symptoms dramatically worsened one month prior to her admission with the birth of her third child. The patient presented with anxiety and depressive symptoms, including decreased energy, disrupted sleep patterns, and emotional lability. At the time of her admission, the patient had failed treatment with bupropion, which had been prescribed by her obstetrician. During her stay, the patient was treated with fluoxetine and participated in group therapy sessions. The patient gradually exhibited improvement in her depressive symptoms during the course of her six-day stay. At the time of discharge, the patient's depression was adequately managed with her medication regimen, and she was eager to be reunited with her newborn child. This case highlights the idiosyncratic nature of major depressive disorder with peripartum onset and the need for providers to tailor the treatment to the patient’s need.

Is Postpartum Depression Different From Depression Occurring Outside of the Perinatal Period? A Review of the Evidence

Whether a major depressive episode occurring in the postpartum period (i.e., postpartum depression [PPD]) is sufficiently distinct from major depressive episodes occurring at other times (i.e., major depressive disorder) to warrant a separate diagnosis is a point of debate with substantial clinical significance. The evidence for and against diagnostic distinction for PPD is reviewed with respect to epidemiology, etiology, and treatment. Overall, evidence that PPD is distinct from major depressive disorder is mixed and is largely affected by how the postpartum period is defined. For depression occurring in the early postpartum period (variably defined, but typically with onset in the first 8 weeks), symptom severity, heritability, and epigenetic data suggest that PPD may be distinct, whereas depression occurring in the later postpartum period may be more similar to major depressive disorder occurring outside of the perinatal period. The clinical significance of this debate is considerable given that PPD, the most common complication of childbirth, is associated with immediate and enduring adverse effects on maternal and offspring morbidity and mortality. Future research investigating the distinctiveness of PPD from major depressive disorder in general should focus on the early postpartum period when the rapid decline in hormones contributes to a withdrawal state, requiring profound adjustments in central nervous system function.

Effectiveness of the Thinking Healthy Programme for perinatal depression delivered through peers: Pooled analysis of two randomized controlled trials in India and Pakistan

BACKGROUND

The Thinking Healthy Programme (THP) is recommended to treat perinatal depression in resource-limited settings, but scale-up is hampered by a paucity of community health workers. THP was adapted for peer-delivery (THPP) and evaluated in two randomized controlled trials in India and Pakistan. Our aim was to estimate the effectiveness of THPP on maternal outcomes across these two settings, and evaluate effect-modification by country and other pre-defined covariates.

METHODS

Participants were pregnant women aged≥18 years with depression (Patient Health Questionnaire (PHQ-9) score≥10), randomized to THPP plus enhanced usual care (EUC) or EUC-only. Primary outcomes were symptom severity and remission (PHQ-9 score<5) 6 months post-childbirth. Secondary outcomes included further measures of depression, disability and social support at 3 and 6 months post-childbirth.

RESULTS

Among 850 women (280 India; 570 Pakistan), 704 (83%) attended 6-month follow-up. Participants in the intervention arm had lower symptom severity (PHQ-9 score adjusted mean difference -0.78 (95% confidence interval -1.47,-0.09)) and higher odds of remission (adjusted odds ratio 1.35 (1.02,1.78)) versus EUC-only. There was a greater intervention effect on remission among women with short chronicity of depression, and those primiparous. There were beneficial intervention effects across multiple secondary outcomes.

LIMITATIONS

The trials were not powered to assess effect-modifications. 10-20% of participants were missing outcome data.

CONCLUSIONS

This pooled analysis demonstrates the effectiveness, acceptability and feasibility of THPP, which can be scaled-up within a stepped-care approach by engaging with the existing health care systems and the communities to address the treatment gap for perinatal depression in resource-limited settings.

Mood instability across the perinatal period: A cross-sectional and longitudinal study

BACKGROUND

As a trans-diagnostic concept, mood instability (MI) is significantly linked to a variety of psychiatric disorders in general and clinical samples. However, there is limited research on perinatal MI, even though perinatal women experience an elevated level of MI. In this study, we examined the relationship between perinatal MI and its risk factors, the association between antenatal MI and postpartum depression (PPD), and the trajectory of perinatal MI.

METHODS

A total of 648 women participated in this longitudinal study at three points: T1 (17.4 ± 4.9 weeks pregnant), T2 (30.6 ± 2.7 weeks pregnant), and T3 (4.2 ± 2.1 weeks postpartum). Linear regression was used to examine MI and its risk factors, hierarchical multiple regression was utilized to investigate the relationship between antenatal MI and PPD, and a linear mixed model was employed to examine the trajectory of perinatal MI over T1-T3.

RESULTS

Perinatal depression, history of depression, and stress at T1, T2, and T3, and labor/birth complications at T3 were significant risk factors for MI. MI at T1 was associated with PPD after controlling for important confounders at T1. The trajectory of perinatal MI had a declined trend from early pregnancy to postpartum.

LIMITATIONS

The participants were predominantly Caucasian and with post-secondary education, which may limit the generalization of our findings. A lack of research on perinatal MI limited our ability to discuss the topic in relation to existing literature.

CONCLUSIONS

This study expands our understanding of MI in perinatal women, and indicates that more research is needed.

Allopregnanolone in postpartum depression: Role in pathophysiology and treatment

Postpartum depression (PPD) is a unique subtype of major depressive disorder and a substantial contributor to maternal morbidity and mortality. In addition to affecting the mother, PPD can have short- and long-term consequences for the infant and partner. The precise etiology of PPD is unknown, but proposed mechanisms include altered regulation of stress response pathways, such as the hypothalamic-pituitary-adrenal axis, and dysfunctional gamma-aminobutyric acid (GABA) signaling, and functional linkages exist between these pathways. Current PPD pharmacotherapies are not directly related to these proposed pathophysiologies. In this review, we focus on the potential role of GABAergic signaling and the GABA_A receptor positive allosteric modulator allopregnanolone in PPD. Data implicating GABAergic signaling and allopregnanolone in PPD are discussed in the context of the development of brexanolone injection, an intravenous formulation of allopregnanolone recently approved by the United States Food and Drug Administration for the treatment of adult women with PPD.

Mobile health applications for postnatal care: Review and analysis of functionalities and technical features

BACKGROUND

Providing a continuum of care from antenatal, childbirth and postnatal period results in reduced maternal and neonatal morbidity and mortality. Timely, high quality postnatal care is crucial for maximizing maternal and newborn health. In this vein, the use of postnatal mobile applications constitutes a promising strategy.

METHODS

A Systematic Literature Review (SLR) protocol was adopted to perform the selection, data extraction and functional evaluation of the available postnatal apps on iOS and Android platforms. The analysis of the functionalities and technical features of the apps selected was performed according to a 37-items assessment questionnaire developed on the basis of the scientific literature of postnatal care and a preliminary analysis of available postnatal apps RESULTS: A total of 48 postnatal apps were retrieved from the app repositories of the iOS and Android platforms. The results of the functional content analysis show that the postnatal apps selected relatively achieved low scores owing to the complexity and the ramification of the postnatal care.

CONCLUSIONS

The present study helps in identifying areas related to the postnatal care that require further endeavors to be properly addressed. It also provides directions for developers to leverage the advancement and innovation on mobile technology to build complete and well-suited postnatal apps.

Magnitude and associated factors of postpartum depression among women in Nekemte town, East Wollega zone, west Ethiopia, 2019: A community-based study

Background

Postpartum depression is a non-psychotic disorder that happens during the first 1year after childbirth. It affects both the mother’s health and child’s development and is given significant public health concern in developed countries. However, in developing countries including Ethiopia, postnatal care is mainly concerned with obstetric problems and the baby’s health, while the psychological well-being of the mother is given little attention. Therefore, this study was aimed to assess the magnitude and associated factors of postpartum depression among women in Nekemte town, East Wollega zone, West Ethiopia, 2019.

Methods

Community-based cross-sectional study was conducted on 295 postnatal women, from May 15 to June 5, 2019, in Nekemte town. The study participants were selected by a simple random sampling method and interviewed using structured questionnaires. Multivariable logistic regression was used to find the independent variables which are associated with postnatal depression. All associations between dependent and independent variables and statistical significance were measured using odds ratio at 95% confidence interval and p-value less than 0.05.

Results

From the total of 295 women sampled, 287 were participated in the study. Out of these 287 women participated, 20.9% had developed postnatal depression. Unplanned pregnancy (AOR = 7.84, 95% CI: 3.19, 19.26), Being first time mother (AOR = 4.99, 95% CI: 1.54, 16.09), History of previous depression (AOR = 3.06, 95% CI: 1.06, 8.82), Domestic violence (AOR = 5.92, 95% CI: 2.44, 14.40), History of substance use (AOR = 3.95, 95% CI: 1.52, 10.30) and poor social support (AOR = 6.59, 95% CI: 2.25, 19.29) were significantly associated with postnatal depression.

Conclusion

In this study, the magnitude of postnatal depression was found moderate compared to other studies. Perinatal depression screening and intervention need to be integrated with maternal health care services, especially for mothers at risk of postnatal depression.

Efficacy of rTMS in decreasing postnatal depression symptoms: A systematic review

BACKGROUND

Repetitive Transcranial Magnetic Stimulation (rTMS) has been suggested as an alternative treatment to postnatal depression (PPD).

OBJECTIVES

This systematic review aims to examine and summarise evidence on rTMS efficacy in treating depression during the postnatal period.

METHODS

We included randomized and non-randomized, single arm, and case report studies, with active rTMS and theta-burst stimulation, sham rTMS, pharmacotherapy or no treatment as comparators. Participants included women with PPD, who were administered rTMS after delivery and up to 12 months postpartum. The observed outcomes were response rate and acceptability.

RESULTS

rTMS shows promising results, with clinically significant decreases in Edinburgh Postnatal Depression Scale (EPDS) scores at week 4 and an overall low risk of dropout.

LIMITATIONS

The reduced number of reports, the lack of complete datasets and the serious/high risk of bias of the studies warrant cautious interpretations.

CONCLUSIONS AND IMPLICATIONS

Despite the promising results, existing evidence on rTMS efficacy is limited, and questions remain on what the most beneficial stimulation parameters should be. Future multicentre randomized clinical trials are needed to better ascertain the clinical efficacy of rTMS in the treatment of depression in the postpartum period.

Postpartum depression: A multi-disciplinary approach to screening, management and breastfeeding support

Postpartum depression (PPD) is a common condition affecting 11%-20% of all postpartum women. Depression can have significant consequences for both mother and infant. There are many risk factors associated with PPD, all of which contribute to an inflammatory response in the mother. An inverse relationship exists between PPD and breastfeeding; women with PPD are less likely to have a positive breastfeeding experience which can lead to early weaning, while long-term exclusive breastfeeding is associated with decreased rates of PPD. A multi-disciplinary approach to managing PPD, including strong breastfeeding support, will lead to improved mental health outcomes for women and their children.

Magnitude of postpartum depression and associated factors among women in Mizan Aman town, Bench Maji zone, Southwest Ethiopia

BACKGROUND

The first 12 months after childbirth may represent a high-risk time for depression. In Ethiopia there is a paucity of evidence about its magnitude and associated factors during that period. So, the aim of this study was to assess the magnitude of depression and associated factors among postpartum women in Mizan Aman town, Bench Maji Zone, Southwest Ethiopia 2017.

METHODS

A community based cross- sectional study design was employed from March 15 to April 15, 2017. Four hundred sixty women were selected using multistage random sampling technique. Face to face interview were conducted using structured questionnaires and standardized scales. Bivariate logistic regression analysis was done to see crude association between each independent variable and outcome variable. Variables with p value < 0.25 in bivariate analysis were entered to multivariable logistic regression analysis to control for confounding. Adjusted odd ratios with 95%CI were calculated to identify independent predictors of postpartum depression.

RESULT

Four hundred fifty-six postpartum women participated in the study giving a response rate of 99%. The magnitude of postpartum depression among the study population was 102 (22.4%, 95% CI: 19.84-24.96). Postpartum depression is relatively higher in the first 6 weeks after birth. Postpartum depression is higher among mothers with age range between 18 and 23 years (aOR 3.89 95%CI: 1.53-9.90), unplanned pregnancy (aOR 3.35 95% CI: 1.701-6.58), child having sleeping problems (aOR 3.72 95%CI: 1.79-7.72), domestic violence (aOR 2.86 95%CI 1.72-8.79), unsatisfied marital relation (aOR 2.72 95% CI 1.32-5.62), poor social support (aOR 4.30 95% CI 1.79-10.30), history of previous depression (aOR 7.38 95% CI 3.12-17.35) and substance use (aOR 5.16 95% CI 2.52-10.60).

CONCLUSION

The magnitude of postpartum depression was high. This underlines health care planners' needs to incorporate screening strategies for depression following childbirth.

Is cognitive behavioral therapy a better choice for women with postnatal depression? A systematic review and meta-analysis

The present study evaluated the combined effectiveness of cognitive behavioral therapy (CBT) for postnatal depression. A systematic search was conducted across databases including PubMed, Embase, and the Cochrane library to identify the randomized controlled trials (RCTs) that assessing CBT versus control for postnatal depression until March 2017. Data was extracted by two reviewers, independently. The Review Manager 5.3 and Stata 11.0 were used to calculate the synthesized effect of CBT on depression, and anxiety. A total of 20 RCTs involving 3623 participants were included. The results of meta-analysis showed that CBT was associated with a better Edinburgh Postnatal Depression Scale (EPDS) than control in short-term (mean difference = -2.86, 95% CI: -4.41--1.31; P<0.05) and long-term (mean difference = -1.68, 95% CI: -1.81-1.56; P<0.05). CBT also improved short-term (mean difference = -6.30, 95% CI: -11.32--1.28; P<0.05) and long-term (mean difference = -4.31, 95% CI: -6.92--1.70; P<0.05) Beck Depression Inventory (BDI). Subgroup analysis based on intervention types showed that in-home and telephone-based therapy exhibited significant reductions in EPDS scores (P<0.05 for all). CBT significantly improved the short-term [odds ratio (OR) = 6.57, 95% CI: 1.84-23.48; P<0.05] and long-term (OR = 2.00, 95% CI: 1.61-2.48; P<0.05) depressive symptomatology as compared to control. CBT also reduced the score of Depression Anxiety Stress Scales (DASS), though without significance. In conclusion, CBT effectively improved the symptoms and progression of postnatal depression.

Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group

INTRODUCTION

Electroconvulsive therapy (ECT) is used to treat postpartum depression and psychosis based on clinical experience and small observational studies.

AIMS

The primary aim was to test the hypothesis that the response rate to ECT for depression and psychosis is higher during the postpartum period than outside this period. The secondary aim was to identify predictors of a response to ECT during the postpartum period.

MATERIALS AND METHODS

Cases with postpartum depression and/or psychosis received ECT within 6 months of delivery. A matched comparison group with depression and/or psychosis (not within the postpartum period) was identified from the Swedish National Quality Register for ECT. The improvement 1 week after ECT was classified according to the Clinical Global Impressions Scale - Improvement scale (CGI-I) as responder (CGI-I score 1-2) or non-responder (CGI-I score 3-7).

RESULTS

185 cases and 185 comparison group subjects were included (46% with psychosis in each groups). More cases (87.0%) than comparison group subjects (73.5%) responded to ECT (p = 0.001). Adjusted binary regression analysis revealed that more severe symptoms prior to treatment were the only statistically significant predictor of response.

LIMITATIONS

There was no control group without ECT treatment.

CONCLUSION

The response rate of those with postpartum depression and/or psychosis to ECT was high. The response rate of patients with psychosis or depression was higher during the postpartum period than outside it. This study supports the use of ECT for severe forms of postpartum depression and/or psychosis.

Could use of Selective Serotonin Reuptake Inhibitors During Lactation Cause Persistent Effects on Maternal Bone?

The lactating mammary gland elegantly coordinates maternal homeostasis to provide calcium for milk. During lactation, the monoamine serotonin regulates the synthesis and release of various mammary gland-derived factors, such as parathyroid hormone-related protein (PTHrP), to stimulate bone resorption. Recent evidence suggests that bone mineral lost during prolonged lactation is not fully recovered following weaning, possibly putting women at increased risk of fracture or osteoporosis. Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants have also been associated with reduced bone mineral density and increased fracture risk. Therefore, SSRI exposure while breastfeeding may exacerbate lactational bone loss, compromising long-term bone health. Through an examination of serotonin and calcium homeostasis during lactation, lactational bone turnover and post-weaning recovery of bone mineral, and the effect of peripartum depression and SSRI on the mammary gland and bone, this review will discuss the hypothesis that peripartum SSRI exposure causes persistent reductions in bone mineral density through mammary-derived PTHrP signaling with bone.

Influence of adjuvant detached mindfulness and stress management training compared to pharmacologic treatment in primiparae with postpartum depression

Ten to 15% of mothers experience postpartum depression (PPD). If untreated, PPD may negatively affect mothers' and infants' mental health in the long term. Accordingly, effective treatments are required. In the present study, we investigated the effect of detached mindfulness (DM) and stress management training (SMT) as adjuvants, compared to pharmacologic treatment only, on symptoms of depression in women with PPD. Forty-five primiparae (mean age: M = 24.5 years) with diagnosed PPD and treated with an SSRI (citalopram; CIT) took part in the study. At baseline, they completed questionnaires covering socio-demographic data and symptoms of depression. Experts rated also symptoms of depression. Next, participants were randomly assigned to one of the following study conditions: adjuvant detached mindfulness (CIT+DM); adjuvant stress management training (CIT+SMT); control condition (CIT). Self- and experts' ratings were completed at the end of the study 8 weeks later, and again at 8 weeks follow-up. Symptoms of depression decreased significantly over time, but more so in the CIT+DM and CIT+SMT group, compared to the control condition. The pattern of results remained stable at follow-up. In primiparae with PPD and treated with a standard SSRI, adjuvant psychotherapeutic interventions led to significant and longer-lasting improvements.

Effectiveness of aerobic gymnastic exercise on stress, fatigue, and sleep quality during postpartum: A pilot randomized controlled trial

BACKGROUND

Gymnastics is a preferable safe exercise for postnatal women performing regularly.

OBJECTIVE

The aim of this pilot randomized controlled trial was to determine whether the aerobic gymnastic exercise improves stress, fatigue, sleep quality and depression in postpartum women.

DESIGN

Single-blinded, randomized controlled trial held from December 2014 until September 2015.

SETTING

Postnatal clinic of a medical center in southern Taiwan.

PARTICIPANTS

140 eligible postnatal women were systematically assigned, with a random start to experimental (n=70) or a control (n=70) group.

INTERVENTIONS

Engage in aerobic gymnastic exercise at least three times (15min per section) a week for three months using compact disc in the home.

OUTCOME MEASURES

Perceived Stress Scale, Postpartum Fatigue Scale, Postpartum Sleep Quality Scale, and Edinburgh Postnatal Depression Scale.

RESULTS

In a two-way ANOVA with repeated measures, the aerobic gymnastic exercise group showed significant decrease in fatigue after practicing exercise 4 weeks and the positive effects extended to the 12-week posttests. Paired t-tests revealed that aerobic gymnastic exercise participants had improved significantly in perceived stress and fatigue after 4 weeks gymnastic exercise; these positive effects extended to the 12-week posttests. In addition, the changes in physical symptoms-related sleep inefficiency after 12 weeks gymnastic exercise were significantly decreased in the experimental group compared with the control group.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used to encourage postnatal women to perform moderate-intensity gymnastic exercise in their daily life to reduce their stress, fatigue and improve sleep quality.

Path model of antenatal stress and depressive symptoms among Chinese primipara in late pregnancy

Background

Antenatal maternal mental health problems have numerous consequences for the well-being of both mother and child. This study aimed to test and construct a pertinent model of antenatal depressive symptoms within the conceptual framework of a stress process model.

Methods

This study utilized a cross-sectional study design. Inclusion criteria: participants were adult women (18 years or older) having a healthy pregnancy, in their third trimester (the mean weeks gestation was 34.71). Data collection: depressive and anxiety symptoms were measured by Zung’s Self-rating Depressive and Anxiety Scale, stress was measured by Pregnancy-related Pressure Scale, social support and coping strategies were measured by Social Support Rating Scale and Simplified Coping Style Questionnaire, respectively. Analysis: path analysis was applied to examine the hypothesized causal paths between study variables.

Results

A total of 292 subjects were enrolled. The final testing model showed good fit, with normed χ² = 32.317, p = 0.061, CFI = 0.961, TLI = 0.917, IFI = 0.964, NFI = 0.900, RMSEA = 0.042. This path model supported the proposed model within the theoretical framework of the stress process model. Pregnancy-related stress, financial strain and active coping have both direct and indirect effects on depressive symptoms. Psychological preparedness for delivery, social support and anxiety levels have direct effects on antenatal depressive symptoms. Good preparedness for delivery could reduce depressive symptoms, while higher levels of anxiety could significantly increase depressive symptoms. Additionally, there were indirect effects of miscarriage history, irregular menstruation, partner relationship and passive coping with depressive symptoms.

Conclusion

The empirical support from this study has enriched theories on the determinants of depressive symptoms among Chinese primipara, and could facilitate the formulation of appropriate interventions for reducing antenatal depressive symptoms, and enhancing the mental health of pregnant women.

Maternal psychologic problems increased the risk of childhood atopic dermatitis

BACKGROUND

Little is known about the effect of postnatal maternal psychologic problems on the development of childhood atopic disorders.

OBJECTIVES

To assess the association between early life maternal psychologic problems and atopic dermatitis (AD) in children in a national birth cohort.

METHODS

We used multistage, stratified systematic sampling to recruit 24,200 mother-newborn pairs from the Taiwan national birth registration. Maternal psychologic problems and potential confounders were gathered by the standard questionnaire at 6 months old. At 3 years of age, information about the development of AD was assessed by International Study of Asthma and Allergies in Childhood via home interviews. Multiple logistic regression analysis was performed to estimate the association of postnatal maternal psychologic problems (postpartum depression (PPD) and maternal mental health index) and AD.

RESULTS

The prevalence of physician-diagnosed AD was 10.5%. PPD increased the risk of subsequent physician-diagnosed AD in children after adjusting for potential confounders and other maternal mental health index (aOR = 1.42, 95% CI = 1.21-1.66). We observed that the risk of AD associated with PPD was not confounded by other social demographic factors such as maternal AD, maternal education, family income, breastfeeding, day care, and number of siblings.

CONCLUSIONS

Postpartum depression increased the risk of childhood AD even when other maternal mental health index and social demographic factors are considered. Early intervention of PPD might be helpful for AD prevention.

Effects of Lavender Tea on Fatigue, Depression, and Maternal-Infant Attachment in Sleep-Disturbed Postnatal Women

BACKGROUND

Lavender inhalation aromatherapy is widely believed to impart a hypnotic effect, act as a mood stabilizer, and enhance the positive feelings of mothers toward their infants. However, research into these and other potential therapeutic effects of lavender tea has been limited.

AIMS

This study was conducted in Taiwan to evaluate the effectiveness of lavender tea in relieving sleep quality, fatigue, and depression; and in improving maternal-infant attachment during the early postpartum period.

METHODS

A total of 80 Taiwanese postnatal women with poor sleep quality (Postpartum Sleep Quality Scale; PSQS score ≥16) and with no history of allergy to herbal teas, foods, or medicines were assigned systematically to either the experimental group (n = 40) or the control group (n = 40). The participants in the experimental group were instructed to drink one cup of lavender tea after spending time to appreciate and smell the aroma each day for a period of 2 weeks, whereas their control group peers received regular postpartum care only. The PSQS, Edinburgh Postnatal Depression Scale, Postpartum Fatigue Scale, and Postpartum Bonding Questionnaire were used to assess outcomes.

RESULTS

ANCOVA analyses using education level and pretest scores as covariates showed that experimental group participants perceived less fatigue (F = 6.281, p = .014) and depression (F = 4.731, p = .033) and showed greater bonding with their infant (F = 4.022, p = .049) compared with the control group. However, the scores for all four instruments were similar for both groups at the 4-week posttest, suggesting that the positive effects of lavender tea were limited to the immediate term.

LINKING EVIDENCE TO ACTION

Healthcare researchers assume accountability for integrating research results into clinical practice. The findings in this study can gain greater attention among healthcare practitioners and encourage the correct and positive use of herbal therapy in postpartum health care.

Postpartum electroconvulsive therapy: a systematic review and case report

OBJECTIVE

Postpartum depression can have devastating consequences on the mother and child. Prompt treatment is challenging. Whereas electroconvulsive therapy (ECT) is considered to be an effective treatment modality in severe depression and brings about rapid clinical improvement, little is known about ECT during the postpartum period.

METHOD

We systematically reviewed the literature on the use of ECT during the postpartum period using PubMed, Institute for Scientific Information Web of Knowledge and PsycINFO databases until September 2014, using the search terms "electroconvulsive therapy" or "ECT" and "postpartum". Then, we described the successful treatment with ECT and the joint mother-baby hospitalization of a woman with severe depression.

RESULTS

Eight case reports and 8 studies were identified. All of the studies reported that ECT is effective in the postpartum period. It is well tolerated, provides a fast response and allows for breastfeeding. In addition, our case report showed the benefits of the hospitalization of the mother-baby unit.

CONCLUSIONS

Combined ECT and joint mother-baby hospitalization could be a valuable treatment by targeting both the mother-infant relationship and the maternal depressive symptoms.

Shear stress, energy losses, and costs: a resolved dilemma of pulsatile cardiac assist devices

Cardiac assist devices (CAD) cause endothelial dysfunction with considerable morbidity. Employment of pulsatile CAD remains controversial due to inadequate perfusion curves and costs. Alternatively, we are proposing a new concept of pulsatile CAD based on a fundamental revision of the entire circulatory system in correspondence with the physiopathology and law of physics. It concerns a double lumen disposable tube device that could be adapted to conventional cardiopulmonary bypass (CPB) and/or CAD, for inducing a homogenous, downstream pulsatile perfusion mode with lower energy losses. In this study, the device's prototypes were tested in a simulated conventional pediatric CPB circuit for energy losses and as a left ventricular assist device (LVAD) in ischemic piglets model for endothelial shear stress (ESS) evaluations. In conclusion and according to the study results the pulsatile tube was successfully capable of transforming a conventional CPB and/or CAD steady flow into a pulsatile perfusion mode, with nearly physiologic pulse pressure and lower energy losses. This represents a cost-effective promising method with low mortality and morbidity, especially in fragile cardiac patients.