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Psychiatry Research Oct 2023Positive allosteric modulators of γ-aminobutyric acid-A (GABA) receptors, or GABAkines, play important roles in the treatment of depression, epilepsy, insomnia, and... (Meta-Analysis)
Meta-Analysis
Positive allosteric modulators of γ-aminobutyric acid-A (GABA) receptors, or GABAkines, play important roles in the treatment of depression, epilepsy, insomnia, and other disorders. Recently, some new GABAkines (zuranolone and brexanolone) have been administrated to patients with major depressive disorder (MDD) or postpartum depression (PPD) in randomized controlled trials (RCTs). This study aims to systematically review and examine the efficacy and safety of zuranolone or brexanolone for treatment of depression. A systematic literature retrieval was conducted through August 20, 2023. RCTs evaluating the efficacy and safety of zuranolone or brexanolone for treatment of depression were included. Eight studies (nine reports) were identified in the study. The percentages of patients with PPD achieving Hamilton Depression Rating Scale (HAM-D) response and remission were significantly higher after brexanolone or zuranolone administration compared with placebo at different points. The percentages of patients with MDD achieving HAM-D response and remission were significantly increased during the zuranolone treatment period compared with placebo. In addition, zuranolone caused more adverse events in patients with MDD compared with placebo. Our findings support the effects of brexanolone on improving the core symptoms of depression in patients with PPD, and the potential of zuranolone in treating patients with MDD or PPD.
Topics: Female; Humans; Antidepressive Agents; Depression, Postpartum; Depression; Randomized Controlled Trials as Topic; Depressive Disorder, Major
PubMed: 37683318
DOI: 10.1016/j.psychres.2023.115450 -
Chronobiology International Oct 2021Blue-blocking glasses, also known as amber glasses, are plastic glasses that primarily block blue light. Blue-blocking glasses have been studied as a sleep intervention...
Blue-blocking glasses, also known as amber glasses, are plastic glasses that primarily block blue light. Blue-blocking glasses have been studied as a sleep intervention for insomnia, delayed sleep-phase disorder, shift work, jet lag, and nonpathologic sleep improvement. Blue-blocking glasses have also been studied as a treatment for bipolar disorder, major depression, and postpartum depression. Blue-blocking glasses improve sleep by inducing dim-light melatonin onset by reducing activation of intrinsically photosensitive retinal ganglion cells (ipRGCs) which are most sensitive to blue light and are a major input for circadian regulation; their mechanism for mood regulation is unclear but may be similar to that of dark therapy for bipolar disorder where patients are kept in darkness for an extended period every night. A systematic search of the scientific literature identified a total of 29 experimental publications involving evening wear of blue-blocking glasses for sleep or mood disorders. These consisted of 16 randomized controlled trials (RCTs) published in journals with a total of 453 patients, 5 uncontrolled trials, 1 case series, 1 case study, and 6 abstracts from conference proceedings. Only 1 case study and 1 RCT were for acutely manic patients but both found substantial decreases in manic symptoms with the use of blue-blocking glasses; these give preliminary clinical evidence of efficacy that makes blue-blocking glasses a high-yield intervention to study for bipolar disorder. Findings in the 3 publications for major depression and postpartum depression were heterogeneous and conflicting as to their efficacy. Out of the 24 publications focusing on sleep, there was substantial evidence for blue-blocking glasses being a successful intervention for reducing sleep onset latency in patients with sleep disorders, jet lag, or variable shift work schedules. Given the well-established biological mechanism and clinical research showing that blue-blocking glasses are effective for inducing sleep, they are a viable intervention to recommend to patients with insomnia or a delayed sleep phase.
Topics: Bipolar Disorder; Circadian Rhythm; Depressive Disorder, Major; Eyeglasses; Female; Humans; Light; Melatonin; Sleep
PubMed: 34030534
DOI: 10.1080/07420528.2021.1930029 -
Journal of Women's Health (2002) Jun 2022Breastfeeding has many positive effects on the health of infants and mothers, however, the effect of breastfeeding on maternal mental health is largely unknown. The...
Breastfeeding has many positive effects on the health of infants and mothers, however, the effect of breastfeeding on maternal mental health is largely unknown. The goal of this systematic review was to (1) synthesize the existing literature on the effects of breastfeeding on maternal mental health, and (2) inform breastfeeding recommendations. A literature search was conducted in electronic databases using search terms related to breastfeeding ( breastfeeding, infant feeding practices) and mental health conditions ( mental illness, anxiety, depression), resulting in 1,110 records. After reviewing article titles and abstracts, 339 articles were advanced to full-text review. Fifty-five articles were included in the final analysis. Thirty-six studies reported significant relationships between breastfeeding and maternal mental health outcomes, namely symptoms of postpartum depression and anxiety: 29 found that breastfeeding is associated with fewer mental health symptoms, one found it was associated with more, and six reported a mixed association between breastfeeding and mental health. Five studies found that breastfeeding challenges were associated with a higher risk of negative mental health symptoms. Overall, breastfeeding was associated with improved maternal mental health outcomes. However, with challenges or a discordance between breastfeeding expectations and actual experience, breastfeeding was associated with negative mental health outcomes. Breastfeeding recommendations should be individualized to take this into account. Further research, specifically examining the breastfeeding experiences of women who experienced mental health conditions, is warranted to help clinicians better personalize breastfeeding and mental health counseling.
Topics: Anxiety; Breast Feeding; Depression, Postpartum; Female; Humans; Infant; Mental Health; Mothers
PubMed: 35442804
DOI: 10.1089/jwh.2021.0504 -
The Cochrane Database of Systematic... May 2017Gestational diabetes (GDM) is glucose intolerance, first recognised in pregnancy and usually resolving after birth. GDM is associated with both short- and long-term... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Gestational diabetes (GDM) is glucose intolerance, first recognised in pregnancy and usually resolving after birth. GDM is associated with both short- and long-term adverse effects for the mother and her infant. Lifestyle interventions are the primary therapeutic strategy for many women with GDM.
OBJECTIVES
To evaluate the effects of combined lifestyle interventions with or without pharmacotherapy in treating women with gestational diabetes.
SEARCH METHODS
We searched the Pregnancy and Childbirth Group's Trials Register (14 May 2016), ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) (14th May 2016) and reference lists of retrieved studies.
SELECTION CRITERIA
We included only randomised controlled trials comparing a lifestyle intervention with usual care or another intervention for the treatment of pregnant women with GDM. Quasi-randomised trials were excluded. Cross-over trials were not eligible for inclusion. Women with pre-existing type 1 or type 2 diabetes were excluded.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by the Cochrane Collaboration. All selection of studies, data extraction was conducted independently by two review authors.
MAIN RESULTS
Fifteen trials (in 45 reports) are included in this review (4501 women, 3768 infants). None of the trials were funded by a conditional grant from a pharmaceutical company. The lifestyle interventions included a wide variety of components such as education, diet, exercise and self-monitoring of blood glucose. The control group included usual antenatal care or diet alone. Using GRADE methodology, the quality of the evidence ranged from high to very low quality. The main reasons for downgrading evidence were inconsistency and risk of bias. We summarised the following data from the important outcomes of this review. Lifestyle intervention versus control groupFor the mother:There was no clear evidence of a difference between lifestyle intervention and control groups for the risk of hypertensive disorders of pregnancy (pre-eclampsia) (average risk ratio (RR) 0.70; 95% confidence interval (CI) 0.40 to 1.22; four trials, 2796 women; I = 79%, Tau = 0.23; low-quality evidence); caesarean section (average RR 0.90; 95% CI 0.78 to 1.05; 10 trials, 3545 women; I = 48%, Tau = 0.02; low-quality evidence); development of type 2 diabetes (up to a maximum of 10 years follow-up) (RR 0.98, 95% CI 0.54 to 1.76; two trials, 486 women; I = 16%; low-quality evidence); perineal trauma/tearing (RR 1.04, 95% CI 0.93 to 1.18; one trial, n = 1000 women; moderate-quality evidence) or induction of labour (average RR 1.20, 95% CI 0.99 to 1.46; four trials, n = 2699 women; I = 37%; high-quality evidence).More women in the lifestyle intervention group had met postpartum weight goals one year after birth than in the control group (RR 1.75, 95% CI 1.05 to 2.90; 156 women; one trial, low-quality evidence). Lifestyle interventions were associated with a decrease in the risk of postnatal depression compared with the control group (RR 0.49, 95% CI 0.31 to 0.78; one trial, n = 573 women; low-quality evidence).For the infant/child/adult:Lifestyle interventions were associated with a reduction in the risk of being born large-for-gestational age (LGA) (RR 0.60, 95% CI 0.50 to 0.71; six trials, 2994 infants; I = 4%; moderate-quality evidence). Birthweight and the incidence of macrosomia were lower in the lifestyle intervention group.Exposure to the lifestyle intervention was associated with decreased neonatal fat mass compared with the control group (mean difference (MD) -37.30 g, 95% CI -63.97 to -10.63; one trial, 958 infants; low-quality evidence). In childhood, there was no clear evidence of a difference between groups for body mass index (BMI) ≥ 85th percentile (RR 0.91, 95% CI 0.75 to 1.11; three trials, 767 children; I = 4%; moderate-quality evidence).There was no clear evidence of a difference between lifestyle intervention and control groups for the risk of perinatal death (RR 0.09, 95% CI 0.01 to 1.70; two trials, 1988 infants; low-quality evidence). Of 1988 infants, only five events were reported in total in the control group and there were no events in the lifestyle group. There was no clear evidence of a difference between lifestyle intervention and control groups for a composite of serious infant outcome/s (average RR 0.57, 95% CI 0.21 to 1.55; two trials, 1930 infants; I = 82%, Tau = 0.44; very low-quality evidence) or neonatal hypoglycaemia (average RR 0.99, 95% CI 0.65 to 1.52; six trials, 3000 infants; I = 48%, Tau = 0.12; moderate-quality evidence). Diabetes and adiposity in adulthood and neurosensory disability in later childhoodwere not prespecified or reported as outcomes for any of the trials included in this review.
AUTHORS' CONCLUSIONS
Lifestyle interventions are the primary therapeutic strategy for women with GDM. Women receiving lifestyle interventions were less likely to have postnatal depression and were more likely to achieve postpartum weight goals. Exposure to lifestyle interventions was associated with a decreased risk of the baby being born LGA and decreased neonatal adiposity. Long-term maternal and childhood/adulthood outcomes were poorly reported.The value of lifestyle interventions in low-and middle-income countries or for different ethnicities remains unclear. The longer-term benefits or harms of lifestyle interventions remains unclear due to limited reporting.The contribution of individual components of lifestyle interventions could not be assessed. Ten per cent of participants also received some form of pharmacological therapy. Lifestyle interventions are useful as the primary therapeutic strategy and most commonly include healthy eating, physical activity and self-monitoring of blood glucose concentrations.Future research could focus on which specific interventions are most useful (as the sole intervention without pharmacological treatment), which health professionals should give them and the optimal format for providing the information. Evaluation of long-term outcomes for the mother and her child should be a priority when planning future trials. There has been no in-depth exploration of the costs 'saved' from reduction in risk of LGA/macrosomia and potential longer-term risks for the infants.
Topics: Blood Glucose Self-Monitoring; Body Mass Index; Body Weight; Cesarean Section; Depression, Postpartum; Diabetes Mellitus, Type 2; Diabetes, Gestational; Diet, Diabetic; Exercise; Female; Humans; Infant, Newborn; Infant, Postmature; Labor, Induced; Life Style; Patient Education as Topic; Perineum; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 28472859
DOI: 10.1002/14651858.CD011970.pub2 -
Social Psychiatry and Psychiatric... Nov 2023This systematic review of systematic reviews aims to provide the first global picture of the prevalence and correlates of perinatal depression, and to explore the... (Review)
Review
PURPOSE
This systematic review of systematic reviews aims to provide the first global picture of the prevalence and correlates of perinatal depression, and to explore the commonalities and discrepancies of the literature.
METHODS
Seven databases were searched from inception until April 2022. Full-text screening and data extraction were performed independently by two researchers and the AMSTAR tool was used to assess the methodological quality.
RESULTS
128 systematic reviews were included in the analysis. Mean overall prevalence of perinatal depression, antenatal depression and postnatal depression was 26.3%, 28.5% and 27.6%, respectively. Mean prevalence was significantly higher (27.4%; SD = 12.6) in studies using self-reported measures compared with structured interviews (17.0%, SD = 4.5; d = 1.0) and among potentially vulnerable populations (32.5%; SD = 16.7, e.g. HIV-infected African women) compared to the general population (24.5%; SD = 8.1; d = 0.6). Personal history of mental illness, experiencing stressful life events, lack of social support, lifetime history of abuse, marital conflicts, maternity blues, child care stress, chronic physical health conditions, preeclampsia, gestational diabetes mellitus, being exposed to second-hand smoke and sleep disturbance were among the major correlates of perinatal depression.
CONCLUSION
Although the included systematic reviews were all of medium-high quality, improvements in the quality of primary research in this area should be encouraged. The standardisation of perinatal depression assessment, diagnosis and measurement, the implementation of longitudinal designs in studies, inclusions of samples that better represent the population and better control of potentially confounding variables are encouraged.
Topics: Female; Humans; Pregnancy; Child; Depression; Prevalence; Systematic Reviews as Topic; Depression, Postpartum; Pregnancy Complications
PubMed: 36646936
DOI: 10.1007/s00127-022-02386-9 -
Maternal and Child Health Journal Dec 2023Postpartum depression (PPD) has deleterious effects on both maternal and child outcomes. Poor maternal nutrition during pregnancy has been implicated in the development...
OBJECTIVE
Postpartum depression (PPD) has deleterious effects on both maternal and child outcomes. Poor maternal nutrition during pregnancy has been implicated in the development of PPD. This review aimed to explore the association between the overall dietary intake patterns during pregnancy and the development of PPD.
METHODS
A literature search was performed in PubMed, Embase, Scopus, CINAHL, and PsycINFO databases for relevant randomized controlled trials, cohort and cross-sectional studies published up to 17th September 2020. Included studies assessed at least one dietary pattern during pregnancy and reported on PPD. The Newcastle Ottawa Scale and the Joanna Briggs Institute critical appraisal tools were used to assess the quality of methodology. A narrative analysis was conducted.
RESULTS
Ten studies (eight cohort and two cross-sectional) were included with substantial heterogeneity in measurements of dietary intake exposures and PPD. The studies identified several types of healthy dietary patterns, including a 'healthy', 'health conscious', 'Japanese', 'high-glycemic index/glycemic load', 'Vegetable', 'Nut-Fruit', 'Seafood', and 'compliance with the Australian Dietary Guidelines'. The 'Western', 'unhealthy', 'Beverage', 'Cereal-Meat', and 'Egg' were labelled as unhealthy dietary patterns. Four of the eight studies showed an inverse association between adherence to healthy diets and risk of PPD, whereas only one of the seven studies showed that adherence to unhealthy diets was associated with increased risk of PPD. Methodological quality of the studies varied across the sample.
CONCLUSIONS
Our findings indicate that adherence to a healthy diet may be beneficial for PPD. However, the relationship between unhealthy diets and PPD needs to be corroborated by more high-quality studies.
Topics: Child; Female; Humans; Pregnancy; Australia; Cross-Sectional Studies; Depression, Postpartum; Diet; Diet, Healthy
PubMed: 37814068
DOI: 10.1007/s10995-023-03781-7 -
Acta Psychiatrica Scandinavica Jun 2023To assess the postpartum depression (PPD) risk in women with postpartum hemorrhage (PPH) and moderators. (Review)
Review
OBJECTIVE
To assess the postpartum depression (PPD) risk in women with postpartum hemorrhage (PPH) and moderators.
METHODS
We identified observational studies of PPD rates in women with versus without PPH in Embase/Medline/PsychInfo/Cinhail in 09/2022. Study quality was evaluated using the Newcastle-Ottawa-Scale. Our primary outcome was the odds ratio (OR, 95% confidence intervals [95%CI]) of PPD in women with versus without PPH. Meta-regression analyses included the effects of age, body mass index, marital status, education, history of depression/anxiety, preeclampsia, antenatal anemia and C-section; subgroup analyses were based on PPH and PPD assessment methods, samples with versus without history of depression/anxiety, from low-/middle- versus high-income countries. We performed sensitivity analyses after excluding poor-quality studies, cross-sectional studies and sequentially each study.
RESULTS
One, five and three studies were rated as good-, fair- and poor-quality respectively. In nine studies (k = 10 cohorts, n = 934,432), women with PPH were at increased PPD risk compared to women without PPH (OR = 1.28, 95% CI = 1.13 to 1.44, p < 0.001), with substantial heterogeneity (I = 98.9%). Higher PPH-related PPD ORs were estimated in samples with versus without history of depression/anxiety or antidepressant exposure (OR = 1.37, 95%CI = 1.18 to 1.60, k = 6, n = 55,212, versus 1.06, 95%CI = 1.04 to 1.09, k = 3, n = 879,220, p < 0.001) and in cohorts from low-/middle- versus high-income countries (OR = 1.49, 95%CI = 1.37 to 1.61, k = 4, n = 9197, versus 1.13, 95%CI = 1.04 to 1.23, k = 6, n = 925,235, p < 0.001). After excluding low-quality studies the PPD OR dropped (1.14, 95%CI = 1.02 to 1.29, k = 6, n = 929,671, p = 0.02).
CONCLUSIONS
Women with PPH had increased PPD risk amplified by history of depression/anxiety, whereas more data from low-/middle-income countries are required.
PubMed: 37286177
DOI: 10.1111/acps.13583 -
Nursing Open Aug 2023Our aim is to clarify the concept of paternal perinatal depression including its definition, attributes, antecedents and consequences. (Review)
Review
AIM
Our aim is to clarify the concept of paternal perinatal depression including its definition, attributes, antecedents and consequences.
DESIGN
A concept analysis.
METHODS
To obtain relevant evidence, several databases were searched systematically including PubMed, EMBASE, Web of Science, CINAHL, PsycINFO and the Cochrane Library. Qualitative or quantitative articles published in English that focused on paternal perinatal depression were included. After the literature quality assessment, Walker and Avant's concept analysis strategy was used.
RESULTS
Five defining attributes (i.e. symptoms occur during the partner's pregnancy or 1-year postpartum and last at least 2 weeks, emotional symptoms, somatic symptoms, negative parenting behaviours and 'masked' symptoms), four antecedents (i.e. personal issues, pregnancy-related issues, infant-related issues, social issues) and three consequences (i.e. offspring outcomes, marital relationship, maternal negative emotions) were identified.
Topics: Female; Humans; Infant; Male; Pregnancy; Depression; Depressive Disorder; Fathers; Parenting; Postpartum Period
PubMed: 37147794
DOI: 10.1002/nop2.1797 -
PloS One 2021Pre-term or full-term childbirth can be experienced as physically or psychologically traumatic. Cumulative and trans-generational effects of traumatic stress on both... (Meta-Analysis)
Meta-Analysis
Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis.
BACKGROUND
Pre-term or full-term childbirth can be experienced as physically or psychologically traumatic. Cumulative and trans-generational effects of traumatic stress on both psychological and physical health indicate the ethical requirement to investigate appropriate preventative treatment for stress symptoms in women following a routine traumatic experience such as childbirth.
OBJECTIVE
The objective of this review was to investigate the effectiveness of early psychological interventions in reducing or preventing post-traumatic stress symptoms and post-traumatic stress disorder in post-partum women within twelve weeks of a traumatic birth.
METHODS
Randomised controlled trials and pilot studies of psychological interventions preventing or reducing post-traumatic stress symptoms or PTSD, that included women who had experienced a traumatic birth, were identified in a search of Cochrane Central Register of Randomised Controlled Trials, MEDLINE, Embase, Psychinfo, PILOTS, CINAHL and Proquest Dissertations databases. One author performed database searches, verified results with a subject librarian, extracted study details and data. Five authors appraised extracted data and agreed upon risk of bias. Analysis was completed with Rev Man 5 software and quality of findings were rated according to Grading of Recommendation, Assessment, Development, and Evaluation.
RESULTS
Eleven studies were identified that evaluated the effectiveness of a range of early psychological interventions. There was firm evidence to suggest that midwifery or clinician led early psychological interventions administered within 72 hours following traumatic childbirth are more effective than usual care in reducing traumatic stress symptoms in women at 4-6 weeks. Further studies of high methodological quality that include longer follow up of 6-12 months are required in order to substantiate the evidence of the effectiveness of specific face to face and online early psychological intervention modalities in preventing the effects of stress symptoms and PTSD in women following a traumatic birth before introduction to routine care and practice.
PROSPERO REGISTRATION
CRD42020202576, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=202576.
Topics: Depression, Postpartum; Female; Humans; Outcome Assessment, Health Care; Parturition; Postpartum Period; Pregnancy; Psychosocial Intervention; Publication Bias; Risk; Stress Disorders, Post-Traumatic
PubMed: 34818326
DOI: 10.1371/journal.pone.0258170 -
Journal of Family & Reproductive Health Mar 2023The incidence and prevalence of postpartum depression is increasing due to multiple factors. Aromatherapy is a widely used complementary and alternative (CAM) therapy in... (Review)
Review
OBJECTIVE
The incidence and prevalence of postpartum depression is increasing due to multiple factors. Aromatherapy is a widely used complementary and alternative (CAM) therapy in the management of depression. This systematic review and meta-analysis was done to find the effect of aromatherapy on postpartum depression.
MATERIALS AND METHODS
Electronic databases like PubMed, Scopus, Cochrane Library and Science Direct since inception till February 2021 were searched using related keywords to obtain eligible studies. Randomised controlled trial studies (RCTs) reporting the effects of aromatherapy therapy in women with postpartum depression were included. Aromatherapy studies conducted on population other than postpartum women were excluded. The primary outcome was depression scores obtained by using valid depression scales. Meta-analysis was performed using the random-effects model of Der Simonian and Laird to produce summary treatment effects in terms of Hedges' g effect sizes with 95% confidence interval (CI).
RESULTS
A total of 4 RCTs (n=303) were included. The results indicate that aromatherapy (Hedges' g =-0.94, 95 CI= -2.55, 0.61, I=88%, p<0.01) reduces depression levels among postpartum women without statistical significance.
CONCLUSION
The available evidences suggest aromatherapy may be effective in reducing post-partum depression. The number of scientific evidences currently available are very limited and more studies with robust study designs are required to strongly recommend aromatherapy in the management of post-partum depressions. However, being a safer intervention with no adverse effects being reported in previous studies, aromatherapy could definitely be added as an effective complementary therapy in the management of post-partum depression along with conventional medicine.
PubMed: 37538225
DOI: 10.18502/jfrh.v17i1.11970