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PloS One 2024Approximately 10 to 20% of pregnant women worldwide experience perinatal depression (PND), a depressive episode with onset during pregnancy or after childbirth. We...
BACKGROUND
Approximately 10 to 20% of pregnant women worldwide experience perinatal depression (PND), a depressive episode with onset during pregnancy or after childbirth. We performed a systematic review to identify, summarize and discuss studies on inflammatory biomarkers described in relation to PND.
METHOD
Inclusion criteria defined the selection of observational studies written in English, French, Spanish or Portuguese, that evaluate analytical levels of inflammatory molecules (protein levels) in biological fluids in women, with a diagnosis of depression using ICD/DSM diagnostic criteria or depressive symptoms assessed by standardized psychometric instruments, during pregnancy and/or postpartum. Case reports, experimental studies, reviews, qualitative analysis, meta-analysis, gray literature or replicated data were excluded. Three electronic databases were used for search (Pubmed, Web of Science and PsychInfo) and quality assessment of selected studies were performed using the Newcastle-Ottawa Scale. Data extraction included study design; number of subjects; obstetric information; tools and timepoints of depression and inflammatory markers assessment.
RESULTS
56 studies (sample size for cross-sectional and case-control studies ranging from 10 to 469; sample size for longitudinal studies ranging from 26 to 467), where the major aim was to analyze the association between depression and inflammatory biomarkers during pregnancy and postpartum period were included in this systematic review. Overall, the findings of our systematic review lend support to the hypothesis that several inflammatory markers may be associated with peripartum depressive symptoms. The associations were somewhat different looking at pregnancy compared to the delivery time-point and postpartum, and mainly referred to increased levels of IL-6, IL-8, CRP and TNF-α among depressed.
DISCUSSION
In summary, our systematic review findings provide evidence supporting the hypothesis that several inflammatory markers may correlate with peripartum depressive symptoms. However, our work also highlighted notable differences in the timing of biological sampling for inflammatory markers and in the methodologies used to assess depression during the perinatal period. Additionally, variations were observed in how inflammatory biomarkers and depression were approached, including their classification as exposure or outcome variables, and the timing of assessments. It is essential for future research to investigate the influence of biological fluids and the timing of assessments for both inflammatory biomarkers and depression to gain a deeper understanding of their association. This comprehensive exploration is pivotal for elucidating the intricate relationship between inflammation and perinatal depression.
Topics: Humans; Female; Pregnancy; Biomarkers; Pregnancy Complications; Depression; Inflammation; Depression, Postpartum
PubMed: 38820411
DOI: 10.1371/journal.pone.0280612 -
BMC Psychology May 2024This review seeks to examine the current state of postpartum social support and psychosocial conditions among women around the world, as well as explore the relationship...
PURPOSE
This review seeks to examine the current state of postpartum social support and psychosocial conditions among women around the world, as well as explore the relationship between these factors. Additionally, it aims to propose a logical framework for enhancing postpartum social support and psychosocial conditions in this population.
METHODS
Following the development of a search strategy, two databases, PubMed and Science Direct, were searched for studies published between January 2019 and May 2023. The search was conducted throughout the entire month of May 2023. The risk of bias in the included cross-sectional studies was assessed using the Newcastle-Ottawa Quality Assessment Scale, which was adapted for this specific study design. To determine if the main objective of the cross-sectional studies was to investigate the relationship between social support and postpartum psychosocial conditions, a review was conducted based on the AMSTAR checklist, PRISMA checklist and PRISMA flow diagram. Data extraction was performed with the consensus of two authors, and a narrative synthesis approach was chosen for data synthesis, following the guidelines provided by the Centre for Reviews and Dissemination (CRD).
RESULTS
Eleven cross-sectional studies were included in the final analysis. Our findings revealed that all reviewed studies provided evidence of a positive association between social support and healthy psychosocial conditions in postpartum period. However, due to the absence of standardized measurement indicators to identify and compare the outcomes of various studies, there was a need to develop a conceptual framework that could enhance our understanding of the postpartum psychosocial condition including anxiety, depression, unfavorable quality of life and social support status up to 24 month after child birth. This framework aimed to incorporate childbirth and motherhood as "stressful events," while considering social support as a crucial "coping resource." Furthermore, it acknowledged empowerment, help-seeking behavior, and peer support as important "coping actions," alongside implementing client-centered interventions. Lastly, it recognized postpartum mental health and optimal quality of life as significant "effects" of these factors.
CONCLUSIONS
The proposed conceptual framework could define postpartum women's health as "the ability to adapt and self-manage."
Topics: Humans; Social Support; Female; Postpartum Period; Adaptation, Psychological; Depression, Postpartum; Cross-Sectional Studies; Pregnancy
PubMed: 38807228
DOI: 10.1186/s40359-024-01814-6 -
Psychopharmacology Jul 2024Zuranolone, a newly FDA-approved synthetic neurosteroid, shows promise in treating depression. (Meta-Analysis)
Meta-Analysis Review
RATIONALE
Zuranolone, a newly FDA-approved synthetic neurosteroid, shows promise in treating depression.
OBJECTIVES
Our aim is to evaluate Zuranolone's efficacy and safety in treating depression.
METHODS
Five databases were searched until September 2023 for relevant randomized clinical trials evaluating the efficacy and safety of zuranolone. The potential risk of bias in the included trials was evaluated by the Cochrane Risk of Bias II guideline Data were extracted and pooled using Review Manager Software (RevMan 5.3).
RESULTS
An analysis of eight studies highlights Zuranolone's efficacy in treating depression compared to placebo across most of the outcomes. Notably, the 30mg and 50mg doses demonstrated significant improvements in reducing HAM-D scores by over 50% within a 15-day follow-up (RR) of 1.46 (95% CI [1.27, 1.68], p < 0.0001) and 1.14 (95% CI [1.01, 1.3], p = 0.04). Additionally, the HAM-D ≤ 7% score analysis revealed significant enhancements with the 30mg dose over both 15-day (RR = 1.82, 95% CI [1.44, 2.31], p < 0.0001) and 45-day (RR = 1.43, 95% CI [1.16, 1.77], p = 0.0008) durations. Adverse Events Drug Discontinuation demonstrated no overall significant difference (OR = 1.33, 95% CI: [0.79, 2.23], p = 0.282). Further, specific adverse events, such as headache, showed no significant overall difference between Zuranolone and placebo (OR = 1.11, 95% CI: [0.84, 1.47], p = 0.47), with dose-dependent analysis revealing less headache in the 30 mg group.
CONCLUSION
Zuranolone demonstrates favorable tolerability and safety, particularly at 30mg and 50mg doses after 15 days, suggesting its potential and effective treatment for depression.
Topics: Humans; Randomized Controlled Trials as Topic; Antidepressive Agents; Depression; Dose-Response Relationship, Drug; Treatment Outcome; Pregnanolone; Pyrazoles
PubMed: 38802705
DOI: 10.1007/s00213-024-06611-y -
Journal of Clinical Medicine May 2024Postpartum depression is usually defined as a major depressive episode that occurs shortly after childbirth. This condition is most commonly found in females; however,... (Review)
Review
Postpartum depression is usually defined as a major depressive episode that occurs shortly after childbirth. This condition is most commonly found in females; however, paternal postpartum depression has begun to attract more research attention. This study aims to identify different instruments for measuring this mental health problem and to detect risk factors as well as the main sources of resilience in paternal postpartum depression. A literature review was conducted following the PRISMA method. After analyzing 10 articles, it was determined that the Edinburgh Postpartum Depression Scale is the most widely used instrument for the diagnosis of postpartum depression in the female population, and after several studies, it has already been validated for the male sex. After several studies were analyzed to highlight the main risk factors for paternal postpartum depression, it was established that the most influential factor is male gender role stress. These findings highlight the traditional role of fathers today. Most health professionals see the mother as the priority. Paternal depression is a major problem for mothers and fathers today, as well as for the newborn. As time goes on, there is a growing need to incorporate fathers into current and future mental health programs to be able to provide the necessary support.
PubMed: 38792491
DOI: 10.3390/jcm13102949 -
Diseases (Basel, Switzerland) Apr 2024Postpartum depression (PPD) is a significant global health concern with profound implications for mothers, families, and societies. This systematic review aims to... (Review)
Review
Postpartum depression (PPD) is a significant global health concern with profound implications for mothers, families, and societies. This systematic review aims to synthesize current research findings to understand better how personality traits, as assessed by the NEO Five-Factor Inventory (NEO-FFI), contribute to the development and progression of PPD. Conducted in January 2024, this review searched major databases like PubMed, PsycINFO, and Scopus up to December 2023, focusing on the NEO-FFI's role in evaluating PPD. Following PRISMA guidelines, studies were selected based on strict criteria, including the exclusive use of NEO-FFI for personality assessment and a focus on postpartum women. A total of seven studies were included after a rigorous two-step screening process, and their data were qualitatively synthesized. The review covered a total of 4172 participants, with a prevalence of clinically significant postpartum depression symptoms ranging from 10.6% to 51.7%. Notably, Neuroticism emerged as a significant predictor of PPD, with odds ratios ranging from 1.07 (95% CI: 0.96-1.20) in some studies to as high as 1.87 (95% CI: 1.53-2.27) in others. In contrast, traits like Extraversion and Conscientiousness generally showed protective effects, with lower scores associated with reduced PPD risk. For instance, Extraversion scores correlated negatively with PPD risk (Beta = -0.171) in one study. However, the impact of other traits such as Openness and Agreeableness on PPD risk was less clear, with some studies indicating negligible effects. The review highlights Neuroticism as a consistent and significant predictor of PPD risk, with varying impacts from other personality traits. The findings suggest potential pathways for targeted interventions in maternal mental health care, emphasizing the need for comprehensive personality evaluations in prenatal and postnatal settings.
PubMed: 38785737
DOI: 10.3390/diseases12050082 -
Neuropsychiatric Disease and Treatment 2024To determine whether perioperative esketamine use decreases the risk of postpartum depression (PPD). (Review)
Review
PURPOSE
To determine whether perioperative esketamine use decreases the risk of postpartum depression (PPD).
METHODS
Online search of PubMed, Web of Science, and Embase was conducted to identify relevant studies. Key words for search included, but were not limited to, postpartum depression, esketamine, and clinical trials. The mean and standard deviation of the Edinburgh Postnatal Depression Scale (EPDS) scores were extracted from the studies as primary parameters.
RESULTS
The literature search identified 226 articles, of which 5 met the criteria and were enrolled in the study. In total, 886 patients in the studies were taken into analysis. The EPDS scores in the esketamine group were lower than those of the control group at the early stage of puerperium (WMD=-2.05, 95% CI: -3.77, -0.34, =0.019), whereas there was no significant difference at the middle and later stages (WMD=-1.41, 95% CI: -2.86, 0.04, =0.056). The sensitivity analyses indicated that the result for the early stage was stable, whereas it was unreliable for the middle and later stages. The results of the Egger's test indicated no publication bias.
CONCLUSION
Perioperative use of esketamine contributes to a lower risk of PPD at the early stage of puerperium but not at the middle and later stages. To further verify this conclusion, more high-quality studies are required.
PubMed: 38770534
DOI: 10.2147/NDT.S451930 -
BMC Pregnancy and Childbirth May 2024
PubMed: 38760768
DOI: 10.1186/s12884-024-06576-y -
Psychoneuroendocrinology Aug 2024Allopregnanolone (ALLO) is a metabolite of progesterone and a neuroactive steroid hormone. As a positive allosteric modulator of gamma-aminobutyric acid (GABA)...
BACKGROUND
Allopregnanolone (ALLO) is a metabolite of progesterone and a neuroactive steroid hormone. As a positive allosteric modulator of gamma-aminobutyric acid (GABA) receptors, ALLO seems to have antidepressant and anxiolytic effects, and was therefore approved as a specific medication for the treatment of postpartum depression in 2019. Despite the growing number of publications investigating ALLO levels, results on the biological and psychological correlates in the peripartum period remain inconsistent, possibly due to methodological challenges regarding measurement. To date, however, there is no systematic review examining the correlates, concentrations, and challenges in measuring ALLO in peripartum women.
METHOD
A systematic literature search of PubMed and PsycINFO was conducted in August 2023. Original research articles that measured ALLO concentrations in peripartum women were included. Reports were excluded if they were not original research, included non-human subjects, did not include peripartum women, did not include ALLO measurement as an outcome, included (pharmacological) interventions, constituted method validations, or used the same cohort as another study.
RESULTS
The literature search yielded 234 articles, and two articles were identified from other sources. After full-text screening, 19 articles (N = 1401) met the inclusion criteria, of which seven focused on biological correlates of ALLO and 12 on mood correlates. Of the latter, six found no association between ALLO and mood, four found a negative association, and two found a positive association. Overall, the results show an increase in ALLO levels during pregnancy and a decrease after birth, with levels then remaining low until six months postpartum. ALLO was most commonly measured in blood plasma and by gas chromatography-mass spectrometry (GC-MS). A significant matrix effect was found for blood serum and a significant method effect for radioimmunoassays (RIAs). A significant effect of time of measurement was found.
CONCLUSION
ALLO measurement shows method and matrix effects. ALLO levels are higher when measured in serum compared to in plasma, and when measured using RIA compared to other methods. Time of measurement, study design, and standardization of measurement also influence the reliability of measurement and the interpretation of results.
Topics: Humans; Pregnanolone; Female; Peripartum Period; Pregnancy; Depression, Postpartum; Adult
PubMed: 38759520
DOI: 10.1016/j.psyneuen.2024.107081 -
Frontiers in Neuroscience 2024Current treatment modalities for Major Depressive Disorder have variable efficacies and a variety of side effects. To amend this, many trials for short term, well...
BACKGROUND
Current treatment modalities for Major Depressive Disorder have variable efficacies and a variety of side effects. To amend this, many trials for short term, well tolerated monotherapies are underway. One such option is Zuranolone (SAGE-217), which is a recent FDA approved antidepressant for depression (PPD) and is undergoing clinical trials for PPD, major depressive disorder (MDD) and essential tremors (ET).
OBJECTIVES
Pool currently available data that compare Zuranolone to Placebo for the treatment of Major Depressive Disorder and evaluate its efficacy and safety profile.
METHODS
We retrieved data from PUBMED and SCOPUS from inception to July 2023. We included articles comparing Zuranolone or SAGE 217 with placebo in patients suffering from Major Depressive Disorder. Review Manager 5.4 was used to analyze the outcomes including changes in the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Montgomery-Åsberg Depression Rating Scale (MADRS) scores from baseline as well as any treatment emergent adverse events (TEAEs) and severe adverse events.
RESULTS
Our review analyzed 4 trials and the data of 1,357 patients. Patients treated with Zuranolone indicated a statistically significant effect in the change from baseline in HAM-D score ( = 0.0009; MD [95% CI]: -2.03 [-3.23, -0.84]) as well as in MADRS score ( = 0.02; MD [95% CI]: -2.30[-4.31, -0.30]) and HAM-A score ( = 0.03; MD [95% CI]: -1.41[-2.70, -0.11]) on 15th day when compared to the Placebo group. Zuranolone was also significantly associated with a higher response rate ( = 0.0008; OR [95% CI]: 1.63[1.14, 2.35]) and higher remission rate ( = 0.03; OR [95% CI]: 1.65[1.05, 2.59]) when compared with the placebo. As for safety, Zuranolone was significantly associated with 1 or more TEAE ( = 0.006; RR [95% CI]: 1.14[1.04, 1.24]) but an insignificant association with side effects that lead to drug discontinuation ( = 0.70; RR [95% CI]: 1.18[0.51, 2.76]) and serious adverse events ( = 0.48; RR [95% CI]: 1.46 [0.52, 4.10]) when compared with placebo.
CONCLUSION
Zuranolone is an effective and safe drug for short course major depressive disorder monotherapy. It shows results in 14 days (compared to 2-4 weeks that SSRI's take) and has anti-anxiolytic effects as well. However, only 4 trials have been used for the analysis and the sample size was small. The trials reviewed also cannot determine the long-term effects of the drug. More trials are needed to determine long term effects.
PubMed: 38726035
DOI: 10.3389/fnins.2024.1361692 -
Frontiers in Psychiatry 2024Maternal mental health problems, such as perinatal depression, are a major public health issue. In the U.S., several states have policies related to mental health during...
INTRODUCTION
Maternal mental health problems, such as perinatal depression, are a major public health issue. In the U.S., several states have policies related to mental health during pregnancy and postpartum. The extent of these laws at the state level needs to be further explored and described.
METHODS
We systematically searched the Illinois General Assembly to determine all existing legislation on the topic of perinatal mental health.
RESULTS
This search uncovered two major Acts that 1) require universal perinatal depression screening and 2) raise awareness of the symptoms and treatment options related to maternal mental health. We also discovered provisions in the law that allow for untreated or undiagnosed postpartum depression or psychosis to be considered as a mitigating factor for women who commit forcible felonies.
DISCUSSION
Through legislation, states can lead change at the systems-level to improve perinatal mental health outcomes.
PubMed: 38699448
DOI: 10.3389/fpsyt.2024.1347382