04Jan 2018

MANAGEMENT OF PERIPARTUM DEPRESSION: BETTER, PREVENT THAN TREAT!.

  • Assistant Professor, Department of Pharmacology, RAK College of Medical Sciences, RAK Medical and Health Sciences University, P.O.Box No.11172, Ras Al Khaimah, UAE.
  • Professor and Chairperson, Department of Pharmacology, RAK College of Medical Sciences, RAK Medical and Health Sciences University, P.O.Box No.11172, Ras Al Khaimah, UAE.
Crossref Cited-by Linking logo

  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Peripartum depression is one of the common mental illness affecting significant population during that period. The disease morbidity not only affects mother but also baby and spouse. Thus adequate management of this condition, has huge positive impact on the whole family. Treatment and prevention are the two dimensions of managing the ailment. Medications and psychological interventions are being used for both treatment and prevention. Selective serotonin reuptake inhibitors (SSRIs) especially sertraline are the common drugs utilized for treatment. Similarly, estrogens have shown some evidence of efficacy. Though, SSRIs are recommended during peripartum period, psychotherapy which is equally effective holds significance due to its safety profile. Psychological intervention includes psychosocial community-based intervention, cognitive behavioral therapy (CBT), interpersonal therapy (IPT). Exercise and yoga have also shown to be useful for peripartum depression. Saffron and light therapy seems to be of promise which needs to be further explored. Preventive strategies are proved to be effective in managing peripartum depression especially psychological interventions. The American College of Obstetrics and Gynecology (ACOG) and American Academy of Pediatrics (AAP) recommends screening for depression and identifying ?at risk mothers?. Thus prevention of peripartum depression has to be part of optimal antenatal care. The psychological interventions being both safe and effective seems to be the ideal to be used in this setting. Among drugs only sertraline has been shown to be good in preventing episodes of depression. Hence, ?prevention is better than treatment? holds good for peripartum depression especially by psychological interventions. The available evidence for treatment and prevention of peripartum depression is overviewed in this review.

  1. Ahokas A, Kaukoranta J, Wahlbeck K, Aito M.(2001) Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17 beta-estradiol: a preliminary study. J Clin Psychiatry., 62:332-6.
  2. Appleby L, Warner R, Whitton A, Faragher B.(1997) A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. BMJ., 314:932-6.
  3. Bloch M, Schmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR.(2000) Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry., 157:924?30.
  4. Bloch M, Meiboom H, Lorberblatt M, Bluvstein I, Aharonov I, Schreiber S.(2012) The effect of sertraline add-on to brief dynamic psychotherapy for the treatment of postpartum depression: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry., 73:235-41.
  5. Buttner MM, Brock RL, O'Hara MW, Stuart S. (2015) Efficacy of yoga for depressed postpartum women: A randomized controlled trial. Complement Ther Clin Pract., 21:94-100.
  6. Corral M, Wardrop AA, Zhang H, Grewal AK, Patton S.(2007) Morning light therapy for postpartum depression. Arch Womens Ment Health., 10:221-4.
  7. De Crescenzo F, Perelli F, Armando M, Vicari S. (2014) Selective serotonin reuptake inhibitors (SSRIs) for post-partum depression (PPD): a systematic review of randomized clinical trials. J Affect Disord., 152-4:39-44.
  8. Dennis CL, Dowswell T.(2013) Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database Syst Rev., 2:CD001134.
  9. di Scalea TL, Wisner KL.(2009) Pharmacotherapy of postpartum depression. Expert Opin Pharmacother., 10:2593-607.
  10. Freeman MP, Davis M, Sinha P, Wisner KL, Hibbeln JR, Gelenberg AJ.(2008) Omega-3 fatty acids and supportive psychotherapy for perinatal depression: a randomized placebo-controlled study. J Affect Disord., 110:142-8.
  11. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T.(2005) Perinatal depression: A systematic review of prevalence and incidence Obstetrics and Gynecology., 106(5pt1):1071-83
  12. Gentile S, Galbally M.(2011) Prenatal exposure to antidepressant medications and neurodevelopmental outcomes: a systematic review. J Affect Disord., 128:1-9.
  13. Glynn LM, Davis EP, Sandman CA. (2013) New insights into the role of perinatal HPA-axis dysregulation in postpartum depression. Neuropeptides., 47:363?70.
  14. Goodman JH, Santangelo G.(2011) Group treatment for postpartum depression: a systematic review. Arch Womens Ment Health., 14:277-93.
  15. Green K, Broome H, Mirabella J.(2006) Postnatal depression among mothers in the United Arab Emirates: socio-cultural and physical factors. Psychol Health Med., 11:425-31 22.
  16. Gregoire AJ, Kumar R, Everitt B, Henderson AF, Studd JW. (1996)Transdermal oestrogen for treatment of severe postnatal depression. Lancet., 347(9006):930-3.
  17. Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L, et al.(2016) Neonatal Outcomes in Women With Untreated Antenatal Depression Compared With Women Without Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry.
  18. Jeste V. (2013): American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edition. American Psychiatric Publishing; Arlington; VA; pp.152.
  19. Kashani L, Eslatmanesh S, Saedi N, Niroomand N, Ebrahimi M, Hosseinian M et al.(2017) Comparison of Saffron versus Fluoxetine in Treatment of Mild to Moderate Postpartum Depression: A Double Blind, Randomized Clinical Trial. Pharmacopsychiatry., 50:64-8.
  20. Kim DR, Epperson CN, Weiss AR, Wisner KL.(2014) Pharmacotherapy of postpartum depression: an update. Expert Opin Pharmacother., 15:1223-34.
  21. Kim DR, Pinheiro E, Luther JF, Eng HF, Dills JL, Wisniewski SR et al.(2016) Is third trimester serotonin reuptake inhibitor use associated with postpartum haemorrhage? J Psychiatr Res., 73:79-85.
  22. Kinser P, Masho S.(2015) "Yoga Was My Saving Grace": The Experience of Women Who Practice Prenatal Yoga. J Am Psychiatr Nurses Assoc., 21:319-26.
  23. Lau Y, Htun TP, Wong SN, Tam WSW, Klainin-Yobas P.(2017) Therapist-Supported Internet-Based Cognitive Behavior Therapy for Stress, Anxiety, and Depressive Symptoms Among Postpartum Women: A Systematic Review and Meta-Analysis. J Med Internet Res.,19:e138.
  24. Lawrie TA, Hofmeyr GJ, De Jager M, Berk M, Paiker J, Viljoen E.(1998) A double-blind randomised placebo controlled trial of postnatal norethisterone enanthate: the effect on postnatal depression and serum hormones. Br J Obstet Gynaecol., 105:1082-90.
  25. Leis JA, Mendelson T, Tandon SD, Perry DF.(2009) A systematic review of home-based interventions to prevent and treat postpartum depression. Arch Womens Ment Health.,12:3-28.
  26. Makrides M.(2012) Oily fish and omega-3 fatty acids: what is the effect size? European Psychiatry., 27: 1.
  27. McCurdy AP, Boul? NG, Sivak A. (2017) Davenport MH. Effects of Exercise on Mild-to-Moderate Depressive Symptoms in the Postpartum Period: A Meta-analysis. Obstet Gynecol., 129:1087-97.
  28. Mendelson T, Cluxton-Keller F, Vullo GC, Tandon SD, Noazin S. (2017) NICU-based Interventions To Reduce Maternal Depressive and Anxiety Symptoms: A Meta-analysis. Pediatrics., 139. pii: e20161870.
  29. Miller BJ, Murray L, Beckmann MM, Kent T, Macfarlane B.(2013) Dietary supplements for preventing postnatal depression. Cochrane Database Syst Rev., 10:CD009104.
  30. Miniati M, Callari A, Calugi S, Rucci P, Savino M, Mauri M et al. (2014) Interpersonal psychotherapy for postpartum depression: a systematic review. Arch Womens Ment Health., 17:257-68.
  31. Moses-Kolko EL, Wisner KL, Price JC, Berga SL, Drevets WC, Hanusa BH et al.(2008) Serotonin 1A receptor reductions in postpartum depression: a positron emission tomography study. Fertil Steril. 89:685-92.
  32. Mozurkewich EL, Clinton CM, Chilimigras JL, Hamilton SE, Allbaugh LJ, Berman DR et al.(2013) The Mothers, Omega-3, and Mental Health Study: a double blind, randomized controlled trial. Am J Obstet Gynecol., 208:313.e1-9.
  33. Ng RC, Hirata CK, Yeung W, Haller E, Finley PR. (2010) Pharmacologic treatment for postpartum depression: a systematic review. Pharmacotherapy., 30:928-41.
  34. O?Hara M, Gorman LL. (2004) Can postpartum depression be predicted? Primary Psychiatry., 11:42-7
  35. Osborne L, Clive M, Kimmel M, Gispen F, Guintivano J, Brown T et al. (2016) Replication of Epigenetic Postpartum Depression Biomarkers and Variation with Hormone Levels. Neuropsychopharmacology., 41:1648-58.
  36. Rojas G, Fritsch R, Solis J, Jadresic E, Castillo C, Gonz?lez M et al. (2007)Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomized controlled trial. Lancet., 370:1629-37.
  37. Schiller CE, Meltzer-Brody S, Rubinow DR. (2015) The role of reproductive hormones in postpartum depression. CNS Spectr., 20:48-59.
  38. Sockol LE, Epperson CN, Barber JP. (2013) Preventing postpartum depression: a meta-analytic review. Clin Psychol Rev., 33:1205-17.
  39. Sockol LE. (2015)A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord., 177:7-21.
  40. Stuart-Parrigon (2014) American College of Obstetrics and Gynecology. [cited 2014 March 27, 2014] Screening for Depression During and After Pregnancy. 2010. Available from:http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Screening_for_Depression_During_and_After_Pregnancy
  41. Underwood L, Waldie KE, Peterson E, D?Souza S, Verbiest M, McDaid F et al. (2017) Paternal Depression Symptoms During pregnancy and after childbirth among participants in the growing up in New Zealand study. JAMA Psychiatry., 74:1-10.
  42. Vaziri F, Nasiri S, Tavana Z, Dabbaghmanesh MH, Sharif F, Jafari P. (2016) A randomized controlled trial of vitamin D supplementation on perinatal depression: in Iranian pregnant mothers. BMC Pregnancy Childbirth., 16: 239. doi: 10.1186/s12884-016-1024-7.
  43. Wang S, Yang L, Wang L, Gao L, Xu B, Xiong Y. (2015) Selective Serotonin Reuptake Inhibitors (SSRIs) and the Risk of Congenital Heart Defects: A Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc., 4. pii: e001681
  44. Werner E, Miller M, Osborne LM, Kuzava S, Monk C. (2015) Preventing postpartum depression: review and recommendations. Arch Womens Ment Health., 18:41-60.
  45. Wirz-Justice A, Bader A, Frisch U, Stieglitz RD, Alder J, Bitzer J et al. (2011) A randomized, double-blind, placebo-controlled study of light therapy for antepartum depression. J Clin Psychiatry., 72:986-93.
  46. Wisner KL, Perel JM, Peindl KS, Hanusa BH, Piontek CM, Findling RL. (2004) Prevention of postpartum depression: a pilot randomized clinical trial. Am J Psychiatry., 161:1290?2.
  47. Wisner KL, Sit DK, Moses-Kolko EL, Driscoll KE, Prairie BA, Stika CS et al. (2015) Transdermal Estradiol Treatment for Postpartum Depression: A Pilot Randomized Trial. J Clin Psychopharmacol.,35:389-95.
  48. Yonkers KA, Lin H, Howell HB, Heath AC, Cohen LS. (2008) Pharmacologic treatment of postpartum women with new-onset major depressive disorder: a randomized controlled trial with paroxetine. J Clin Psychiatry., 69:659-65.

[Suresh Kumar and Laxminarayana Kurady Bairy. (2018); MANAGEMENT OF PERIPARTUM DEPRESSION: BETTER, PREVENT THAN TREAT!. Int. J. of Adv. Res. 6 (Jan). 281-289] (ISSN 2320-5407). www.journalijar.com

Laxminarayana Kurady Bairy
RAK College of Medical Sciences, RAK Medical and Health Sciences University,

DOI:

Article DOI: 10.21474/IJAR01/6216      
DOI URL: https://dx.doi.org/10.21474/IJAR01/6216

Download Full Paper

Download PDF No. of Downloads: 12 | No. of Views: 65