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Frontiers in Neuroendocrinology Jan 2019This review aims to summarize the diverse proposed pathophysiological mechanisms contributing to postpartum depression, highlighting both clinical and basic science... (Review)
Review
This review aims to summarize the diverse proposed pathophysiological mechanisms contributing to postpartum depression, highlighting both clinical and basic science research findings. The risk factors for developing postpartum depression are discussed, which may provide insight into potential neurobiological underpinnings. The evidence supporting a role for neuroendocrine changes, neuroinflammation, neurotransmitter alterations, circuit dysfunction, and the involvement of genetics and epigenetics in the pathophysiology of postpartum depression are discussed. This review integrates clinical and preclinical findings and highlights the diversity in the patient population, in which numerous pathophysiological changes may contribute to this disorder. Finally, we attempt to integrate these findings to understand how diverse neurobiological changes may contribute to a common pathological phenotype. This review is meant to serve as a comprehensive resource reviewing the proposed pathophysiological mechanisms underlying postpartum depression.
Topics: Animals; Depression, Postpartum; Epigenesis, Genetic; Female; Humans; Hypothalamo-Hypophyseal System; Inflammation; Pituitary-Adrenal System
PubMed: 30552910
DOI: 10.1016/j.yfrne.2018.12.001 -
Annual Review of Clinical Psychology 2013Postpartum depression (PPD) is a common and serious mental health problem that is associated with maternal suffering and numerous negative consequences for offspring.... (Review)
Review
Postpartum depression (PPD) is a common and serious mental health problem that is associated with maternal suffering and numerous negative consequences for offspring. The first six months after delivery may represent a high-risk time for depression. Estimates of prevalence range from 13% to 19%. Risk factors mirror those typically found with major depression, with the exception of postpartum-specific factors such as sensitivity to hormone changes. Controlled trials of psychological interventions have validated a variety of individual and group interventions. Medication often leads to depression improvement, but in controlled trials there are often no significant differences in outcomes between patients in the medication condition and those in placebo or active control conditions. Reviews converge on recommendations for particular antidepressant medications for use while breastfeeding. Prevention of PPD appears to be feasible and effective. Finally, there is a growing movement to integrate mental health screening into routine primary care for pregnant and postpartum women and to follow up this screening with treatment or referral and with follow-up care. Research and clinical recommendations are made throughout this review.
Topics: Adult; Depression, Postpartum; Female; Forecasting; Humans; Pregnancy
PubMed: 23394227
DOI: 10.1146/annurev-clinpsy-050212-185612 -
Annual Review of Medicine Jan 2019Postpartum depression (PPD) is common, disabling, and treatable. The strongest risk factor is a history of mood or anxiety disorder, especially having active symptoms... (Review)
Review
Postpartum depression (PPD) is common, disabling, and treatable. The strongest risk factor is a history of mood or anxiety disorder, especially having active symptoms during pregnancy. As PPD is one of the most common complications of childbirth, it is vital to identify best treatments for optimal maternal, infant, and family outcomes. New understanding of PPD pathophysiology and emerging therapeutics offer the potential for new ways to add to current medications, somatic treatments, and evidence-based psychotherapy. The benefits and potential harms of treatment, including during breastfeeding, are presented.
Topics: Adult; Antidepressive Agents; Depression, Postpartum; Female; Humans; Incidence; Pregnancy; Prognosis; Psychotherapy; Risk Assessment; Severity of Illness Index; Treatment Outcome
PubMed: 30691372
DOI: 10.1146/annurev-med-041217-011106 -
Obstetrics and Gynecology Clinics of... Sep 2020Perinatal care, including the management of mental health issues, often falls under the auspices of primary care providers. Postpartum depression (PPD) is a common... (Review)
Review
Perinatal care, including the management of mental health issues, often falls under the auspices of primary care providers. Postpartum depression (PPD) is a common problem that affects up to 15% of women. Most women at risk can be identified before delivery based on psychiatric history, symptoms during pregnancy, and recent psychosocial stressors. Fortunately, there have been a variety of treatment studies using antidepressants, nonpharmacologic interactions, and most recently, allopregnanolone (Brexanolone) infusion that have shown benefits. The most commonly used screening scale, Edinburgh Postnatal Depression Scale, a 10-item self-rated scale, has been translated into a variety of languages.
Topics: Adult; Antidepressive Agents; Depression, Postpartum; Drug Combinations; Female; Humans; Infant; Mass Screening; Neurosteroids; Perinatal Care; Postpartum Period; Pregnancy; Pregnanolone; Prevalence; Psychiatric Status Rating Scales; Psychotherapy; Risk Factors; Selective Serotonin Reuptake Inhibitors; Surveys and Questionnaires; beta-Cyclodextrins
PubMed: 32762926
DOI: 10.1016/j.ogc.2020.05.001 -
Current Psychiatry Reports Dec 2022As maternal mortality climbs in the USA with mental health conditions driving these preventable deaths, the field of reproductive psychiatry must shift towards... (Review)
Review
PURPOSE OF REVIEW
As maternal mortality climbs in the USA with mental health conditions driving these preventable deaths, the field of reproductive psychiatry must shift towards identification of women and other birthing individuals at risk and facilitating access. This review brings together recent studies regarding risk of perinatal depression and highlights important comorbidities that place individuals at higher vulnerability to poor perinatal outcomes.
RECENT FINDINGS
Recent research suggests that identifying risk for perinatal depression including historical diagnoses of depression, anxiety, trauma, and comorbid substance use and intimate partner violence may move the field to focus on preventive care in peripartum populations. Emerging data shows stark health inequities in racial and ethnic minority populations historically marginalized by the health system and in other vulnerable groups such as LGBTQ+ individuals and those with severe mental illness. Innovative models of care using systems-level approaches can provide opportunities for identification and risk analyses of vulnerable peripartum patients and facilitate access to therapeutic or preventive interventions. Utilizing intergenerational approaches and leveraging multidisciplinary teams that thoughtfully target high-risk women and other birthing individuals could promote significant changes to population-level care in maternal health.
Topics: Pregnancy; Female; Humans; Depression, Postpartum; Ethnicity; Minority Groups; Anxiety Disorders; Anxiety; Depression; Postpartum Period
PubMed: 36422834
DOI: 10.1007/s11920-022-01392-7 -
American Journal of Obstetrics and... Apr 2009Postpartum depression (PPD) affects up to 15% of mothers. Recent research has identified several psychosocial and biologic risk factors for PPD. The negative short-term... (Review)
Review
Postpartum depression (PPD) affects up to 15% of mothers. Recent research has identified several psychosocial and biologic risk factors for PPD. The negative short-term and long-term effects on child development are well-established. PPD is under recognized and under treated. The obstetrician and pediatrician can serve important roles in screening for and treating PPD. Treatment options include psychotherapy and antidepressant medication. Obstacles to compliance with treatment recommendations include access to psychotherapists and concerns of breastfeeding mothers about exposure of the infant to antidepressant medication. Further research is needed to examine systematically the short-term and long-term effect of medication exposure through breastmilk on infant and child development.
Topics: Dangerous Behavior; Depression, Postpartum; Female; Humans; Risk Factors
PubMed: 19318144
DOI: 10.1016/j.ajog.2008.11.033 -
The American Journal of Nursing Jul 2021Despite extensive research, the etiology behind postpartum depression (PPD) remains a mystery. Experts have theorized about various potential risk factors, including... (Review)
Review
Despite extensive research, the etiology behind postpartum depression (PPD) remains a mystery. Experts have theorized about various potential risk factors, including hormonal fluctuations, genetics, prior history of depression, low socioeconomic status, adolescent pregnancy, and certain personality traits. This article provides foundational information about PPD, reviewing the risk factors for and the consequences of this mood disorder. Postpartum blues and postpartum psychosis are briefly discussed for context, although they differ from PPD. Screening and treatment options are explained, and nursing implications for practice are presented.
Topics: Depression, Postpartum; Female; Humans; Maternal-Child Nursing; Mother-Child Relations; Risk Factors; Sexual Partners
PubMed: 34117132
DOI: 10.1097/01.NAJ.0000756516.95992.8e -
Hormones and Behavior Jan 2016This article is part of a Special Issue "Parental Care". Pregnancy and postpartum are associated with dramatic alterations in steroid and peptide hormones which alter... (Review)
Review
This article is part of a Special Issue "Parental Care". Pregnancy and postpartum are associated with dramatic alterations in steroid and peptide hormones which alter the mothers' hypothalamic pituitary adrenal (HPA) and hypothalamic pituitary gonadal (HPG) axes. Dysregulations in these endocrine axes are related to mood disorders and as such it should not come as a major surprise that pregnancy and the postpartum period can have profound effects on maternal mood. Indeed, pregnancy and postpartum are associated with an increased risk for developing depressive symptoms in women. Postpartum depression affects approximately 10-15% of women and impairs mother-infant interactions that in turn are important for child development. Maternal attachment, sensitivity and parenting style are essential for a healthy maturation of an infant's social, cognitive and behavioral skills and depressed mothers often display less attachment, sensitivity and more harsh or disrupted parenting behaviors, which may contribute to reports of adverse child outcomes in children of depressed mothers. Here we review, in honor of the "father of motherhood", Jay Rosenblatt, the literature on postnatal depression in the mother and its effect on mother-infant interactions. We will cover clinical and pre-clinical findings highlighting putative neurobiological mechanisms underlying postpartum depression and how they relate to maternal behaviors and infant outcome. We also review animal models that investigate the neurobiology of maternal mood and disrupted maternal care. In particular, we discuss the implications of endogenous and exogenous manipulations of glucocorticoids on maternal care and mood. Lastly we discuss interventions during gestation and postpartum that may improve maternal symptoms and behavior and thus may alter developmental outcome of the offspring.
Topics: Adult; Animals; Child Development; Depression; Depression, Postpartum; Female; Humans; Infant; Maternal Behavior; Mother-Child Relations; Mothers; Postpartum Period; Pregnancy; Risk Factors
PubMed: 26319224
DOI: 10.1016/j.yhbeh.2015.08.008 -
Clinical Psychology Review Dec 2013This meta-analysis assessed the efficacy of a wide range of preventive interventions designed to reduce the severity of postpartum depressive symptoms or decrease the... (Meta-Analysis)
Meta-Analysis Review
This meta-analysis assessed the efficacy of a wide range of preventive interventions designed to reduce the severity of postpartum depressive symptoms or decrease the prevalence of postpartum depressive episodes. A systematic review identified 37 randomized or quasi-randomized controlled trials in which an intervention was compared to a control condition. Differences between treatment and control conditions in the level of depressive symptoms and prevalence of depressive episodes by 6 months postpartum were assessed in separate analyses. Depressive symptoms were significantly lower at post-treatment in intervention conditions, with an overall effect size in the small range after exclusion of outliers (Hedges' g=0.18). There was a 27% reduction in the prevalence of depressive episodes in intervention conditions by 6 months postpartum after removal of outliers and correction for publication bias. Later timing of the postpartum assessment was associated with smaller differences between intervention and control conditions in both analyses. Among studies that assessed depressive symptoms using the EPDS, higher levels of depressive symptoms at pre-treatment were associated with smaller differences in depressive symptoms by 6 months postpartum. These findings suggest that interventions designed to prevent postpartum depression effectively reduce levels of postpartum depressive symptoms and decrease risk for postpartum depressive episodes.
Topics: Depression; Depression, Postpartum; Female; Humans; Psychotherapy; Treatment Outcome
PubMed: 24211712
DOI: 10.1016/j.cpr.2013.10.004 -
The Nursing Clinics of North America Dec 2019Postpartum depression (PPD) affects10% to 20% of women within the first year after birth and 25% beyond the first year. PPD, despite advances in diagnosis and treatment,... (Review)
Review
Postpartum depression (PPD) affects10% to 20% of women within the first year after birth and 25% beyond the first year. PPD, despite advances in diagnosis and treatment, remains underdiagnosed and misunderstood. Women do not always display signs of PPD while in care for delivery of the infant and may not discuss mood changes to their primary care provider at discharge and first post-delivery appointment. Identifying screening and treatment options for non-mental health providers was the purpose of this article.
Topics: Depression, Postpartum; Drug Therapy; Female; Humans; Mass Screening; Nurse's Role; Psychiatric Status Rating Scales; Risk Factors
PubMed: 31703781
DOI: 10.1016/j.cnur.2019.07.006