While we are becoming more attentive to screening for depressive symptoms during pregnancy and the postpartum period, we may not always ask about a history of trauma, especially when a woman has had what most would consider an “uncomplicated” pregnancy. A recent study, however, indicates that a history of trauma may be a risk factor for depression during pregnancy.
Many studies have demonstrated an increased risk for depression among the children of mothers with depression. Exactly how this vulnerability to depression is transmitted to the child is not precisely understood. Genetic factors clearly play an important role, but there are other important factors which contribute to the intergenerational transmission of depression. For example, many studies have shown that postpartum depression may contribute to parenting styles which increase a child’s likelihood of developing depression later on. While the child appears to be particularly sensitive to the effects of maternal depression during the first year of life, it appears that older children are also affected by maternal depression and are more likely to suffer from depression and other psychiatric symptoms than children with non-depressed mothers.
In an excellent and thoughtful review article, Kristina Deligiannidis and Marlene Freeman (from the MGH Center for Women’s Mental Health) summarize data on the efficacy of complementary and alternative medicine therapies for the treatment of perinatal depression. This is one of the most thorough reviews on CAM and provides thoughtful, evidence-based recommendations regarding the use of these treatments for women with perinatal depression. It is definitely worth tracking down a copy of this review, but if you can’t find it, here is a summary.
Some studies have shown an association between in utero exposure to antidepressants and various pregnancy outcomes, including preterm delivery, low birth weight, and lower Apgar scores; however, these outcomes have also been observed in infants born to depressed mothers who are not taking medication. Thus, it has been difficult to determine if there is a causal relationship between antidepressant exposure and these negative pregnancy outcomes or if untreated maternal depression is itself responsible for these negative outcomes.
For women the postpartum period is a time of increased vulnerability to mood disorders. Recent estimates indicate that about 20% of women will suffer from significant depressive symptoms during the year after the birth of a child. Despite a significant push over the last decade to identify and effectively treat women with mood disorders during pregnancy and the postpartum period, treatment rates in this population remain unacceptably low. Furthermore, questions still remain regarding the optimal timing of screening and the best instruments to be used in this setting.
Last summer, we posted a blog about using folate to treat (and perhaps prevent) depression in women of childbearing age. Supporting that recommendation are the several reports indicating that people with lower folate levels are at higher risk of major depression or may experience more severe depressive symptoms. Other studies have indicated that in folate-deficient patients, antidepressants may be less effective or may take longer to take effect.
This is a topic we do not typically cover on our site, but it is clearly an important one. The U.S. Preventive Services Task Force (USPSTF) has updated its recommendations on screening for family and intimate partner violence (IPV). These guidelines, published in the Annals of Internal Medicine, recommend that all women of reproductive age be screened for intimate partner violence. The review provides some information on which screening instruments to use and reviews interventions to reduce the risk of IPV.
Over the last decade, attention in the medical literature has gathered logarithmically to focus on potentially efficacious treatments for perinatal depression. Studies of relevant databases, editorials, and various reviews have addressed the reproductive safety concerns of antidepressant treatments, particularly selective serotonin reuptake inhibitors (SSRIs) on one hand, and the impact of untreated maternal psychiatric illness on fetal and maternal well-being on the other.
Prozac hit the market in 1988, the first selective serotonin reuptake inhibitor (SSRI) antidepressant approved by the FDA for the treatment of depression. Because it was safer and more tolerable than the antidepressants that preceded it, Prozac was soon the most commonly prescribed antidepressant in the United States.
Several studies have shown that vitamin D deficiency is associated with depression. A recent study has assessed the relationship between vitamin D levels and risk for antenatal depression in a cohort of African-American women. Vitamin D deficiency is more common among African-American women than in Caucasians. The active form of vitamin D is produced as a byproduct of natural sun exposure. Because women with darker skin have more melanin, which blocks the sun’s rays and affects the skin’s ability to produce the active form of vitamin D, they typically have lower vitamin D levels.
