There has been a long held belief that diet may influence well-being. The phrase “you are what you eat” suggests that nutrition has an impact on physical as well as mental health. Until recently, however, there have been few studies that provide data to support this idea.
Depression during pregnancy is relatively common, affecting about 10 to 15% of women. While there is a growing body of literature supporting the reproductive safety of certain antidepressants, many women and their physicians would prefer to avoid the use of these medications during pregnancy; thus, there is a clear need for effective non-pharmacologic treatments for women who suffer from depression during pregnancy.
Approximately 10-15% of women will experience mood symptoms that meet criteria for a Major Depressive Episode during the postpartum period. However, as many as 50% of women may experience some level of depressive symptoms during the postpartum period. Recent evidence suggests that even depressive symptoms that do not qualify for a diagnosis of postpartum depression may have a negative impact on both mother and child. In spite of the fact that so many postpartum women will experience depressive symptoms, little research has been conducted in order to identify potentially modifiable factors that could reduce the risk of depressive symptoms or the development of a major depressive episode during this time.
It is well established that women are at increased risk for developing depression compared to men. It has been hypothesized that this vulnerability to depression may be hormonally mediated, and several longitudinal studies have documented an increased risk of depressive symptoms during perimenopause or the menopausal transition. Based on the results of two prospective cohort studies, approximately one-third of women will develop their first episode of depression during the menopausal transition. (Cohen LS et al 2006, Freeman EW et al 2006).
There have been multiple studies suggesting that depression during pregnancy increases the risk for preterm labor. Most studies do not attribute this increase in risk to antidepressant exposure, but to the effects of the depression itself. The mechanism is believed to be related to increased levels of corticotropin releasing hormone (CRH) which is triggered by stress. Elevated levels of CRH have been shown to be a predictor of preterm birth.
Recent changes expanded the scope of mental health parity in the Commonwealth of Massachusetts, which requires insurance companies to cover specified diagnoses on a “nondiscriminatory basis”. This means that copayments, deductibles, coinsurance, unit of service limits- such as hospital days and outpatient visits, and/or annual or lifetime maximums are no greater for mental disorders when compared to physical conditions.
Ms. A is a 27-year-old woman who is seven weeks pregnant and is currently taking duloxetine (Cymbalta). She has a history of recurrent major depressive disorder (MDD) and has had a good response to duloxetine at 60 mg per day. She has had four previous episodes of major depressive disorder (most untreated) and has been in remission for one year. Past episodes have lasted up to six months and caused difficulty with functioning at work and in relationships, although she was not diagnosed and treated until one year ago.
An ideal treatment for major depressive disorder (MDD) in women would be efficacious, safe, and offer broad health benefits. MDD is prevalent in women of childbearing years, and recent research underscores the risk of recurrence [...]
About 15% of women suffer from depression during pregnancy, and many reports have suggested that depression during pregnancy may have negative effects on the fetus. A new study from researchers at the University of Michigan indicates a link between depression during pregnancy and infant sleep problems.
Women with bipolar disorder are at increased risk for recurrence of illness during pregnancy. Therefore, many women with bipolar disorder elect to continue treatment with medications during pregnancy after weighing the risks and benefits of various treatment options with their physicians. Lamotrigine (Lamictal) is an anticonvulsant used to treat bipolar disorder. While the safety data on this relatively new anticonvulsant in pregnancy is limited, pregnancy registry data suggests that lamotrigine may pose less of a risk to the developing fetus than with older anticonvulsants, such as valproate (Depakote). With lamotrigine emerging as an effective and relatively safe treatment for pregnant women with bipolar disorder, more attention is now being paid to the effects of pregnancy on lamotrigine levels.
