Mass General Hospital

Harvard Medical School



EPDS Modified to Screen for Lifetime Perinatal Depression

The Edinburgh Postnatal Depression Scale (EPDS) was modified by adding lifetime PND screening questions, assessing worst episode, and symptom timing of onset, in order to assess the lifetime prevalence of perinatal depression. Subjects from the Netherlands Study of Depression and Anxiety (NESDA) were screened using the EPDS-Lifetime. Of 682 women with lifetime major depressive disorder […]

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Women Who Stop SSRIs Prior to Pregnancy Have Same Risk of Miscarriage as Women who elect to Remain on SSRI Antidepressants

Some, but not all, studies have demonstrated an increased risk of miscarriage among women who take antidepressants. However, it has been difficult to determine whether this increased risk was related to exposure to the medication or to exposure to other risk factors, including maternal depression. Several recent studies have been reassuring and indicate that antidepressants […]

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Better Peripartum Pain Management: An Intervention to Reduce Risk of Postpartum Depression

A recent report suggests that epidural labor analgesia is associated with a decreased risk of postpartum depression (PPD). This prospective study included 214 pregnant women from Beijing, China who were preparing for a vaginal delivery. Epidural labor analgesia was performed in 107 of 214 patients based on their request. Depressive symptoms were assessed with the Edinburgh Postnatal […]

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Screening for Postpartum Depression: Uninsured Women

While we are advocating universal screening for perinatal mood and anxiety disorders, it is unclear if we have the ability to provide mental health services to this population in need. One significant obstacle to treatment is health insurance; this is a considerable problem in this population, since many women may not want or be able […]

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Wellbutrin (Bupropion) Exposure and Risk of Cardiac Malformations

Bupropion is commonly used to treat depression, and is also prescribed to support smoking cessation. Early data on bupropion-exposure during pregnancy raised concern for a possible increase in risk of malformations of the heart and large blood vessels in bupropion-exposed infants. Subsequent data from bupropion pregnancy registries has been reassuring, however, and do not demonstrate an overall increase in risk of cardiac defects following first trimester bupropion exposure. Although the overall risk of cardiac defects was not increased, the distribution of specific defects in these registries was unexpected in some ways. For example, the GlaxoSmithKline Bupropion Pregnancy Registry included two cases of coarctation of the aorta out of the 675 bupropion-exposed infants, compared to the rate of 6 cases per 10,000 births in the general population.

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Internet Cognitive Behavioral Therapy for Postpartum Depression

Although postpartum depression (PPD) affects about 15% of all women after the birth of a child, most women with PPD receive no treatment. One of the problems has been inadequate screening for perinatal mood and anxiety disorders. Over the last decade, there has been an emphasis on educating health care professionals to reliably screen for PPD; however, other obstacles to obtaining treatment remain. Many women cannot find appropriate treaters in their area. Others are not able to get childcare in order to attend weekly appointments. Given these limitations, it is important that we explore other types of interventions that might be used to reach and effectively treat women with PPD.

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Response to the New York Times Article on SSRIs and Pregnancy: Moving Toward a More Balanced View of Risk

We have received many emails and calls from colleagues and patients regarding the recent article on the safety of SSRI use during pregnancy published in the New York Times.  In this article, health writer Roni Caryn Rabin, detailed the risks associated with the use of antidepressants during pregnancy.

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Breastfeeding and Postpartum Depression: Further Insights Into a Complicated Relationship

For decades, researchers have postulated a connection between breastfeeding and postpartum depression (PPD). Many have suggested that breastfeeding may protect against postpartum depression and have suggested that the cessation of breastfeeding may be a trigger for postpartum depression and/or anxiety. However, the research examining the association between postpartum depression and breastfeeding has been somewhat difficult […]

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Low Dose Paroxetine Improves Sleep in Postmenopausal Symptoms

Last year, the FDA approved the first non-hormonal treatment for hot flashes – a 7.5-mg formulation of the selective serotonin reuptake inhibitor (SSRI) paroxetine which was marketed under the name of Brisdelle. A new study suggests that low dose paroxetine (7.5 mg) not only helps with vasomotor symptoms, it can also improve sleep. In a […]

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A New Strategy for Managing Premenstrual Symptoms

Current research suggests that women with premenstrual dysphoric disorder (PMDD) have an abnormal affective response to normal hormonal shifts that occur during the menstrual cycle. Some researchers have hypothesized a metabolite of progesterone (PROG), allopregnanolone (ALLO), may mediate this sensitivity. In rodents, exposure to or withdrawal from ALLO modulates GABA-A receptors and, in this way, […]

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