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Journal of Affective Disorders Oct 2023Postpartum depression (PPD) is a prevalent public health issue. Although ketamine has prophylactic effects on PPD in women undergoing cesarean section, the effects of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Postpartum depression (PPD) is a prevalent public health issue. Although ketamine has prophylactic effects on PPD in women undergoing cesarean section, the effects of esketamine on PPD remain unclear. This trial aimed to evaluate the efficacy of perioperative esketamine infusion on PPD risk by assessing Edinburgh Postnatal Depression Scale (EPDS) scores and blood biomarkers.
METHODS
A total of 150 participants undergoing elective cesarean section were randomly allocated to receive either esketamine or normal saline. Since 27 participants were excluded due to consent withdrawal or loss to follow-up, 123 patients were included. The primary outcome was the prevalence of PPD risk. Secondary outcomes included the prevalence of postpartum anxiety (PPA) risk, levels of biomarkers, postoperative pain intensity, and cumulative sufentanil consumption.
RESULTS
The prevalence of PPD and PPA risk at 3 days, 42 days, 3 months, and 6 months postpartum did not differ between the two groups. Furthermore, EPDS scores, pain intensity at rest, and during coughing on postoperative days (POD) 1 and 2 did not differ between the two groups. Sufentanil consumption during 0-12 h, 12-24 h, 0-24 h, and 0-48 h postoperatively were significantly lower in the esketamine group compared to the control group. Blood biomarkers did not differ between the two groups on POD 3.
LIMITATIONS
The sample size was small. PPD risk was simply screened, not diagnosed.
CONCLUSIONS
Perioperative administration of esketamine did not decrease the incidence of PPD risk in women after elective cesarean section. However, esketamine reduced opioid consumption.
Topics: Humans; Female; Pregnancy; Cesarean Section; Ketamine; Depression, Postpartum; Sufentanil; Biomarkers
PubMed: 37482224
DOI: 10.1016/j.jad.2023.07.103 -
EBioMedicine Dec 2023
Topics: Female; Humans; Depression; Depression, Postpartum; Postpartum Period
PubMed: 38099513
DOI: 10.1016/j.ebiom.2023.104925 -
Translational Psychiatry Nov 2023It remains inconclusive whether postpartum depression (PPD) and depression with onset outside the postpartum period (MDD) are genetically distinct disorders. We aimed to... (Meta-Analysis)
Meta-Analysis
It remains inconclusive whether postpartum depression (PPD) and depression with onset outside the postpartum period (MDD) are genetically distinct disorders. We aimed to investigate whether polygenic risk scores (PGSs) for major mental disorders differ between PPD cases and MDD cases in a nested case-control study of 50,057 women born from 1981 to 1997 in the iPSYCH2015 sample in Demark. We identified 333 women with first-onset postpartum depression (PPD group), who were matched with 993 women with first-onset depression diagnosed outside of postpartum (MDD group), and 999 female population controls. Data on genetics and depressive disorders were retrieved from neonatal biobanks and the Psychiatric Central Research Register. PGSs were calculated from both individual-level genetic data and meta-analysis summary statistics from the Psychiatric Genomics Consortium. Conditional logistic regression was used to calculate the odds ratio (OR), accounting for the selection-related reproductive behavior. After adjustment for covariates, higher PGSs for severe mental disorders were associated with increased ORs of both PPD and MDD. Compared with MDD cases, MDD PGS and attention-deficit/hyperactivity disorder PGS were marginally but not statistically higher for PPD cases, with the OR of PPD versus MDD being 1.12 (95% CI: 0 .97-1.29) and 1.11 (0.97-1.27) per-standard deviation increase, respectively. The ORs of PPD versus MDD did not statistically differ by PGSs of bipolar disorder, schizophrenia, or autism spectrum disorder. Our findings suggest that relying on PGS data, there was no clear evidence of distinct genetic make-up of women with depression occurring during or outside postpartum, after taking the selection-related reproductive behavior into account.
Topics: Infant, Newborn; Humans; Female; Depression, Postpartum; Case-Control Studies; Depressive Disorder, Major; Autism Spectrum Disorder; Postpartum Period; Risk Factors
PubMed: 37953300
DOI: 10.1038/s41398-023-02649-2 -
Annals of Medicine 2023Depression during pregnancy or postpartum carries the same risks as general depression as well as additional risks specific to pregnancy, infant health and maternal...
BACKGROUND/OBJECTIVES/INTRODUCTION
Depression during pregnancy or postpartum carries the same risks as general depression as well as additional risks specific to pregnancy, infant health and maternal well-being. The purpose of this study is to document the prevalence of depression symptoms and diagnosis during pregnancy and in the first 3 months postpartum among a cohort of women receiving prenatal care in a large health system. Secondarily, we examine variability in screening results and diagnosis by race, ethnicity, language, economic status and other maternal characteristics during pregnancy and postpartum.
PATIENTS/MATERIALS AND METHODS
A retrospective study with two cohorts of patients screened for depression during pregnancy and postpartum. Out of 7807 patients with at least three prenatal care visits and a delivery in 2016, 6725 were screened for depression (87%) at least once during pregnancy or postpartum. Another 259 were excluded because of missing race data. The final sample consisted of 6523 prenatal care patients who were screened for depression; 4914 were screened for depression in pregnancy, 4619 were screened postpartum (0-3 months). There were 3010 screened during both periods who are present in both the pregnancy and postpartum cohorts. Depression screening results are from the Patient Health Questionnaire (PHQ-9) and diagnosis of depression was measured using ICD codes. For patients screened more than once during either time period, the highest score is used for analysis.
RESULTS
Approximately, 11% of women had a positive depression screen as indicated by an elevated PHQ-9 score (>10) during pregnancy (11.3%) or postpartum (10.7%). Prevalence of depression diagnosis was similar in the two periods: 12.6% during pregnancy and 13.0% postpartum. A diagnosis of depression during pregnancy was most prevalent among women who were age 24 and younger (19.7%), single (20.5%), publicly insured (17.8%), multiracial (24.1%) or Native American (23.8%), and among women with a history of depression in the past year (58.9%). Among women with a positive depression screen, Black women were less than half as likely as White women to receive a diagnosis in adjusted models (AOR 0.40, CI: 0.23-0.71, = .002). This difference was not present postpartum.
CONCLUSIONS
Depression symptoms and diagnoses differ by maternal characteristics during pregnancy with some groups at substantially higher risk. Efforts to examine disparities in screening and diagnosis are needed to identify reasons for variability in prenatal depression diagnosis between Black and White women.Key messagesWomen who were young, single, have public insurance, and women who identify as multiracial or non-Hispanic (NH) Native American were most likely to have a positive depression screen or a diagnosis for depression.After adjustment for confounders, NH Black women with a positive depression screen were about half as likely to have a diagnosis of depression during pregnancy as NH White women.Awareness of the differing prevalence of depression risk screening results, diagnoses and potential for variation in diagnosis may identify opportunities to improve equity in the delivery of essential mental health care to all patients.
Topics: Pregnancy; Female; Humans; Young Adult; Adult; Depression, Postpartum; Retrospective Studies; Prevalence; Ethnicity; Racial Groups; Postpartum Period
PubMed: 37963220
DOI: 10.1080/07853890.2023.2281507 -
Trends in Psychiatry and Psychotherapy 2017Prevalence rates of postpartum depression (PPD) vary widely, depending on the methodological parameters used in studies: differences in study populations, diagnostic... (Review)
Review
INTRODUCTION:
Prevalence rates of postpartum depression (PPD) vary widely, depending on the methodological parameters used in studies: differences in study populations, diagnostic methods, and postpartum time frame. There is also no consensus on the ideal time to perform screening, on whether PPD can only be diagnosed in the early postnatal period, or on how soon after a delivery depression may be related to it.
OBJECTIVE:
To review which instruments have been used over recent years to screen and diagnose PPD and the prevailing periods of diagnosis.
METHODS:
Only articles published within 5 years and related exclusively to screening and diagnosis were selected. The sample comprised 22 articles.
RESULTS:
The Edinburgh Posnatal Depression Scale (EPDS) was the most common screening tool, used in 68% of the sample (15 articles), followed by the Beck Depression Inventory (BDI-II) (27%, 6 articles), and the Patient Health Questionnaire-9 (PHQ-9) (18%, 4 articles). Screening time frame was reported in 21/22 articles: 0 to 3 months postpartum in 9 (43%), up to 6 months in 4 (19%), and up to 12 months or more in 8 (38%). In short, 13 articles screened during the first 6 months (59%) while only 8 (36%) screened up to 1 year.
CONCLUSION:
The most frequent PPD diagnosis tool was the EPDS, but other scales were also used. The most common period for diagnosis was up to 3 months postpartum. However, some researchers diagnosed PPD 12 months or more postpartum. Greater standardization of parameters for investigation of this disease is needed.
Topics: Depression, Postpartum; Female; Humans; Psychiatric Status Rating Scales; Time Factors
PubMed: 28403324
DOI: 10.1590/2237-6089-2016-0034 -
Archives of Women's Mental Health Dec 2022The study aimed to quantify and compare rate of parental postpartum depression (PPD) among medical residents to that of the general population and identify potential...
The study aimed to quantify and compare rate of parental postpartum depression (PPD) among medical residents to that of the general population and identify potential areas of further support for resident parents. Our team, University of Nebraska Medical Center (UNMC) OB/GYN and Creighton Psychiatry departments, developed and disseminated 22 item anonymous survey distributed via email link to targeted specialties as well as the "Physician Mom's Group" on Facebook. The survey included both quantitative and qualitative measures on medical resident and resident partner mental health, demographics, specialty, year in residency, support from residency program, parental leave, and an open comment section. Seventy-two resident parents, 64% of whom were female, completed the survey. 42% of female respondents reported feeling they suffered from PPD symptoms, representing more than four times the rate of PPD within the general population (11%). Only 12% of these women reported having sought treatment or were diagnosed with PPD. Male residents did not report an increased rate of depressive symptoms; however, 19% of respondents believed their partner's symptoms were consistent with PPD. Responses from the survey and open-ended questions emphasized need for emotional support, transparency in programmatic leave policy, breastfeeding accommodations, and additional parental leave time. This is the first study of its kind to examine PPD among both male and female medical resident parents. Limitations of the study included small sample size, which impacted statistical significance. The data and commentary are nonetheless useful in highlighting risk of PPD amongst medical residents and indicate further study is warranted.
Topics: Female; Humans; Male; Internship and Residency; Surveys and Questionnaires; Physicians; Breast Feeding; Mental Health; Depression, Postpartum
PubMed: 36434278
DOI: 10.1007/s00737-022-01271-3 -
Archives of Women's Mental Health Feb 2015Nearly 20 % of mothers will experience an episode of major or minor depression within the first 3 months postpartum, making it the most common complication of... (Review)
Review
Nearly 20 % of mothers will experience an episode of major or minor depression within the first 3 months postpartum, making it the most common complication of childbearing. Postpartum depression (PPD) is significantly undertreated, and because prospective mothers are especially motivated for self-care, a focus on the prevention of PPD holds promise of clinical efficacy. This study is a qualitative review of existing approaches to prevent PPD. A PubMed search identified studies of methods of PPD prevention. The search was limited to peer-reviewed, published, English-language, randomized controlled trials (RCTs) of biological, psychological, and psychosocial interventions. Eighty articles were initially identified, and 45 were found to meet inclusion criteria. Eight RCTs of biological interventions were identified and 37 RCTs of psychological or psychosocial interventions. Results were mixed, with 20 studies showing clear positive effects of an intervention and 25 showing no effect. Studies differed widely in screening, population, measurement, and intervention. Among biological studies, anti-depressants and nutrients provided the most evidence of successful intervention. Among psychological and psychosocial studies, 13/17 successful trials targeted an at-risk population, and 4/7 trials using interpersonal therapy demonstrated success of the intervention versus control, with a further two small studies showing trends toward statistical significance. Existing approaches to the prevention of PPD vary widely, and given the current literature, it is not possible to identify one approach that is superior to others. Interpersonal therapy trials and trials that targeted an at-risk population appear to hold the most promise for further study.
Topics: Depression, Postpartum; Female; Humans; Mothers; Psychotherapy; Randomized Controlled Trials as Topic; Social Support
PubMed: 25422150
DOI: 10.1007/s00737-014-0475-y -
Dialogues in Clinical Neuroscience Dec 2023Postpartum depression has deleterious effects on childbearing persons globally. Existing treatments have been largely extrapolated from those for other forms of... (Review)
Review
Postpartum depression has deleterious effects on childbearing persons globally. Existing treatments have been largely extrapolated from those for other forms of depression and have included pharmacotherapy, psychotherapy, and neuromodulation. Hormonal treatments with oestrogen and progestogens, thought to be a rational approach to treatment in response to an emerging literature on the pathophysiology of postpartum depression, have only limited evidence for efficacy to date. Novel antidepressant development with allopregnanolone analogues, in contrast, has proven a promising avenue for the development of rationally designed and efficacious treatments. This state-of-the-art review presents the evidence for the current standard-of-care pharmacotherapy, hormonal treatment, and emerging allopregnanolone analogues for the treatment of postpartum depression along with a discussion of the current understanding of its neuroactive steroid-driven pathophysiology.
Topics: Female; Humans; Depression, Postpartum; Pregnanolone; Antidepressive Agents; Psychotherapy
PubMed: 37796239
DOI: 10.1080/19585969.2023.2262464 -
Preventing Chronic Disease Nov 2023Postpartum depression is a serious public health problem that can adversely impact mother-child interactions. Few studies have examined depressive symptoms in the later...
INTRODUCTION
Postpartum depression is a serious public health problem that can adversely impact mother-child interactions. Few studies have examined depressive symptoms in the later (9-10 months) postpartum period.
METHODS
We analyzed data from the 2019 Pregnancy Risk Assessment Monitoring System (PRAMS) linked with data from a telephone follow-up survey administered to PRAMS respondents 9 to 10 months postpartum in 7 states (N = 1,954). We estimated the prevalence of postpartum depressive symptoms (PDS) at 9 to 10 months overall and by sociodemographic characteristics, prior depression (before or during pregnancy), PDS at 2 to 6 months, and other mental health characteristics. We used unadjusted prevalence ratios (PRs) to examine associations between those characteristics and PDS at 9 to 10 months. We also examined prevalence and associations with PDS at both time periods.
RESULTS
Prevalence of PDS at 9 to 10 months was 7.2%. Of those with PDS at 9 to 10 months, 57.4% had not reported depressive symptoms at 2 to 6 months. Prevalence of PDS at 9 to 10 months was associated with having Medicaid insurance postpartum (PR = 2.34; P = .001), prior depression (PR = 4.03; P <.001), and current postpartum anxiety (PR = 3.58; P <.001). Prevalence of PDS at both time periods was 3.1%. Of those with PDS at both time periods, 68.5% had prior depression.
CONCLUSION
Nearly 3 in 5 women with PDS at 9 to 10 months did not report PDS at 2 to 6 months. Screening for depression throughout the first postpartum year can identify women who are not symptomatic early in the postpartum period but later develop symptoms.
Topics: Pregnancy; United States; Female; Humans; Depression; Postpartum Period; Depression, Postpartum; Risk Assessment; Prevalence
PubMed: 37943725
DOI: 10.5888/pcd20.230107 -
Biochemical Pharmacology Jan 2022Women are nearly twice as likely to develop mood disorders compared with men, and incidence is greatest during reproductive transitions, including pregnancy and... (Review)
Review
Women are nearly twice as likely to develop mood disorders compared with men, and incidence is greatest during reproductive transitions, including pregnancy and postpartum. Because these periods are characterized by dramatic hormonal and physiologic changes, there is heightened susceptibility to external factors, such as exposure to environmental toxicants, which may play a role in maternal psychopathology. The purpose of this scoping review was to provide an overview of studies conducted in humans and animal models on the effects of nonoccupational exposure to environmental chemicals on maternal psychopathology during the perinatal period. The largest number of studies examined exposure to environmental tobacco smoke and antenatal depression and showed consistently positive findings, although more prospective studies using biomarkers for exposure assessment are needed. The few studies examining persistent organic pollutants such as polybrominated diphenyl ethers and perinatal depression were consistent in showing associations with increased depressive symptoms. Results were mixed for exposure to heavy metals and non-persistent chemicals, but a strong literature in animal models supported an association between bisphenols and phthalates and reduced maternal behavior and care of pups after parturition. Biological mechanisms may include endocrine disruption, neurotransmitter system impairment, alterations in gene expression, and immune activation and inflammation. Additional longitudinal studies that include biospecimen collection are essential to furthering the understanding of how environmental toxicants during pregnancy may affect perinatal psychopathology and the underlying mechanisms of action. Future work should also leverage the parallels between animal and human maternal behavior, thereby highlighting the opportunity for multidisciplinary work in this avenue.
Topics: Animals; Depression, Postpartum; Environmental Exposure; Environmental Pollutants; Female; Humans; Maternal Exposure; Mental Disorders; Postpartum Period; Pregnancy
PubMed: 34774531
DOI: 10.1016/j.bcp.2021.114835