Data on the most recent randomized controlled trial of brexanolone, a novel treatment for postpartum depression, were released. (We will review those in greater detail next week.)   Guidelines for the treatment of perimenopausal depression were also published.


Ruta Nonacs, Md PhD

Brexanolone injection in post-partum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials.

Meltzer-Brody S, Colquhoun H, Riesenberg R, Epperson CN, et al.  Lancet Sept 2018.
Intravenous administration of brexanolone for postpartum depression resulted in significant reductions in HAM-D total scores at 60 hours compared with placebo, with rapid onset of action and durable treatment response.

Course of major depressive disorder after pregnancy and the postpartum period.

Freeman MP, Claypoole LD, Burt VK, Sosinsky AZ, Moustafa D, Noe OB, Cheng LJ, Cohen LS.  Depress Anxiety. 2018 Sep 7.

Although approximately one third reported sustained remission from MDD since the pregnancy during which they had been originally followed, of the remaining two thirds of women who reported subsequent depressive episodes, almost one fifth (?12% of the total sample) endorsed depression more than 50% of the time following their index pregnancy. A total of 6.3% of the women with previous validated diagnoses of MDD reported new diagnoses of bipolar disorder. Women reported similar treatment choices regarding the use of antidepressants during pregnancies subsequent to the one followed in the previous study.

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). 2018 Sep 5.

Prenatal Treatment and Outcomes of Women With Opioid Use Disorder.

Brogly SB, Saia KE, Werler MM, Regan E, Hernández-Díaz S.  Obstet Gynecol. 2018 Sep 7.

Few women were married (8.9%). More than half of the cohort had been incarcerated, 29.2% had current legal involvement, and 15.0% generally had unstable housing. A majority (70.8%) were infected with hepatitis C and histories of sexual (56.6%) and physical (65.5%) abuse were prevalent. Regular substance used included heroin (92.0%), injection heroin (83.2%), other opioids (69.0%), marijuana (73.5%), alcohol (56.6%), and cocaine (62.8%).

Associations of paternal postpartum depressive symptoms with infant development in a Chinese longitudinal study.

Ip P, Li TMH, Chan KL, Ting AYY, Chan CY, Koh YW, Ho FKW, Lee A.  Infant Behav Dev. 2018 Sep .

Fathers with postpartum depression symptoms experienced reduced paternal-infant attachment, which also acted as mediators between postpartum depression in fathers and adverse infants’ social and overall development.

Intrusive thoughts and images of intentional harm to infants in the context of maternal postnatal depression, anxiety, and OCD.

Lawrence PJ, Craske MG, Kempton C, Stewart A, Stein A.  Br J Gen Pract. 2017 Aug;67(661):376-377.  

Free  Article

A guide for primary care clinicians, regarding intrusive thoughts in postpartum women and how to ask about them.   

Cost-effectiveness of interventions for perinatal anxiety and/or depression: a systematic review.

Camacho EM, Shields GE.  BMJ Open. 2018 Aug 10;8(8).   Free Article

8 studies met the inclusion criteria for the review; all but one focussing solely on postnatal depression in mothers. Interventions included prevention (3/8), treatment (3/8) or identification plus treatment (2/8). Two interventions were likely to be cost-effective, both incorporated identification plus treatment.

Associations between postpartum depression and hypertensive disorders of pregnancy.

Strapasson MR, Ferreira CF, Ramos JGL.  Int J Gynaecol Obstet. 2018 Sep 7.

Women diagnosed with hypertension during pregnancy were more likely to have depressive symptoms than their normotensive counterparts. This article is protected by copyright. All rights reserved.

Family physicians perceived role in perinatal mental health: an integrative review.

Noonan M, Doody O, Jomeen J, O’Regan A, Galvin R.  BMC Fam Pract. 2018 Sep 8;19(1):154.    Free Article

Family physicians require timely access to local integrated care pathways that provide a wide range of services that are culturally sensitive, perinatal mental health specific, support psychological well-being and infant/family mental health. Family physicians are open to incorporating a brief validated screening tool into primary practice supported by succinct guidelines.

Normal cholesterol levels in the immediate postpartum period: A risk factor for depressive and anxiety symptoms?

Troisi A, Croce Nanni R.  Psychiatry Res. 2018 Aug 25;269:394-398.

In the subgroup of mothers with normal cholesterol, those with lower levels experienced more symptoms of anxiety, depression and fatigue. In the larger group of mothers with high cholesterol levels, history of mood disturbances and postpartum depressive and anxiety symptoms were not correlated with total cholesterol. Measuring cholesterol levels in the peripartum can be useful to identify a subgroup of women with naturally low cholesterol levels and an increased risk for postpartum depressive and anxiety symptoms.

Repetitive Negative Thinking and Its Role in Perinatal Mental Health.

Moulds ML, Black MJ, Newby JM, Hirsch CR.  Psychopathology. 2018;51(3):161-166.

Repetitive negative thinking may be a modifiable risk factor which can be targeted in pregnancy to prevent depression and anxiety in new mothers.

The prevalence and correlates of self-harm ideation trajectories in Australian women from pregnancy to 4-years postpartum.

Giallo R, Pilkington P, Borschmann R, Seymour M, Dunning M, Brown S.  J Affect Disord. 2018 Mar 15;229:152-158.

Approximately 4-5% of women reported experiencing self-harm ideation at each time-point from pregnancy to 4-years postpartum. Cross-sectional analyses revealed that self-harm ideation was most frequently endorsed in the first 12-months postpartum (4.6%), and approximately 15% of women reported self-harm ideation at least once during the study period.  Longitudinally, approximately 7% of women had an enduring pattern of self-harm ideation from pregnancy to 4-years postpartum.

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