Most women experience a spectrum of symptoms as they transition into the menopause.  These symptoms may be mild, but many women experience significant symptoms which persist and affect functioning over many years.  Given concerns regarding the long term use of hormone replacement therapy, many women are reluctant to pursue hormonal treatments to manage their symptoms.  Gabapentin and serotonergic antidepressants have been helpful for managing vasomotor symptoms; however, options for the management of menopausal symptoms are limited.  

Several recent studies explore the use of a new class of medications for the treatment of menopausal symptoms: neurokinin 3 receptor (NK3R) antagonists.  You can read more about this new strategy for managing menopausal symptoms HERE.

For more detailed descriptions of many of these topics, you can read the CWMH NEWSLETTER which comes out every Thursday.  You can sign up for our newsletter HERE.

 

Ruta Nonacs, MD PhD

 

PMS AND PMDD

No articles this week

 

INFERTILITY AND MENTAL HEALTH

No articles this week

 

PSYCHIATRIC ILLNESS DURING PREGNANCY

The Perinatal Mental Health of Indigenous Women: A Systematic Review and Meta-Analysis.

Owais S, Faltyn M, Johnson AVD, Gabel C, Downey B, Kates N, Van Lieshout RJ.  Can J Psychiatry. 2019 Oct 10

Indigenous women are at increased risk of mental health problems during the perinatal period, particularly depression, anxiety, and substance misuse. However, resiliency among Indigenous women, cultural teachings, and methodological issues may be affecting estimates.


Denial of Pregnancy: Psychopathology and Clinical Management.

Nanjundaswamy MH, Gaddapati S, Thippeswamy H, Thampy M, Vaiphei K, Kashyap H, Kishore T, Ganjekar S, Chandra PS.  Psychopathology. 2019 Oct 8:1-4. 

MEDICATIONS AND PREGNANCY

Antidepressant use during pregnancy and the risk of gestational diabetes mellitus: a nested case-control study.

Dandjinou M, Sheehy O, Bérard A.  BMJ Open. 2019 Oct 1. Free Article

Commonly used SSRIs are not associated with an increased risk of gestational diabetes.  Read more HERE.

POSTPARTUM PSYCHIATRIC ILLNESS

Postnatal depressive symptoms display marked similarities across continents.

Wesselhoeft R, Madsen FK, Lichtenstein MB, Sibbersen C, Manongi R, Mushi DL, Nguyen HTT, Van TN, Kyhl H, Bilenberg N, Meyrowitsch DW, Gammeltoft TM, Rasch V.  J Affect Disord. 2019 Oct 1;261:58-66. 

Postnatal depressive symptoms constitute a three-factor model across cultures including the factors anhedonia, anxiety and depression. 


Assessing the effectiveness of mindfulness-based programs on mental health during pregnancy and early motherhood – a randomized control trial.

Pan WL, Chang CW, Chen SM, Gau ML.  BMC Pregnancy Childbirth. 2019 Oct 10;19(1):346. 

A mindfulness intervention beginning in the second trimester of pregnancy effectively reduced postpartum self-perceived stress and depression, suggesting that this program provides acceptable and long-term benefits to women during pregnancy and the postpartum period. The teaching and practice of mindfulness meditation and parenting education during pregnancy may help reduce stress and depression in pregnant women as they transition into parenthood.

MEDICATIONS AND BREASTFEEDING

No articles this week

 

PERINATAL SUBSTANCE USE DISORDERS

Marijuana smoking and outcomes of infertility treatment with assisted reproductive technologies.

Nassan FL, Arvizu M, Mínguez-Alarcón L, Gaskins AJ, Williams PL, Petrozza JC, Hauser R, Chavarro JE; EARTH Study Team.  Hum Reprod. 2019 Sep 29;34(9):1818-1829. 

Even though marijuana smoking has not been found in past studies to impact the ability to become pregnant among pregnancy planners in the general population, it may increase the risk of pregnancy loss among couples undergoing infertility treatment. Marijuana smoking by females and males may have opposing effects on outcomes of infertility treatment with ART.

MATERNAL MENTAL HEALTH AND CHILD OUTCOMES

The association between prenatal maternal anxiety disorders and postpartum perceived and observed mother-infant relationship quality.

Nath S, Pearson RM, Moran P, Pawlby S, Molyneaux E, Challacombe FL, Howard LM.  J Anxiety Disord. 2019 Sep 21;68:102148. 

Prenatal anxiety disorders were associated with higher perceived bonding impairment, but not associated with observed poor mother-infant interaction quality. Higher levels of depressive symptoms were associated with lower maternal sensitivity.


Matched cohort study of healthcare resource utilization and costs in young children of mothers with postpartum depression in the united states.

Moore Simas TA, Huang MY, Packnett ER, Zimmerman NM, Moynihan M, Eldar-Lissai A.  J Med Econ. 2019 Oct 10:

Healthcare resource utilization and costs over the first 24 months of life in children of mothers with PPD exceeded that of children of mothers without evidence of PPD.

MENOPAUSE AND MENTAL HEALTH

Modi M, Dhillo WS.  Neurokinin 3 Receptor Antagonism: A Novel Treatment for Menopausal Hot Flushes.  Neuroendocrinology. 2019; 109(3):242-248. 

NK3 receptor antagonists represent a novel way to treat menopausal vasomotor symptoms.  


Timmerman D, Donders G, Sieprath P, Ramael S, Combalbert J, Hoveyda HR, Fraser GL, Depypere H.  Treatment of Menopausal Vasomotor Symptoms with Fezolinetant, a Neurokinin 3 Receptor Antagonist: A Phase 2a Trial.  J Clin Endocrinol Metab. 2019 Aug 15. 

In a Phase 2a trial, fezolinetant (ESN364) significantly reduced total VMS scores compared to placebo (-26.5 versus -12.2, P<0.001) and decreased mean frequency of moderate/severe VMS by 5 episodes per day.


Prague JK, Roberts RE, Comninos AN, et al.  Neurokinin 3 receptor antagonism as a novel treatment for menopausal hot flushes: a phase 2, randomised, double-blind, placebo-controlled trial.  Lancet. 2017 May 6;389(10081):1809-1820. Free Article

By day 3, women receiving oral MLE4901 experienced a 72% reduction in hot flash frequency (95% CI, ?81.3 to ?63.3%), compared to 20% in the placebo group.

OTHER TOPICS IN WOMEN’S MENTAL HEALTH

DNA methylation of HPA-axis genes and the onset of major depressive disorder in adolescent girls: a prospective analysis.

Humphreys KL, Moore SR, Davis EG, MacIsaac JL, Lin DTS, Kobor MS, Gotlib IH.  Transl Psychiatry. 2019 Oct 3;9(1):245. Free Article

Methylation levels of HPA-axis genes continued to significantly predict the onset of MDD, suggesting that variation in the epigenome, independent of proximal genetic variants, prospectively predicts the onset of MDD. These findings suggest that variation in the HPA axis at the level of the methylome may predict the development of MDD.