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Pawluski JL. The parental brain, perinatal mental illness, and treatment: A review of key structural and functional changes. Semin Perinatol 2024:151951. [PMID: 39030131 DOI: 10.1016/j.semperi.2024.151951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
The transition to parenthood is perhaps the only time in adult life when the brain changes to such a significant degree in such a short period, particularly in birthing parents. It is also a time when there is an increased risk of developing a mental illness, which may be due, in part, to the increased neuroplasticity. Thus, we must develop interventions and treatments that support parents and promote parental brain health. This review will highlight key findings from current research on how human brain structure and function are modified with 1) the transition to parenthood, 2) parenting stress and perinatal mental illness, and 3) treatments aimed at promoting perinatal mental health. The focus will be on birthing parents and mothers, but brain changes in non-birthing parents will also be discussed. Improvements in our understanding of the parental brain, in health and with illness, will promote the well-being of generations to come.
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Affiliation(s)
- Jodi L Pawluski
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, F-35000, Rennes, France.
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Shenoy S, Ibrahim S. Perinatal Depression and the Role of Synaptic Plasticity in Its Pathogenesis and Treatment. Behav Sci (Basel) 2023; 13:942. [PMID: 37998688 PMCID: PMC10669186 DOI: 10.3390/bs13110942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
Emerging evidence indicates that synaptic plasticity is significantly involved in the pathophysiology and treatment of perinatal depression. Animal models have demonstrated the effects of overstimulated or weakened synapses in various circuits of the brain in causing affective disturbances. GABAergic theory of depression, stress, and the neuroplasticity model of depression indicate the role of synaptic plasticity in the pathogenesis of depression. Multiple factors related to perinatal depression like hormonal shifts, newer antidepressants, mood stabilizers, monoamine systems, biomarkers, neurotrophins, cytokines, psychotherapy and electroconvulsive therapy have demonstrated direct and indirect effects on synaptic plasticity. In this review, we discuss and summarize the various patho-physiology-related effects of synaptic plasticity in depression. We also discuss the association of treatment-related aspects related to psychotropics, electroconvulsive therapy, neuromodulation, psychotherapy, physical exercise and yoga with synaptic plasticity in perinatal depression. Future insights into newer methods of treatment directed towards the modulation of neuroplasticity for perinatal depression will be discussed.
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Affiliation(s)
- Sonia Shenoy
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
| | - Sufyan Ibrahim
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN 55902, USA
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Oljira L, Abdissa E, Lema M, Merdassa E, Wakoya Feyisa J, Desalegn M. Antenatal depression and associated factors among pregnant women attending antenatal care at public health facilities in the Gida Ayana district, Oromia Region, West Ethiopia, in 2022. Front Public Health 2023; 11:1176703. [PMID: 37876710 PMCID: PMC10591076 DOI: 10.3389/fpubh.2023.1176703] [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: 03/07/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023] Open
Abstract
Background Though antenatal depression (AND) has a risk of maternal and fetal morbidity and mortality, it is a neglected component of pregnancy care in Ethiopia. Research evidence is compulsory in different parts of the country to alleviate this problem. Thus, this study was needed to assess antenatal depression and its associated factors, which can help antenatal care (ANC) providers and program coordinators focus on the mental health of pregnant mothers. Objectives This study aimed to assess antenatal depression and associated factors among pregnant women attending ANC at public health facilities in the Gida Ayana district, Oromia Region, West Ethiopia, in 2022. Methods A facility-based cross-sectional study was conducted among 370 pregnant women attending ANC at public health facilities. Systematic random sampling techniques were used to select study participants. A standard (validated) tool, the Edinburgh Postnatal Depression Scale, was also used to assess antenatal depression. The collected data were coded, entered into Epi-data software version 4.6, and analyzed by SPSS version 23. Multivariable logistic regression analyses were used to identify associated factors with a p-value <0.05. Results In this study, the prevalence of antenatal depression was 62 (16.8%; 95% CI: 13, 20.5). Being single in marital status (AOR = 3, 95% CI: 1.5, 6.2), having an unplanned pregnancy (AOR = 2.7, 95% CI: 1.45, 5.1), and having partner conflict (AOR = 3.49, 95% CI: 1.79, 6.8) were the factors associated with antenatal depression. Conclusion About one in five pregnant women has antenatal depression. Being single, having an unplanned pregnancy, and having a dissatisfied relationship with a sexual partner were the factors associated with antenatal depression. Therefore, women or partners are expected to plan pregnancy, and the dissemination of health information related to an unplanned pregnancy needs to be intensified by health providers. The partner ought to avoid conflict during the pregnancy, and healthcare providers or families are needed to support the single or widowed pregnant women. Further prospective cohort studies are needed to ascertain the effect of antenatal depression on fetal-maternal outcomes.
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Affiliation(s)
- Lelisa Oljira
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Eba Abdissa
- Department of Psychiatry Nursing, School of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Matiyos Lema
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Emiru Merdassa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Jira Wakoya Feyisa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Markos Desalegn
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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de Wet M. Systematic review of ethical issues in perinatal mental health research. Nurs Ethics 2023; 30:482-499. [PMID: 36829119 PMCID: PMC10637090 DOI: 10.1177/09697330231153683] [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] [Indexed: 02/26/2023]
Abstract
BACKGROUND Maternal mental health during the peripartum period is critically important to the wellbeing of mothers and their infants. Numerous studies and clinical trials have focused on various aspects of interventions and treatments for perinatal mental health from the perspective of researchers and medical health professionals. However, less is known about women's experiences of participating in perinatal mental health research, and the ethical issues that arise. AIM To systematically review the literature on the ethical issues that emerge from pregnant and/or postpartum women's experiences of taking part in perinatal mental health-related research. METHODS Systematic review of nine bibliographic databases, from inception to July 2021. Qualitative, quantitative and mixed method studies were included if they reported on ethical issues experienced by perinatal women. Research ethical issues encompassed any issue relating to women's experiences of being offered study information, recruitment, consent, retention and respect for autonomy.Titles, abstracts and full text screening, appraisal of the methodological quality of included studies, and data extraction, were conducted independently by two reviewers. ETHICAL CONSIDERATIONS Ethical approval was not required for this systematic review. FINDINGS A total of 9830 unique citations was retrieved. Six studies met the inclusion criteria. Studies were clinically and methodologically heterogenous, and only one was purposively designed to explore women's experiences. The key finding was the establishment of trust between the researcher and participant in all stages of the research process. Findings are presented according to recruitment and consent processes, participation and retention, and study follow-up and completion. CONCLUSION The establishment of trust between the researcher and perinatal women leads to a dynamic with research ethical implications relevant to all stages of perinatal mental health-related research. Further research on the research ethical issues experienced by perinatal women is required because of the limited literature.
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Affiliation(s)
- Mickie de Wet
- Department of Philosophy, Universidade da Beira Interior, Portugal
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Cheung T, Li TMH, Ho YS, Kranz G, Fong KNK, Leung SF, Lam SC, Yeung WF, Lam JYT, Fong KH, Beisteiner R, Xiang YT, Cheng CPW. Effects of Transcranial Pulse Stimulation (TPS) on Adults with Symptoms of Depression-A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032333. [PMID: 36767702 PMCID: PMC9915638 DOI: 10.3390/ijerph20032333] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 05/29/2023]
Abstract
Transcranial pulse stimulation (TPS) is a recent development in non-invasive brain stimulations (NIBS) that has been proven to be effective in terms of significantly improving Alzheimer patients' cognition, memory, and execution functions. Nonetheless, there is, currently, no trial evaluating the efficacy of TPS on adults with major depression disorder (MDD) nationwide. In this single-blinded, randomized controlled trial, a 2-week TPS treatment comprising six 30 min TPS sessions were administered to participants. Participants were randomized into either the TPS group or the Waitlist Control (WC) group, stratified by gender and age according to a 1:1 ratio. Our primary outcome was evaluated by the Hamilton depression rating scale-17 (HDRS-17). We recruited 30 participants that were aged between 18 and 54 years, predominantly female (73%), and ethnic Chinese from 1 August to 31 October 2021. Moreover, there was a significant group x time interaction (F(1, 28) = 18.8, p < 0.001). Further, when compared with the WC group, there was a significant reduction in the depressive symptom severity in the TPS group (mean difference = -6.60, p = 0.02, and Cohen's d = -0.93). The results showed a significant intervention effect; in addition, the effect was large and sustainable at the 3-month follow-up. In this trial, it was found that TPS is effective in reducing depressive symptoms among adults with MDD.
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Affiliation(s)
- Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Tim Man Ho Li
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuen Shan Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Georg Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Joyce Yuen Ting Lam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kwan Hin Fong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Roland Beisteiner
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, University of Macau, Macao SAR, China
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Marwaha S, Palmer E, Suppes T, Cons E, Young AH, Upthegrove R. Novel and emerging treatments for major depression. Lancet 2023; 401:141-153. [PMID: 36535295 DOI: 10.1016/s0140-6736(22)02080-3] [Citation(s) in RCA: 126] [Impact Index Per Article: 126.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/09/2022] [Accepted: 10/19/2022] [Indexed: 12/23/2022]
Abstract
Depression is common, costly, debilitating, and associated with increased risk of suicide. It is one of the leading global public health problems. Although existing available pharmacological treatments can be effective, their onset of action can take up to 6 weeks, side-effects are common, and recovery can require treatment with multiple different agents. Although psychosocial interventions might also be recommended, more effective treatments than those currently available are needed for people with moderate or severe depression. In the past 10 years, treatment trials have developed and tested many new targeted interventions. In this Review, we assess novel and emerging biological treatments for major depressive disorder, evaluate their putative brain and body mechanisms, and highlight how close each might be to clinical use.
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Affiliation(s)
- Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
| | - Edward Palmer
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Emily Cons
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, UK.
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Lu X, Yang Z, Liu F, Zhou Y, Xu Y, Zhuo Y, Huang X, Gong M. Effectiveness of non-pharmacological treatments for postpartum depression: an umbrella review protocol. BMJ Open 2023; 13:e066395. [PMID: 36599640 PMCID: PMC9815009 DOI: 10.1136/bmjopen-2022-066395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Non-pharmacological treatments for postpartum depression have been investigated in various systematic reviews, and their efficacy has been evaluated. However, the quality of the evidence as a whole has not been quantified. The quality of this evidence may influence the choice of interventions and even cause misleading clinical decisions. This study aims to provide an objective presentation of the methodological bias and identify treatments supported by solid evidence. METHODS AND ANALYSIS For the purpose of conducting systematic reviews and meta-analyses, a comprehensive search of the relevant published literature will be conducted in English databases such as PubMed, Embase, Cochrane Library, PsycINFO and Scopus, as well as in four Chinese databases: the Chinese Biomedical Databases (CBM), Wan fang database, China National Knowledge Infrastructure and VIP Database (VIP). The time of publication will be limited from their inception to 31 May 2022. We will extract the following data from the included literature: title, first author, journal type of included literature, number and sample size, intervention/control measures, outcome indicators and main study outcomes. The Assessment of Multiple Systematic Reviews-2 will be used to measure the quality of the methods. In addition, we will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to evaluate the quality of the reporting, as well as the Grading of Recommendations Assessment, Development and Evaluation to evaluate the quality of the evidence. PROSPERO REGISTRATION NUMBER CRD42021285470.
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Affiliation(s)
- Xiaofei Lu
- Fourth Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
| | - Zhuoxin Yang
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Fan Liu
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yumei Zhou
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yuqin Xu
- Fourth Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
| | - Yuanyuan Zhuo
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Xingxian Huang
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Mingqiang Gong
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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Effect of transcutaneous auricular vagus nerve stimulation on major depressive disorder with peripartum onset: A multicenter, open-label, controlled proof-of-concept clinical trial (DELOS-1). J Affect Disord 2022; 316:34-41. [PMID: 35932937 DOI: 10.1016/j.jad.2022.07.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/23/2022] [Accepted: 07/30/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postpartum depression has a high prevalence in the United States (~13 %) and often goes undertreated/untreated. We conducted a multicenter, open-label, proof-of-concept trial to assess the Nēsos wearable, non-invasive, transcutaneous auricular vagus nerve stimulation (taVNS) system for the treatment of major depressive disorder with peripartum onset (PPD). METHODS Women (n = 25), ages 18 to 45, within 9 months postpartum, and diagnosed with PPD were enrolled at 3 sites. The study included 6 weeks open-label therapy and 2 weeks observation. Efficacy outcomes included change from baseline (CFB) in Hamilton Rating Scale for Depression (HAMD17) total scores, HAM-D17 response and remission, and patient and clinician global impression of change (PGIC, CGIC) scores. Analysis included descriptive statistics and mixed-effects models for repeated measures. RESULTS The most common AEs (≥5 %) were discomfort (n = 5), headache (n = 3), and dizziness (n = 2); all resolved without intervention. No serious AEs or deaths occurred. Baseline mean HAM-D17 score was 18.4. Week 6 least squares (LS) mean CFB in HAM-D17 score was -9.7; 74 % achieved response and 61 % achieved remission. At week 6, at least some improvement was reported by 21 of 22 (95 %) clinicians on CGIC and 22 of 23 (96 %) participants on PGIC. LIMITATIONS This was a single-arm, open-label study, and enrollment was limited to participants with mild-to-moderate peripartum depression. CONCLUSION Results from this proof-of-concept study suggest that the Nēsos taVNS system is well tolerated and may be an effective non-invasive, non-pharmacological treatment for major depressive disorder with peripartum onset. Further evaluation in larger sham-controlled studies is needed. CLINICALTRIALS govNCT03972995.
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Efficacy and Safety of Transcranial Electric Stimulation during the Perinatal Period: A Systematic Literature Review and Three Case Reports. J Clin Med 2022; 11:jcm11144048. [PMID: 35887812 PMCID: PMC9318834 DOI: 10.3390/jcm11144048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: The perinatal period is an at-risk period for the emergence or decompensation of psychiatric disorders. Transcranial electrical stimulation (tES) is an effective and safe treatment for many psychiatric disorders. Given the reluctance to use pharmacological treatments during pregnancy or breastfeeding, tES may be an interesting treatment to consider. Our study aims to evaluate the efficacy and safety of tES in the perinatal period through a systematic literature review followed by three original case reports. Method: Following PRISMA guidelines, a systematic review of MEDLINE and ScienceDirect was undertaken to identify studies on tES on women during the perinatal period. The initial research was conducted until 31 December 2021 and search terms included: tDCS, transcranial direct current stimulation, tACS, transcranial alternating current stimulation, tRNS, transcranial random noise stimulation, pregnancy, perinatal, postnatal, and postpartum. Results: Seven studies reporting on 33 women during the perinatal period met the eligibility criteria. No serious adverse effects for the mother or child were reported. Data were limited to the use of tES during pregnancy in patients with schizophrenia or unipolar depression. In addition, we reported three original case reports illustrating the efficacy and safety of tDCS: in a pregnant woman with bipolar depression, in a pregnant woman with post-traumatic stress disorder (sham tDCS), and in a breastfeeding woman with postpartum depression. Conclusions: The results are encouraging, making tES a potentially safe and effective treatment in the perinatal period. Larger studies are needed to confirm these initial results, and any adverse effects on the mother or child should be reported. In addition, research perspectives on the medico-economic benefits of tES, and its realization at home, are to be investigated in the future.
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