Although there are data to support the use of many different antidepressants and other psychotropic medications, many women and their providers would prefer to avoid the use of medications during pregnancy.  Options for non-pharmacologic treatment are limited. Some women respond to psychotherapy; however, we often see women with histories of depression who have experienced recurrent depression after discontinuing treatment.  Vigod and colleagues explore the efficacy of transcranial direct current stimulation (tDCS) for the treatment of depression during pregnancy. We will review the details of this study in an upcoming post.

In another article, Tong and colleagues review 12 randomized controlled trials of traditional Chinese acupuncture for the treatment of postpartum depression.  This analysis included a total of 887 women with PPD and indicated that acupuncture was more effective than placebo.  I was surprised to see that there were so many studies looking at the efficacy of acupuncture in this population; that’s because nearly all of them were published in Chincese and in less widely read journals.  Given the promising results of this intervention for PPD, similar trials in the United States, where acupuncture is not a first-line treatment, are warranted.  


Ruta Nonacs, MD PhD



Evidence-Based Treatments for Premenstrual Disorders.

Yonkers KA, Simoni M.  Am J Obstet Gynecol. 2018 Aug;219(2):215-216. 


Transcranial direct current stimulation (tDCS) for depression in pregnancy: A pilot randomized controlled trial.

Vigod SN, Murphy KE, Dennis CL, Oberlander TF, Ray JG, Daskalakis ZJ, Blumberger DM.  Brain Stimul. 2019 Jun 19.

At 4 weeks postpartum, 75.0% of tDCS women were remitted versus 12.5% sham-control (p?=?0.04).


Prevalence of antenatal suicidal ideation among racially and ethnically diverse WIC enrolled women receiving care in a Midwestern public health clinic.

Tabb KM, Gavin AR, Faisal-Cury A, Nidey N, Chan YF, Malinga T, Meline B, Huang H.  J Affect Disord. 2019 Jun 4;256:278-281.

The prevalence of suicidal ideation was 4.6%. After adjusting for smoking, women with depression were 13 times as likely to report suicidal ideation.


Suicidal Ideation in Pregnant and Postpartum Women Veterans: An Initial Clinical Needs Assessment.

Szpunar MJ, Crawford JN, Baca SA, Lang AJ.  Mil Med. 2019 Jul 9.

This was a small study.  Over 30% of the veteran women had past lifetime suicide attempts, and over 10% of the veterans had suicidal ideation in the perinatal period.


Validation of the MGMQ in screening for emotional difficulties in women during pregnancy.

Matthey S, Souter K, Valenti B, Ross-Hamid C.  J Affect Disord. 2019 May 23;256:156-163.

The MGMQ has good psychometric properties when compared to the usual gold-standard applied to emotional health screening measures.


Anticonvulsant Mood Stabilizer and Lithium Use and Risk of Adverse Pregnancy Outcomes.

Cohen JM, Huybrechts KF, Patorno E, Desai RJ, Mogun H, Bateman BT, Hernández-Díaz S.  J Clin Psychiatry. 2019 Jun 18;80(4).

Anticonvulsant mood stabilizers and lithium are not associated with an increased risk of placenta-mediated complications or preterm birth after accounting for confounding by indication.


Benzodiazepine Use During Pregnancy Alone or in Combination With an Antidepressant and Congenital Malformations: Systematic Review and Meta-Analysis.

Grigoriadis S, Graves L, Peer M, Mamisashvili L, Dennis CL, Vigod SN, Steiner M, Brown C, Cheung A, Dawson H, Rector N, Guenette M, Richter M.  J Clin Psychiatry. 2019 Jul 9;80(4). 

Prenatal benzodiazepine use was not associated with an increased risk of congenital malformations(odds ratio [OR] = 1.13; 95% CI, 0.99 to 1.30, 8 studies)  There was no significant association with cardiac malformation following exposure (OR = 1.27; 95% CI, 0.98 to 1.65. However, concurrent use of benzodiazepine and antidepressants during pregnancy was associated with an increased risk of congenital malformations (OR = 1.40; 95% CI, 1.09 to 1.80, P = .008; 3 studies).


Epidural Analgesia During Childbirth and Postpartum Depressive Symptoms: A Population-Based Longitudinal Cohort Study.

Eckerdal P, Kollia N, Karlsson L, Skoog-Svanberg A, Wikström AK, Högberg U, Skalkidou A.  Anesth Analg. 2019 Jun 24. 

Epidural analgesia was not associated with the risk of PPD at 6 weeks postpartum after adjusting for sociodemographic, psychosocial, and obstetric variables. 


Sleeping problems during pregnancy-a risk factor for postnatal depressiveness.

Pietikäinen JT, Polo-Kantola P, Pölkki P, Saarenpää-Heikkilä O, Paunio T, Paavonen EJ.  Arch Womens Ment Health. 2019 Jun;22(3):327-337. 

After adjusting for main background characteristics and prenatal depressive symptoms (CES-D ??10), poor general sleep quality (AOR 1.87, 95% CI 1.21-2.88), tiredness during the day (AOR 2.19, 95% CI 1.41-3.38), short sleep ??6 and ??7 h, sleep latency >?20 min, and sleep loss ??2 h were associated with postpartum depressive symptoms (all p?<?.050). 


Traditional Chinese acupuncture and postpartum depression: A systematic review and meta-analysis.

Tong P, Dong LP, Yang Y, Shi YH, Sun T, Bo P. J Chin Med Assoc. 2019 Jun 17. 

A total of 887 PPD patients from 12 randomised controlled trials were included in the quantitative meta-analysis, with 443 patients in the treatment group and 444 patients in the control group. Patients in the acupuncture group had significantly better performances assessed by the Hamilton Depression Scale than those in the control group.


Effectiveness of Acupuncture Used for the Management of Postpartum Depression: A Systematic Review and Meta-Analysis.

Li W, Yin P, Lao L, Xu S.  Biomed Res Int. 2019 Mar 20;2019.  Free Article


Prenatal Risk Factors and Perinatal and Postnatal Outcomes AssociatedWith Maternal Opioid Exposure in an Urban, Low-Income, Multiethnic USPopulation.

Azuine RE, Ji Y, Chang HY, Kim Y, Ji H, DiBari J, Hong X, Wang G, Singh GK, Pearson C, Zuckerman B, Surkan PJ, Wang X.  JAMA Netw Open. 2019 Jun 5;2(6):e196405.

Opioid exposure during pregnancy was associated with higher risk of fetal growth restriction, preterm birth, and lack of expected physiological development.  In preschoolers, those exposed to opioids in utero were more likely to exhibit childhood conduct disorder and emotional disturbance, and in school-aged children, attention-deficit/hyperactivity disorder was more common in exposed children.


Medical marijuana laws are associated with increases in substance use treatment admissions by pregnant women.

Meinhofer A, Witman A, Murphy SM, Bao Y.  Addiction. 2019 May 20. 


How maternal pre- and postnatal symptoms of depression and anxiety affect early mother-infant interaction?

Hakanen H, Flykt M, Sinervä E, Nolvi S, Kataja EL, Pelto J, Karlsson H, Karlsson L, Korja R.  J Affect Disord. 2019 Jul 2;257:83-90. 

After controlling for background factors, generalized anxiety during the third trimester of pregnancy was associated with higher maternal intrusiveness on Emotional Availability Scales  (EAS). Depressive symptoms at 6 months postpartum were associated with lower maternal structuring behavior and with lower involvement of the mother with the child.


The role of sleep difficulties in the vasomotor menopausal symptoms and depressed mood relationships: an international pooled analysis of eight studies in the InterLACE consortium.

Chung HF, Pandeya N, Dobson AJ, Kuh D, Brunner EJ, Crawford SL, Avis NE, Gold EB, Mitchell ES, Woods NF, Bromberger JT, Thurston RC, Joffe H, Yoshizawa T, Anderson D, Mishra GD.  Psychol Med. 2018 Nov;48(15):2550-2561.    Free Article


Age at menarche and depression: results from the NHANES 2005-2016.

Shen Y, Varma DS, Zheng Y, Boc J, Hu H.  PeerJ. 2019 Jun 13;7:e7150. Free Article

Women with early age of menarche had 1.36 (95% CI [1.16-1.61]) times the odds of current depressive symptoms compared with the normal menarche group, after controlling for age, race/ethnicity, education, poverty income ratio (PIR) and marital status. 


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