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.

Maybe I was in a particularly good mood when I put together this list, but there are so many good articles to read this week!

Two articles look at the role of poor sleep in perinatal women.  A meta-analysis from Pangini and colleagues demonstrates a more than threefold increase in risk for suicidal ideation in women reporting insomnia and poor sleep.  A review from Sharma and colleagues suggests that more aggressive management of sleep disturbance may also be a means of reducing risk of postpartum depression.

Several studies look at ketamine administered at delivery as a means of managing pain and reducing risk for postpartum depression. 

For policy makers, there is a nice review documenting the beneficial effects of paid maternity leave in terms of reducing risk of postpartum depression. No surprise, but it is good to have solid data when advocating for change.

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


Emotion-induced brain activation across the menstrual cycle in individuals with premenstrual dysphoric disorder and associations to serum levels of progesterone-derived neurosteroids.

Stiernman L, Dubol M, Comasco E, Sundström-Poromaa I, Boraxbekk CJ, Johansson M, Bixo M. Transl Psychiatry. 2023 Apr 14;13(1):124.

ndividuals with PMDD show altered emotion-induced brain responses in the late-luteal phase of the menstrual cycle which may be related to an abnormal response to physiological levels of GABAA-active neurosteroids.


No articles this week


Antidepressant continuation and adherence in pregnancy, and risk of antenatal hospitalization for unipolar major depressive and/or anxiety disorders.

Lupattelli A, Corrao G, Gatti C, Rea F, Trinh NTH, Cantarutti A. J Affect Disord. 2023 Jul 16;339:502-510.

This study found no difference in risk for antenatal hospitalization for depression/anxiety in women who continued antidepressant during pregnancy or who had higher levels of adherence in pregnancy, relative to discontinuation or lower adherence. It is difficult to interpret these results given that the women who elect to continue medication during pregnancy are clinically distinct from those who elect to discontinue medication.

Social media use as a risk factor for depressive symptoms during pregnancy.

Muskens L, Hulsbosch LP, van den Heuvel MI, Croes EAJ, Kop WJ, Pop VJM, Boekhorst MGBM. J Affect Disord. 2023 Oct 1;338:495-501.

Three trajectories of depressive symptoms during pregnancy were identified: a low stable (N = 489, 70.2 %), intermediate stable (N = 183, 26.3 %), and high stable (N = 25, 3.6 %) class. SMU Time and Frequency were significantly associated with belonging to the high stable class. Problematic SMU was significantly associated with belonging to the intermediate or high stable class.

Insomnia, poor sleep quality and perinatal suicidal risk: A systematic review and meta-analysis.

Palagini L, Cipriani E, Miniati M, Bramante A, Gemignani A, Geoffroy PA, Riemann D. J Sleep Res. 2023 Jul 13:e14000.

The results of the meta-analysis indicated that insomnia and poor sleep quality increase the odds of suicidal risk in pregnant women by more than threefold (OR = 3.47; 95% CI: 2.63-4.57). Specifically, the odds ratio (OR) for poor sleep quality was 3.72 (95% CI: 2.58-5.34; p < 0.001), and for insomnia symptoms, after taking into account perinatal depression, was 4.76 (95% CI: 1.83-12.34; p < 0.001).

Comparing the factor structures and reliabilities of the EPDS and the PHQ-9 for screening antepartum and postpartum depression: a multigroup confirmatory factor analysis.

Stefana A, Langfus JA, Palumbo G, Cena L, Trainini A, Gigantesco A, Mirabella F. Arch Womens Ment Health. 2023 Jul 18.

This study suggests that the EPDS should be preferred to PHQ-9 for measuring depressive symptoms in peripartum populations.

Pre-pregnancy obesity is associated with greater systemic inflammation and increased risk of antenatal depression.

Sominsky L, O’Hely M, Drummond K, Cao S, Collier F, Dhar P, Loughman A, Dawson S, Tang ML, Mansell T, Saffery R, Burgner D, Ponsonby AL, Vuillermin P; Barwon Infant Study Investigator Group. Brain Behav Immun. 2023 Jul 10;113:189-202.

Pre-pregnancy obesity increases the risk of antenatal depressive symptoms and is also associated with systemic inflammation during pregnancy. While discrete inflammatory markers are associated with antenatal depressive symptoms and perceived stress, their role in mediating the effects of pre-pregnancy obesity on antenatal depression requires further investigation.

Social support, temperament and previous prenatal loss interact to predict depression and anxiety during pregnancy.

Echabe-Ecenarro O, Orue I, Cortazar N. J Reprod Infant Psychol. 2023 Jul 17:1-14.

Pregnant women, especially those who have suffered a previous prenatal loss and score high in neuroticism or low in extraversion, may benefit from interventions that enhance social support.


Risks and benefits of pre-delivery taper in pregnant women taking antidepressants.

Robakis TK, Miyares S, Bergink V. Acta Psychiatr Scand. 2023 Jul 8.

Greater reductions in maternal antidepressant dose just prior to delivery were associated with fewer admissions to the neonatal intensive care unit (NICU) for infants. There was a slightly greater increase in depressive symptoms across delivery for women who tapered, which was not statistically significant.


Effects of different doses of esketamine intervention on postpartum depressive symptoms in cesarean section women: A randomized, double-blind, controlled clinical study.

Yang SQ, Zhou YY, Yang ST, Mao XY, Chen L, Bai ZH, Ping AQ, Xu SY, Li QW, Gao K, Wang SY, Duan KM. J Affect Disord. 2023 Jul 11;339:333-341.

Esketamine (0.25 mg kg-1) intravenous infusion combined with 1 mg kg-1 or 2 mg kg-1 esketamine PCIA seems safe and with few adverse effects in the management of PDS and pain in women undergoing cesarean section.

Predicting efficacy of sub-anesthetic ketamine/esketamine i.v. dose during course of cesarean section for PPD prevention, utilizing traditional logistic regression and machine learning models.

Li Q, Gao K, Yang S, Yang S, Xu S, Feng Y, Bai Z, Ping A, Luo S, Li L, Wang L, Shi G, Duan K, Wang S. J Affect Disord. 2023 Jul 13;339:264-270.

Logistic regression and machine learning algorithms could be used to predict the effectiveness of IV ketamine/esketamine during the course of cesarean section for PPD prevention. An individualized preventative strategy could be developed after entering individuals’ clinical features into the model, which would be of great clinical value in terms of reducing PPD incidence.

Preventing recurrence of postpartum depression by regulating sleep.

Sharma V, Sharkey KM, Palagini L, Mazmanian D, Thomson M. Expert Rev Neurother. 2023 Jul 18:1-9.

Targeting disturbed and/or insufficient sleep – a common and early transdiagnostic symptom of peripartum psychiatric disorders – may be a more effective intervention for the prevention of postpartum depression and psychiatric comorbidities in some individuals than the traditional approach of antidepressant use.

Association between maternity leave policies and postpartum depression: a systematic review.

Hidalgo-Padilla L, Toyama M, Zafra-Tanaka JH, Vives A, Diez-Canseco F. Arch Womens Ment Health. 2023 Jul 17.

Paid and longer maternity leaves tend to be associated with a reduction of postpartum depression symptoms in high-income countries. No studies explored the association between employment protection and postpartum depression.

Effects of Drospirenone only pill contraception on postpartum mood disorders: A prospective, comparative pilot study.

Caruso S, Caruso G, Bruno MT, Minona P, Di Guardo F, Palumbo M. Eur J Obstet Gynecol Reprod Biol. 2023 Jul 6;288:73-77.

Drospirenone (DRSP) only pill (DOP) 4 mg, in a 24 active/4 placebo regimen, appeared to modulate risk of postpartum depression.

Maternal postpartum depressive symptoms: The predictive role of objective and subjective birth experience and hair glucocorticoids.

Jaramillo I, Karl M, Bergunde L, Mack JT, Weise V, Weidner K, Gao W, Steudte-Schmiedgen S, Garthus-Niegel S. J Affect Disord. 2023 Jul 15;339:974-983.

These results suggest that negative objective birth experience is associated with an altered hair cortisol to cortisone ratio (HairF/HairE), which in turn, seems to be a promising biomarker to identify women at risk for developing PPD. A negative subjective birth experience may be less critical for alterations of the HPA-axis but remains an essential risk factor for PPD.

A systematic review of interpersonal psychotherapy for postpartum depression.

Wang X, Qiu Q, Shen Z, Yang S, Shen X. J Affect Disord. 2023 Jul 16;339:823-831.

Interpersonal psychotherapy was effective for the treatment of depression in patients with postpartum depression, but the appropriate time of intervention was between 4 and 8 weeks. IPT also improved satisfaction with the family of patients, and the longer the intervention, the higher the satisfaction.

Fathers’ subjective childbirth stress predicts depressive symptoms at six months postpartum.

Aviv EC, Preston EG, Waizman YH, Dews AA, Flores G, Saxbe DE. J Affect Disord. 2023 Jul 17;339:593-600.

Fathers’ ratings of subjective birth stress significantly predicted postpartum depressive symptoms at six months postpartum. Subjective birth stress ratings varied significantly for fathers whose partners delivered via emergency cesarean section compared to those whose partners gave birth via both medicated and the unmedicated vaginal delivery.


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