Every week we review the most recent publications in women’s mental health, covering topics related to premenstrual symptoms, perinatal mood and anxiety disorders, use of medications in pregnant and breastfeeding women, perinatal substance use, and menopausal mental health. 

An interesting article from Pop and colleagues analyzed data from the Netherlands and found that depression in pregnancy is on the rise, doubling from 7% in 1988-1989 to 14% in 2012-2014.  The big question is why.

There are two interesting and clinically useful articles on lithium during pregnancy.  In a review and meta-analysis, Fornaro and colleagues pull together data from 29 previously published studies on the use of lithium during pregnancy.  No surprises, lithium exposure during the first trimester is associated with a small increase in risk of cardiovascular malformations.  Molenaar and colleagues discuss the adjustment of lithium dosage near the time of delivery.

For more detailed descriptions of many of these topics, you can sign up to receive our weekly CWMH NEWSLETTER which comes out every Thursday.  


Ruta Nonacs, MD PhD



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The feasibility of acupuncture as an adjunct intervention for antenatal depression: a pragmatic randomised controlled trial.

Ormsby SM, Smith CA, Dahlen HG, Hay PJ.  J Affect Disord. 2020 May 24;275:82-93.

At end-of-intervention there were significantly lower depression scores in the acupuncture group versus treatment as usual (TAU) and prospective muscle relaxation (PMR). Between group differences were not significant at six-weeks postnatal. No adverse events were reported.

 Increase of depressive symptomatology during pregnancy over 25 years’ time in four population based cohorts.

Pop V, van Son M, Wijnen H, Spek V, Denollet J, Bergink V.  J Affect Disord. 2019 Dec 1;259:175-179.

From 1988 to 2014, mean EPDS scores during the first and third trimester of pregnancy increased significantly (P < 0.001). The number of women with elevated EPDS scores doubled from 7% in 1988-1989 to 14% in 2012-2014 (P = 0.001).

Maternal perinatal depressive symptoms and offspring psychotic experiences at 18 years of age: a longitudinal study.

Srinivasan R, Pearson RM, Johnson S, Lewis G, Lewis G.  Lancet Psychiatry. 2020 May;7(5):431-440. 

Maternal antenatal depressive symptoms were associated with both offspring psychotic experiences at the age of 18 years (n=2830, OR for a 5-point increase in EPDS score: 1·32 [95% CI 1·16-1·51], p<0·0001) and offspring depression at 18 years (OR for a 5-point increase in EPDS score: 1·18 [1·03-1·34], p=0·016). This type of study, however, cannot establish a causal relationship.

Trajectories of perinatal depressive symptoms from early pregnancy to six weeks postpartum and their risk factors—a longitudinal study.

Yu M, et al.  J Affect Disord, July 2020.

A longitudinal study was conducted at two hospitals in China including 1,126 participants. About half of the women who experienced perinatal depression noted its onset early in pregnancy.   Anxiety symptoms were more common among women who had high levels of depressive symptoms throughout pregnancy.  Decreased marital satisfaction was more common among women with high levels of postpartum depressive symptoms.

Depression across pregnancy and the postpartum, antidepressant use and the association with female sexual function.

Galbally M, Watson SJ, Permezel M, Lewis AJ.  Psychol Med. 2019 Jul;49(9): 1490-1499.

Pregnancy and the postpartum are a time of reduced sexual functioning for women; however, women with depression are more likely to have lower levels of sexual functioning and this was not predicted by antidepressant use. 

Adolescent antecedents of maternal and paternal perinatal depression: a 36-year prospective cohort.

Thomson KC, Romaniuk H, Greenwood CJ, Letcher P, Spry E, Macdonald JA, McAnally HM, Youssef GJ, McIntosh J, Hutchinson D, Hancox RJ, Patton GC, Olsson CA.  Psychol Med. 2020 Apr 28:1-8. 

Most pregnancies (81%) in which mothers reported perinatal depression were preceded by a history of mental health problems in adolescence or young adulthood. Similarly, most pregnancies (83%) in which fathers reported postnatal depression were preceded by a preconception history of mental health problems.



In utero exposure to selective serotonin reuptake inhibitors and development of mental disorders: a systematic review and meta-analysis.

Halvorsen A, Hesel B, Østergaard SD, Danielsen AA.  Acta Psychiatr Scand. 2019 Jun;139(6):493-507. 

Researchers found a statistically significant positive association between in utero exposure to SSRIs and mental or behavioural disorders such as autism spectrum disorder (hazard ratio (HR) = 1.27; 95% confidence interval (CI) = 1.10-1.47), attention-deficit/hyperactivity disorder (HR = 1.33; 95% CI = 1.06-1.66) and mental retardation (HR = 1.41; 95% CI = 1.03-1.91). Confounding by indication was identified in five of seven studies investigating this aspect.

Management of lithium dosing around delivery: An observational study.

Molenaar NM, Poels EMP, Robakis T, Wesseloo R, Bergink V.  Bipolar Disord. 2020 Jun 11. 

Maternal and neonatal lithium blood levels were strongly correlated. We observed no associations between neonatal lithium blood levels at delivery and neonatal outcomes.

Lithium Exposure During Pregnancy and the Postpartum Period: A Systematic Review and Meta-Analysis of Safety and Efficacy Outcomes.

Fornaro M, Maritan E, Ferranti R, Zaninotto L, Miola A, Anastasia A, Murru A, Solé E, Stubbs B, Carvalho AF, Serretti A, Vieta E, Fusar-Poli P, McGuire P, Young AH, Dazzan P, Vigod SN, Correll CU, Solmi M.  Am J Psychiatry. 2020 Jan 1;177(1):76-92.

Comparing lithium-exposed with unexposed pregnancies, exposed infants had a greater risk of cardiac malformations (exposure during the first trimester), but not for spontaneous abortion. Lithium was more effective than no lithium in preventing postpartum relapse (N=48, k=2; odds ratio=0.16, 95% CI=0.03-0.89; number needed to treat=3, 95% CI=1-12). The qualitative synthesis showed that mothers with serum lithium levels <0.64 mEq/L and dosages <600 mg/day had more reactive newborns without an increased risk of cardiac malformations.



Psychological impact of COVID-19 quarantine measures in northeastern Italy on mothers in the immediate postpartum period.

Zanardo V, Manghina V, Giliberti L, Vettore M, Severino L, Straface G.Int J Gynaecol Obstet. 2020 Aug;150(2):184-188. 

The COVID-19 study group (n=91) had significantly higher mean EPDS scores compared with the control group (n=101) (8.5 ± 4.6 vs 6.34 ± 4.1; P<0.001). Furthermore, 28.6% of women in the COVID-19 group had a global EPDS score above 12.

Predictors of response to antidepressants in women with postpartum depression: a systematic review.

Sharma V, Khan M, Baczynski C, Boate I.  Arch Womens Ment Health. 2020 Jun 16.

This study identifies predictors of response and remission that could potentially assist in the optimization of drug treatment of postpartum depression.

Effects of repetitive transcranial magnetic stimulation on depression symptoms and cognitive function in treating patients with postpartum depression: A systematic review and meta-analysis of randomized controlled trials.

Peng L, Fu C, Xiong F, Zhang Q, Liang Z, Chen L, He C, Wei Q.  Psychiatry Res. 2020 May 29;290:113124. 

Compared with control group, rTMS treatment yielded a reduction in Hamilton Depression Rating Scale score and Edinburgh Postnatal Depression Scale score, and improved the cognitive function of patients with PPD.

The Association between Immediate Postpartum Etonogestrel Implants and Positive Postpartum Depression Screens in Adolescents and Young Adults.

Drake E, Grush K, Sheeder J, Tocce K.  J Pediatr Adolesc Gynecol. 2020 Jun 11:

At 6 weeks postpartum, 7.6% had a positive postpartum depression screen; this rate was significantly lower for those initiating immediate postpartum implants compared to those choosing other methods (4.1% vs 9.5%, P = .04).

Is There an Association Between Diet, Physical Activity and Depressive Symptoms in the Perinatal Period? An Analysis of the UPBEAT Cohort of Obese Pregnant Women.

Wilson CA, Seed P, Flynn AC, Howard LM, Molyneaux E, Sigurdardottir J, Poston L.  Matern Child Health J. 2020 Apr 30.

Increased glycaemic load was associated with small increases in levels of depressive symptoms across the perinatal period. There was no evidence for an association between reduced physical activity and increased saturated fat intake and increased levels of depressive symptoms.



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No articles this week



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Confirmatory factor analysis of the Insomnia Severity Index (ISI) and invariance across race: a pooled analysis of MsFLASH data.

Otte JL, Bakoyannis G, Rand KL, Ensrud KE, Guthrie KA, Joffe H, McCurry SM, Newton KM, Carpenter JS.  Menopause. 2019 Aug;26(8):850-855. 

The Insomnia Severity Index (ISI) in midlife women with hot flashes is composed of two factors that capture dimensions of the insomnia severity and daytime impact. The instrument is a psychometrically sound scale appropriate for use in research and clinical practice to capture the severity and daytime impact of insomnia symptoms in diverse samples of midlife women with hot flashes.

Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations.

Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, Bobo WV, Rubin LH, Koleva HK, Cohen LS, Soares CN.  J Womens Health (Larchmt). 2019 Feb;28(2):117-134. 



  Maternal Prenatal Depression and Epigenetic Age Deceleration: Testing Potentially Confounding Effects of Prenatal Stress and SSRI Use.

McKenna BG, Hendrix CL, Brennan PA, Smith AK, Stowe ZN, Newport DJ, Knight AK.  Epigenetics. 2020 Jul 13.

Researchers analyzed the relationship between maternal prenatal exposures (i.e., depression, stress, and SSRI use) and offspring epigenetic age deceleration in 303 mother-offspring dyads. Maternal prenatal depression was associated with decelerated epigenetic age, but this relationship did not hold when accounting for maternal use of SSRIs. Conversely, maternal SSRI use significantly predicted newborn epigenetic age deceleration over and above the influence of maternal depression.

Paternal influences from early pregnancy to postpartum years on child development: A longitudinal study.

Wang HY, Huang JP, Lin CL, Au HK, Chen YH.  J Affect Disord. 2020 Jun 24;275:23-30. 

The increment in parental stress from early to late pregnancy was independently and significantly associated with higher risks of low birthweight (adjusted odds ratio [aOR] = 5.3, 95% confidence interval [CI] = 1.0-27.7). 

Maternal trauma and emotional availability in early mother-infant interaction: findings from the Mercy Pregnancy and Emotional Well-being Study (MPEWS) cohort.

MacMillan KK, Lewis AJ, Watson SJ, Jansen B, Galbally M.  Attach Hum Dev. 2020 Jul 20:1-23. 

Proximate trauma specific to the perinatal period may not account for the effect of distal childhood trauma on maternal emotional availability at six-months postpartum.



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