Postpartum depression: Pathophysiology, treatment, and emerging therapeutics

Annual Review of Medicine

Volumn 70, Issue , 2019, Pages 183-196

  Stewart, Donna E ^a,b,c,d   Vigod, Simone N ^a,e  

^a UNIVERSITY OF TORONTO   (Canada)

^b UNIVERSITY OF TORONTO   (Canada)

^c UNIVERSITY HEALTH NETWORK   (Canada)

^d UNIVERSITY HEALTH NETWORK   (Canada)

^e WOMEN S COLLEGE HOSPITAL   (Canada)

Author keywords

allopregnanolone; emerging therapies; genetic aspects; pathophysiology; postpartum depression

Indexed keywords

HORMONE; ANTIDEPRESSANT AGENT;

ARTICLE; DIFFERENTIAL DIAGNOSIS; DISEASE COURSE; HEREDITY; HUMAN; IMMUNITY; PATHOPHYSIOLOGY; PATIENT CARE; POSTNATAL DEPRESSION; PRIORITY JOURNAL; PSYCHIATRIC TREATMENT; PSYCHOPHARMACOTHERAPY; SOCIAL PSYCHOLOGY; ADULT; FEMALE; INCIDENCE; PREGNANCY; PROCEDURES; PROGNOSIS; PSYCHOTHERAPY; RISK ASSESSMENT; SEVERITY OF ILLNESS INDEX; TREATMENT OUTCOME;

ADULT; ANTIDEPRESSIVE AGENTS; DEPRESSION, POSTPARTUM; FEMALE; HUMANS; INCIDENCE; PREGNANCY; PROGNOSIS; PSYCHOTHERAPY; RISK ASSESSMENT; SEVERITY OF ILLNESS INDEX; TREATMENT OUTCOME;

EID: 85060577244     PISSN: 00664219     EISSN: 1545326X     Source Type: Book Series    
DOI: 10.1146/annurev-med-041217-011106     Document Type: Article

References (79)

1. Hamilton JA, Harberger PN, eds. 1992. Postpartum Psychiatric Illness: A Picture Puzzle. Philadelphia: Univ. Pa. Press
2. Kanes S, Colquhoun H, Gunduz-Bruce H, et al. 2017. Brexanolone (SAGE-547 injection) in post-partum depression: A randomised controlled trial. Lancet 390(10093):480-89
3. Am. Psychiatr. Assoc. 2013. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: Am. Psychiatr. Assoc.
4. Schiller CE, Meltzer-Brody S, Rubinow DR. 2015. The role of reproductive hormones in postpartum depression. CNS Spectr. 20(01):48-59
5. Stewart DE, Vigod S. 2016. Postpartum depression. N. Engl. J. Med. 375(22):2177-86
6. Wisner KL, Sit DKY, McShea MC, et al. 2013. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 70:490-98
7. NICE (Natl. Inst.Health Care Excell.). 2014. Antenatal and postnatal mental health: Clinical management and service guidance. Updated Apr. 2018, accessed Apr. 28, 2018. http://www.nice.org.uk/guidance/cg192
8. Comm. Obstet. Practice. 2015. The American College of Obstetricians and Gynecologists Committee Opinion no. 630. Screening for perinatal depression. Obstet. Gynecol. 125:1268-71
9. EarlsMF. 2010. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics 126:1032-39
10. Siu AL, Bibbins-Domingo K, GrossmanDC, et al. 2016. Screening for depression in adults:US Preventive Services Task Force recommendation statement. JAMA 315(4):380
11. Thombs BD, Arthurs E, Coronado-Montoya S, et al. 2014. Depression screening and patient outcomes in pregnancy or postpartum: A systematic review. J. Psychosom. Res. 76(6):433-46
12. Kroenke K, Spitzer RL. 2001. The PHQ-9: Validity of a brief depression severity measure. J. Gen. Intern. Med. 16:606-13
13. Cox JL, Holden JM, Sagovsky R. 1987. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br. J. Psychiatry 150:782-86
14. Henshaw C. 2003. Mood disturbance in the early puerperium: A review. Arch. Women's Ment. Health 6(2):S22-42
15. Paykel ES, EmmsEM, Fletcher J, Rassaby ES. 1980. Life events and social support in puerperal depression. Br. J. Psychiatry 136:339-46
16. Howard LM, Oram S, GalleyH, et al. 2013. Domestic violence and perinatal mental disorders: A systematic review and meta-analysis. PLOS Med. 10:e1001452
17. Dale-Hewitt V, Slade P, Wright I, et al. 2012. Patterns of attention and experiences of post-traumatic stress symptoms following childbirth: An experimental study. Arch. Women's Ment. Health 15(4):289-96
18. Howard LM, Molyneaux E, Dennis C-L, et al. 2014. Non-psychotic mental disorders in the perinatal period. Lancet 384:1775-88
19. Munk-Olsen T, Laursen TM, Pedersen CB, et al. 2006. New parents and mental disorders. JAMA 296:2582-89
20. Forty L, Jones L, Macgregor S, et al. 2006. Familiality of postpartum depression in unipolar disorder: Results of a family study. Am. J. Psychiatry 163(9):1549-53
21. Cameron EE, Sedov ID, Tomfohr-Madsen LM. 2016. Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis. J. Affect. Disord. 206:189-203
22. Leung BMY, Letourneau NL, Giesbrecht GF, et al. 2017. Predictors of postpartum depression in partnered mothers and fathers from a longitudinal cohort. Community Ment. Health J. 53(4):420-31
23. Kerstis B, Engstr öm G, Edlund B, et al. 2013. Association between mothers' and fathers' depressive symptoms, sense of coherence and perception of their child's temperament in early parenthood in Sweden. Scand. J. Public Health 41(3):233-39
24. Campbell SB, Cohn JF. 1997. The timing and chronicity of postpartum depression: Implications for infant development. In Postpartum Depression and Child Development, ed. P Cooper, L Murray, pp. 165-97. New York: Guilford
25. Goodman JH. 2004. Postpartum depression beyond the early postpartum period. J. Obstet. Gynecol.Neonatal Nurs. 33:410-20
26. Dennis C-L, McQueen K. 2007. Does maternal postpartum depressive symptomatology influence infant feeding outcomes? Acta Paediatr. 96(4):590-94
27. Zajicek-Farber ML. 2009. Postnatal depression and infant health practices among high-risk women. J. Child Fam. Stud. 18(2):236-45
28. O'Hara MW, McCabe JE. 2013. Postpartum depression: Current status and future directions. Annu. Rev. Clin. Psychol. 9:379-407
29. Goodman SH, Rouse MH, Connell AM, et al. 2011. Maternal depression and child psychopathology: A meta-analytic review. Clin. Child Fam. Psychol. Rev. 14(1):1-27
30. Murray L, Arteche A, Fearon P, et al. 2011. Maternal postnatal depression and the development of depression in offspring up to 16 years of age. J. Am. Acad. Child Adolesc. Psychiatry 50(5):460-70
31. Brand SR, Brennan PA. 2009. Impact of antenatal and postpartum maternal mental illness: How are the children? Clin. Obstet. Gynecol. 52(3):441-55
32. Grace SL, Evindar A, Stewart DE. 2003. The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature. Arch. Women's Ment. Health 6(4):263-74
33. Ban L, Gibson JE, West J, et al. 2010. Association between perinatal depression in mothers and the risk of childhood infections in offspring: A population-based cohort study. BMC Public Health 10(1):799
34. Ertel KA, Koenen KC, Rich-Edwards JW, et al. 2010. Antenatal and postpartum depressive symptoms are differentially associated with early childhood weight and adiposity. Paediatr. Perinat. Epidemiol. 24(2):179-89
35. Gress-Smith JL, Luecken LJ, Lemery-Chalfant K, et al. 2012. Postpartum depression prevalence and impact on infant health, weight, and sleep in low-income and ethnic minority women and infants. Matern. Child Health J. 16(4):887-93
36. Berman KF, Schmidt PJ, Rubinow DR, et al. 1997. Modulation of cognition-specific cortical activity by gonadal steroids: A positron-emission tomography study in women. PNAS 94(16):8836-41
37. Goldstein JM, Jerram M, Poldrack R, et al. 2005. Hormonal cycle modulates arousal circuitry in women using functional magnetic resonance imaging. J. Neurosci. 25(40):9309-16
38. Protopopescu X, Pan H, Altemus M, et al. 2005. Orbitofrontal cortex activity related to emotional processing changes across the menstrual cycle. PNAS 102(44):16060-65
39. O'Hara MW, Schlechte JA, Lewis DA, et al. 1991. Prospective study of postpartum blues. Biologic and psychosocial factors. Arch. Gen. Psychiatry 48(9):801-6
40. Buckwalter JG, Stanczyk FZ, McClearyCA, et al. 1999. Pregnancy, the postpartum, and steroid hormones: Effects on cognition and mood. Psychoneuroendocrinology 24(1):69-84
41. Gregoire AJ, Kumar R, Everitt B, et al. 1996. Transdermal oestrogen for treatment of severe postnatal depression. Lancet 347(9006):930-33
42. Ahokas A, Kaukoranta J, Wahlbeck K, et al. 2001. Estrogen deficiency in severe postpartum depression: Successful treatment with sublingual physiologic 17beta-estradiol: A preliminary study. J. Clin. Psychiatry 62(5):332-36
43. Bloch M, Schmidt PJ, Danaceau M, et al. 2000. Effects of gonadal steroids in women with a history of postpartum depression. Am. J. Psychiatry 157:924-30
44. Stewart DE, Boydell KM. 1993. Psychologic distress during menopause: Associations across the reproductive life cycle. Int. J. Psychiatry Med. 23(2):157-62
45. Majewska MD, HarrisonNL, Schwartz RD, et al. 1986. Steroid hormone metabolites are barbiturate-like modulators of the GABA receptor. Science 232(4753):1004-7
46. Epperson CN, Gueorguieva R, Czarkowski KA, et al. 2006. Preliminary evidence of reduced occipital GABA concentrations in puerperal women: A 1H-MRS study. Psychopharmacology 186(3):425-33
47. Deligiannidis KM, Sikoglu EM, Shaffer SA, et al. 2013. GABAergic neuroactive steroids and resting-state functional connectivity in postpartum depression: A preliminary study. J. Psychiatr. Res. 47(6):816-28
48. Couto TCE, BrancaglionMYM, Alvim-Soares A, et al. 2015. Postpartum depression: A systematic review of the genetics involved. World J. Psychiatry 5:103-11
49. Guintivano J, Arad M, Gould TD, et al. 2014. Antenatal prediction of postpartum depression with blood DNA methylation biomarkers. Mol. Psychiatry 19:560-67
50. Figueira P, Malloy-Diniz L, Campos SB, et al. 2010. An association study between the Val66Met polymorphism of the BDNF gene and postpartum depression. Arch. Women's Ment. Health 13(3):285-89
51. Mahon PB, Payne JL, MacKinnon DF, et al. 2009. Genome-wide linkage and follow-up association study of postpartum mood symptoms. Am. J. Psychiatry 166(11):1229-37
52. Segman RH, Goltser-Dubner T, Weiner I, et al. 2010. Blood mononuclear cell gene expression signature of postpartum depression. Mol. Psychiatry 15(1):93-100
53. Krause D, Jobst A, Kirchberg F, et al. 2014. Prenatal immunologic predictors of postpartum depressive symptoms: A prospective study for potential diagnostic markers. Eur. Arch. Psychiatry Clin. Neurosci. 264(7):615-24
54. Pritchett RV, Daley AJ, Jolly K. 2017. Does aerobic exercise reduce postpartum depressive symptoms? A systematic review and meta-analysis. Br. J. Gen. Pract. 67(663):e684-91
55. McCurdyAP, BouléNG, SivakA, et al. 2017. Effects of exercise onmild-to-moderate depressive symptoms in the postpartum period: A meta-analysis. Obstet. Gynecol. 129(6):1087-97
56. Kempler L, Sharpe L, Miller CB, et al. 2016. Do psychosocial sleep interventions improve infant sleep or maternal mood in the postnatal period? A systematic review and meta-analysis of randomised controlled trials. Sleep Med. Rev. 29:15-22
57. Dennis C-L, Chung-Lee L. 2006. Postpartum depression help-seeking barriers and maternal treatment preferences: A qualitative systematic review. Birth 33:323-31
58. Byatt N, Levin LL, Ziedonis D, et al. 2015. Enhancing participation in depression care in outpatient perinatal care settings: A systematic review. Obstet. Gynecol. 126:1048-58
59. Lee EW, Denison FC, Hor K, et al. 2016. Web-based interventions for prevention and treatment of perinatal mood disorders: A systematic review. BMC Pregnancy Childbirth 16(1):38
60. Lau Y, Htun TP, Wong SN, et al. 2017. Therapist-supported internet-based cognitive behavior therapy for stress, anxiety, and depressive symptoms among postpartum women: A systematic review and metaanalysis. J. Med. Internet Res. 19(4):e138
61. Letourneau NL, Dennis C-L, Cosic N, et al. 2017. The effect of perinatal depression treatment for mothers on parenting and child development: A systematic review. Depress. Anxiety 34(10):928-66
62. Leger J, Letourneau N. 2015. Newmothers and postpartum depression: A narrative review of peer support intervention studies. Health Soc. Care Community 23(4):337-48
63. Sharp DJ, Chew-Graham C, Tylee A, et al. 2010. A pragmatic randomised controlled trial to compare antidepressants with a community-based psychosocial intervention for the treatment of women with postnatal depression: The RESPOND trial. Health Technol. Assess. 14(43):iii-iv, ix-xi, 1-153
64. Dennis C-L. 2014. Psychosocial interventions for the treatment of perinatal depression. Best Pract. Res. Clin. Obstet. Gynaecol. 28:97-111
65. Stephens S, Ford E, Paudyal P, et al. 2016. Effectiveness of psychological interventions for postnatal depression in primary care: A meta-analysis. Ann. Fam. Med. 14(5):463-72
66. Molyneaux E, Howard LM, McGeown H, et al. 2014. Antidepressant treatment for postnatal depression. Cochrane Database Syst Rev. 11:CD002018
67. Davanzo R, Copertino M, De Cunto A, et al. 2011. Antidepressant drugs and breastfeeding: A review of the literature. Breastfeed. Med. 6(2):89-98
68. Sigurdsson HP, Hefner G, Ben-Omar N, et al. 2015. Steady-state serum concentrations of venlafaxine in patients with late-life depression. Impact of age, sex and BMI. J. Neural Transm. 122:721-29
69. Waldschmitt C, Vogel F, Pfuhlmann B, et al. 2009. Duloxetine serum concentrations and clinical effects. Data from a therapeutic drug monitoring (TDM) survey. Pharmacopsychiatry 42:189-93
70. Smit M, Dolman KM, Honig A. 2016. Mirtazapine in pregnancy and lactation-a systematic review. Eur. Neuropsychopharmacol. 26:126-35
71. Sriraman NK, Melvin K, Meltzer-Brody S. 2015. ABM Clinical Protocol #18: Use of antidepressants in breastfeeding mothers. Breastfeed. Med. 10:290-99
72. Walton GD, Ross LE, Stewart DE, et al. 2014. Decisional conflict among women considering antidepressant medication use in pregnancy. Arch. Women's Ment. Health 17(6):493-501
73. Gressier F, Rotenberg S, Cazas O, et al. 2015. Postpartum electroconvulsive therapy: A systematic review and case report. Gen. Hosp. Psychiatry 37(4):310-14
74. Milev RV, Giacobbe P, Kennedy SH, et al. 2016. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 4. Neurostimulation treatments. Can. J. Psychiatry 61(9):561-75
75. Kim DR, Snell JL, Ewing GC, O'Reardon J. 2015. Neuromodulation and antenatal depression: A review. Neuropsychiatr. Dis. Treat. 11:975-82
76. Beyondblue, Austin MP, Highet N, Natl. Health Med. Res. Counc. 2011. Clinical practice guidelines for depression and related disorders-anxiety, bipolar disorder and puerperal psychosis-in the perinatal period. A guideline for primary care health professionals. Clin. practice guidel. Beyondblue, Melbourne, Aust. http://resources.beyondblue.org.au/prism/file?token=BL/0891
77. Scottish Intercoll. Guidel. Netw. (SIGN). 2012. Management of perinatal mood disorders. A national clinical guideline. Clin. practice guidel., SIGN, Edinburgh, Scotland. https://www.sign.ac.uk/assets/ sign127_update.pdf
78. Can. Netw. Mood Anxiety Treat. (CANMAT). 2016. Clinical guidelines for the management of adults with major depressive disorder. Can. J. Psychiatry 61:550, 594-95
79. Am. Psychiatr. Assoc. (APA). 2010. Practice guideline for the treatment of patients with Major Depressive Disorder. 3rd ed. Clin. prac. guidel., APA. http://psychiatryonline.org/pb/assets/raw/sitewide/ practice_guidelines/guidelines/mdd.pdf