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.
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
PMS AND PMDD
GABAergic neuroactive steroid response to sertraline in premenstrual dysphoric disorder – PubMed
Participants included 38 controls and 32 women with PMDD. There were no significant differences in neuroactive steroid levels between controls and participants with PMDD in the luteal phase (p > 0.05). Within the PMDD group, sertraline treatment significantly increased serum pregnanolone levels and the pregnanolone to progesterone ratio, and decreased 3?,5?-androsterone.
Management options include psychotropic agents, ovulation suppression and dietary modification. Selective serotonin reuptake inhibitors (SSRIs) are considered primary therapy for psychological symptoms. Ovulation suppression is another option with the combined oral contraceptive pill (COCP) or GnRH (gonadotropin-releasing hormone) agonists.
Suicide and the Menstrual Cycle
Editorial from David Rubinow.
MEDICATIONS AND PREGNANCY
Infants exposed to lamotrigine-levetiracetam duotherapy during the first trimester had a 60% lower risk of major congenital malformation (MCM) than infants exposed to valproate monotherapy; however, lamotrigine-topiramate carried a risk of MCM similar to valproate monotherapy.
Among over 3 million pregnancies, the medications most commonly dispensed at any time during pregnancy were analgesics, antibiotics, and antiemetics. The use of antidiabetic and psychotropic medications has continued to increase in the U.S. during the last decade.
POSTPARTUM PSYCHIATRIC DISORDERS
The lived experiences of individuals with postpartum psychosis: A qualitative analysis – PubMed
Initiated in 2018, the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3) consists of a large, international sample of those who have experienced PP. This analysis included 130 participants who reported on 133 episodes of PP.
Sleep and Postpartum Psychosis: A Narrative Review of the Existing Literature – PubMed
Some of the existing literature suggests an association between sleep problems, specifically insomnia, sleep loss and sleep disruption during pregnancy and postpartum. However, it is still unclear whether the previously mentioned sleep problems are a symptom of, or a trigger for PP.
The intervention was a live video-based 12-week interactive psychotherapy group focused on maternal symptoms and maternal-infant relationships. There were significant pre- to post-group reductions in maternal depressive and post-traumatic symptoms, supporting proceeding to larger-scale implementation and evaluation of the intervention.
This study does not support the use of the Edinburgh Postnatal Depression Scale to distinguish perinatal depressive subtypes for the purposes of predicting course and complications associated with perinatal depression.
This article reviews zuranolone (SAGE217), focusing on available clinical studies in individuals with major depressive disorder, in addition to PPD.
Association of Postpartum Mental Illness Diagnoses with Severe Maternal Morbidity
In this cohort, 3.1% experienced severe maternal morbidity (SMM) during pregnancy and/or delivery hospitalization, and 20.1% had a mental illness diagnosis within 1 year postpartum. In adjusted analyses, individuals with SMM had a 10.6% increased risk of having any mental illness diagnosis compared to individuals without SMM, primarily due to an increased risk of a depression or post-traumatic stress disorder.
In women receiving epidural anesthesia at the time of labor and delivery, esketamine combined with ropivacaine hydrochloride, compared to ropivacaine alone, was associated with a lower incidence of postpartum depressive symptoms at weeks 1 and 6, after delivering without increasing related side effects.
IMPACT OF MATERNAL DEPRESSION ON CHILD OUTCOMES
Increasing maternal depressive symptoms over the perinatal period is associated with poorer executive functioning outcomes in children at age 4 – independent of prenatal smoking, drinking, or antidepressant use. Chronicity and severity of postpartum depressive symptoms may play crucial roles in determining childhood executive functioning.
OTHER ARTICLES OF INTEREST
Earlier birth predicted an increased risk for anxiety disorders. The risk for ADHD increased with lower gestational age independent of birthweight. In contrast, gestational age was not associated with Oppositional Defiant Disorder, Conduct Disorder, internalizing or externalizing symptoms.
Prenatal exposure to infections was associated with higher child total, internalizing, and externalizing problems, showing temporally persistent effects, even after adjusting for important genetic and environmental confounders.
Leave A Comment