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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 -
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 -
Archivos Argentinos de Pediatria Jun 2020
Topics: Adult; Depression, Postpartum; Early Diagnosis; Female; Humans; Risk Factors
PubMed: 32470247
DOI: 10.5546/aap.2020.eng.154 -
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 -
Cleveland Clinic Journal of Medicine May 2020Perinatal depression affects 10% to 20% of women in the United States during pregnancy, the postpartum period, or both, but it can be difficult to recognize. Identifying... (Review)
Review
Perinatal depression affects 10% to 20% of women in the United States during pregnancy, the postpartum period, or both, but it can be difficult to recognize. Identifying and treating this problem can reduce the alarming number of suicides among depressed perinatal women and the possible adverse effects of untreated maternal depression on their child's cognitive and behavioral development. In this review, we discuss the latest developments in screening, treatment, and prevention methods.
Topics: Depression; Depression, Postpartum; Disease Management; Female; Humans; Pregnancy; Pregnancy Complications; Suicide; Suicide Prevention
PubMed: 32357982
DOI: 10.3949/ccjm.87a.19054 -
Current Opinion in Anaesthesiology Jun 2021Perinatal depression is a common and debilitating complication of pregnancy and childbirth. Recent studies have elucidated relationships between acute birth events on... (Review)
Review
PURPOSE OF REVIEW
Perinatal depression is a common and debilitating complication of pregnancy and childbirth. Recent studies have elucidated relationships between acute birth events on depression risk, and novel treatments for postpartum depression have been discovered and approved. This article reviews current understandings about birth events on depression, new screening standards, and novel treatments for postpartum depression.
RECENT FINDINGS
Pain, analgesia, and depression are complex traits that are inter-related during and after pregnancy. Certain individuals may benefit more than others from addressing pain and suffering around childbirth. Exposures to general anesthesia or postdural puncture headache are associated with postpartum depression symptoms, although a causal relationship is unlikely. Brexanolone, ketamine and its related compounds, and nonpharmacologic options offer new or alternative therapies for depression, although safety information for some of these treatments in pregnancy and lactation are needed. Maternal health bundles call for close attention to perinatal mental health screening with validated instruments, and for timely treatment referrals in the 'fourth trimester'.
SUMMARY
Clinical monitoring and timely treatment of depression in the perinatal and postpartum periods is critical for maternal postpartum health and recovery. Perinatal specialists and researchers should continue to focus on tailored treatments specific to this special population.
Topics: Delivery, Obstetric; Depression; Depression, Postpartum; Female; Humans; Mass Screening; Postpartum Period; Pregnancy
PubMed: 33935170
DOI: 10.1097/ACO.0000000000000998 -
Journal of Midwifery & Women's Health 2013The mainstays of treatment for peripartum depression are psychotherapy and antidepressant medications. More research is needed to understand which treatments are safe,... (Review)
Review
The mainstays of treatment for peripartum depression are psychotherapy and antidepressant medications. More research is needed to understand which treatments are safe, preferable, and effective. Postpartum depression, now termed peripartum depression by the DSM-V, is one of the most common complications in the postpartum period and has potentially significant negative consequences for mothers and their families. This article highlights common clinical challenges in the treatment of peripartum depression and reviews the evidence for currently available treatment options. Psychotherapy is the first-line treatment option for women with mild to moderate peripartum depression. Antidepressant medication in combination with therapy is recommended for women with moderate to severe depression. Although pooled case reports and small controlled studies have demonstrated undetectable infant serum levels and no short-term adverse events in infants of mothers breastfeeding while taking sertraline (Zoloft) and paroxetine (Paxil), further research is needed including larger samples and long-term follow-up of infants exposed to antidepressants via breastfeeding controlling for maternal depression. Pharmacologic treatment recommendations for women who are lactating must include discussion with the patient regarding the benefits of breastfeeding, risks of antidepressant use during lactation, and risks of untreated illness. There is a growing evidence base for nonpharmacologic interventions including repetitive transcranial magnetic stimulation, which may offer an attractive option for women who wish to continue to breastfeed and are concerned about their infants being exposed to medication. Among severe cases of peripartum depression with psychosis, referral to a psychiatrist or psychiatric advanced practice registered nurse is warranted. Suicidal or homicidal ideation with a desire, intent, or plan to harm oneself or anyone else, including the infant, is a psychiatric emergency, and an evaluation by a mental health professional should be conducted immediately. Peripartum depression treatment research is limited by small sample sizes and few controlled studies. Much work is still needed to better understand which treatments women prefer and are the most effective in ameliorating the symptoms and disease burden associated with peripartum depression.
Topics: Antidepressive Agents; Breast Feeding; Depression, Postpartum; Female; Humans; Psychotherapy
PubMed: 24131708
DOI: 10.1111/jmwh.12104 -
Jornal de Pediatria 2013To review the literature on the association between breastfeeding and postpartum depression. (Review)
Review
OBJECTIVE
To review the literature on the association between breastfeeding and postpartum depression.
SOURCES
A review of literature found on MEDLINE/PubMed database.
SUMMARY OF FINDINGS
The literature consistently shows that breastfeeding provides a wide range of benefits for both the child and the mother. The psychological benefits for the mother are still in need of further research. Some studies point out that pregnancy depression is one of the factors that may contribute to breastfeeding failure. Others studies also suggest an association between breastfeeding and postpartum depression; the direction of this association is still unclear. Breastfeeding can promote hormonal processes that protect mothers against postpartum depression by attenuating cortisol response to stress. It can also reduce the risk of postpartum depression, by helping the regulation of sleep and wake patterns for mother and child, improving mother's self-efficacy and her emotional involvement with the child, reducing the child's temperamental difficulties, and promoting a better interaction between mother and child.
CONCLUSIONS
Studies demonstrate that breastfeeding can protect mothers from postpartum depression, and are starting to clarify which biological and psychological processes may explain this protection. However, there are still equivocal results in the literature that may be explained by the methodological limitations presented by some studies.
Topics: Breast Feeding; Child; Depression, Postpartum; Female; Humans; Mother-Child Relations; Mothers
PubMed: 23791236
DOI: 10.1016/j.jped.2012.12.002 -
Ginekologia Polska 2021Epidemiological data clearly indicate that depression is becoming an increasingly important health and social problem today. According to the World Health Organization...
Epidemiological data clearly indicate that depression is becoming an increasingly important health and social problem today. According to the World Health Organization (WHO), depression currently affects 350 million people worldwide and is considered the second most common cause of disability in Europe after ischemic heart disease. It is estimated that this health problem may affect as many as five million people in Poland. The gap between the reported number of patients treated and the prevalence of depression, highlights the scale of unmet needs. With the limited availability of specialists in psychiatric care, the most appropriate measures seem to be those aimed at increasing the competence of doctors of other specialties in the diagnosis and treatment of depression. Early detection and treatment results in faster remission, reduces relapses and mortality. The recommendations concerning prevention of depression were commissioned by the Polish Ministry of Health as a part of the Depression Prevention Program for 2016-2020. The Program has developed recommendations addressed to specialists in various fields of medicine, other than psychiatry, focusing on three risk groups: children and adolescents, women in the perinatal period and the elderly. These recommendations focus on the management of suspected postpartum depression and provide specific guidelines for medical staff having contact with pregnant and postpartum women (gynecologists, midwives, pediatricians).
Topics: Adolescent; Adult; Depression; Depression, Postpartum; Female; Humans; Poland; Pregnancy; Pregnancy Complications; Risk Factors
PubMed: 33448014
DOI: 10.5603/GP.a2020.0141