Two new studies explore the efficacy of non-pharmacologic treatments for depression during pregnancy.  The first uses internet-derived cognitive behavioral therapy (Loughnan et al, 2018) in a group of pregnant women with anxiety and/or depression.  The second is a randomized controlled trial of transcranial magnetic stimulation or TMS (Kim et al, 2018) for the treatment of antenatal depression.

Ruta Nonacs, MD PhD

A randomized controlled trial of ‘MUMentum Pregnancy’: Internet-delivered cognitive behavioral therapy program for antenatal anxiety and depression.

Loughnan SA, Sie A, Hobbs MJ, Joubert AE, Smith J, Haskelberg H, Mahoney AEJ, Kladnitski N, Holt CJ, Milgrom J, Austin MP, Andrews G, Newby JM.  J Affect Disord. 2018 Sep 21;243:381-390.

Of the 36 women who started internet-delivered CBT or  iCBT, 26 completed all three lessons of treatment (76% adherence rate). iCBT produced moderate to large effect size reductions for anxiety on the GAD-7 and psychological distress on the Kessler-10.  Only small nonsignificant differences were found for depression outcomes.

Randomized controlled trial of transcranial magnetic stimulation in pregnant women with major depressive disorder.

Kim DR, Wang E, McGeehan B, Snell J, Ewing G, Iannelli C, O’Reardon JP, Sammel MD, Epperson CN.  Brain Stimul. 2018 Sep 14.

Results demonstrated significantly decreased Hamilton Depression Rating Scale (HDRS-17) scores for the active compared to the sham group (p=0.003). Response rates were 81.82% for the active and 45.45% for the sham coil (p=0.088). Remission rates were 27.27% for the active 18.18% for the sham coil (p=0.613). Late preterm birth (PTB) occurred in three women receiving active TMS. All other maternal and delivery outcomes were normal.

MAGDALENA: study protocol of a randomised, placebo-controlled trial on cognitive development at 2 years of age in children exposed to SSRI in utero.

Heinonen E, Szymanska-von Schultz B, Kaldo V, Nasiell J, Andersson E, Bergmark M, Blomdahl-Wetterholm M, Forsberg L, Forsell E, Forsgren A, Frööjd S, Goldman A, Nordenadler EM, Sklivanioti M, Blennow M, Wide K, Gustafsson LL.  BMJ Open. 2018 Aug 5.  Free Article

An interesting study.  MAGDALENA is a randomised, placebo-controlled, double-blinded trial in Stockholm Healthcare Region where women will be recruited during weeks 9-21 of pregnancy and women diagnosed with moderate depression will be recruited. The women in the intervention arm will receive sertraline combined with a 12-week period of ICBT; the control arm is treated with placebo and ICBT.  The cognitive development in the offspring will be assessed at the age of 2 years using Bayley Scales of Infant and Toddler Development, third edition (BSID-III).

Predictors of Depressive Relapse in Women Undergoing Infertility Treatment.

Freeman MP, Lee H, Savella GM, Sosinsky AZ, Marfurt SP, Murphy SK, Cohen LS.  J Womens Health (Larchmt). 2018 Aug 1.

Participants with MDD (N?=?25) experienced a depressive relapse rate of 44.0%. Relapse rates among antidepressant maintainers (N?=?15; relapse rate?=?40.0%) and antidepressant discontinuers (N?=?10; relapse rate?=?50.0%) were not significantly different. Among participants with bipolar disorder (N?=?13), the overall relapse rate was 30.8%. Among psychotropic medication maintainers (N?=?10), 40.0% relapsed, and among discontinuers (N?=?3), none relapsed.

Are infectious agents involved in the pathogenesis of postpartum psychosis?

de Witte LD, Snijders G, Litjens M, Kamperman AM, Kushner SA, Kahn RS, Bergink V.  J Affect Disord. 2018 Mar 15;229:141-144.

Researchers measured the prevalence and titers of immunoglobulin G (IgG) and M (IgM) to herpes simplex virus type 1 (HSV-1) and 2 (HSV-2), Epstein-Barr virus (EBV), cytomegalovirus (CMV) and Toxoplasma Gondii (TG) in a cohort of patients with postpartum psychosis (n = 81) and compared these to matched postpartum controls.  They did not find significant differences in seroprevalence or antibody titers for any of these pathogens.

Sex Differences in Vulnerability to Prenatal Stress: a Review of the Recent Literature.

Sutherland S, Brunwasser SM.  Curr Psychiatry Rep. 2018 Sep 18;20(11):102.

Evidence for sex-dependent effects was strongest in the group of studies evaluating child neural/nervous system development and temperament as outcomes. There is sufficient evidence of sex-dependent associations to recommend that researchers always consider the potential role of child sex in prenatal exposure to maternal stress programming studies and report descriptive statistics for study outcomes stratified by child biological sex.

Antiepileptic drug clearances during pregnancy and clinicalimplications for women with epilepsy.

Voinescu PE, Park S, Chen LQ, Stowe ZN, Newport DJ, Ritchie JC, Pennell PB.  Neurology. 2018 Sep 25;91(13):e1228-e1236.

AED clearances were calculated for levetiracetam (n = 18 pregnancies), oxcarbazepine (n = 4), topiramate (n = 10), valproate (n = 5), and phenytoin (n = 7). Mean maximal clearances were reached for (1) levetiracetam in first trimester (1.71-fold baseline clearance), (2) oxcarbazepine in second trimester (1.63-fold), and (3) topiramate in second trimester (1.39-fold).

Buprenorphine medication-assisted treatment during pregnancy: An exploratory factor analysis associated with adherence.

Coker JL, Catlin D, Ray-Griffith S, Knight B, Stowe ZN.  Drug Alcohol Depend. 2018 Sep 15;192:146-149.

64 women met criteria for inclusion in this study with 41 (64%) adherent; eight (13%) moderately adherent; and 15 (23%) non-adherent. In the non-adherent group compared to the adherent group, the clinician-rated opioid withdrawal scale score was significantly higher, and the daily buprenorphine dose at last visit was significantly lower.

Inflammatory markers in women with postpartum depressive symptoms.

Bränn E, Fransson E, White RA, Papadopoulos FC, Edvinsson Å, Kamali-Moghaddam M, Cunningham JL, Sundström-Poromaa I, Skalkidou A.  J Neurosci Res. 2018 Sep 5.

Women with PPD had elevated levels of some inflammatory biomarkers. It is, therefore, plausible that PPD is associated with a compromised adaptability of the immune system.

Mood-Stabilizing Anticonvulsants, Spina Bifida, and Folate Supplementation: Commentary.

Patel N, Viguera AC, Baldessarini RJ.  J Clin Psychopharmacol. 2018 Feb;38(1):7-10.

Risks of neural tube defects (especially spina bifida) and other major malformations are especially great with valproate and can arise even before pregnancy is diagnosed. Standard supplementation of folic acid during pregnancy can reduce risk of spontaneous spina bifida, but not that associated with valproate or carbamazepine.