Antidepressant treatment for postnatal depression

Brown, Jennifer Valeska Elli; Wilson, Claire A.; Ayre, Karyn; South, Emily; Molyneaux, Emma; Trevillion, Kylee; Howard, Louise; Khalifeh, Hind

doi:10.1002/14651858.cd013560

Cited by 9 publications

(15 citation statements)

References 37 publications

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“…3 PPD is preventable and treatable, and therefore, early identification of women at high risk is important to prevent or mitigate the detrimental consequences observed in relation to PPD. [4][5][6] Several risk factors for PPD have been identified and summarized in systematic reviews; however, having a relative with a psychiatric disorder is often not listed as a risk factor in reviews summarizing all identified risk factors. [7][8][9][10][11][12][13][14][15][16][17][18] Recently, 3 comprehensive umbrella reviews, compiling evidence from several systematic reviews on risk factors for PPD, also did not identify family history of psychiatric disorders as a risk factor.…”

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confidence: 99%

Family History of Psychiatric Disorders as a Risk Factor for Maternal Postpartum Depression

et al. 2022

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ImportanceCurrent evidence on the association between family history of psychiatric disorders and postpartum depression is inconsistent; family studies have identified familial risk of postpartum depression, whereas systematic reviews and umbrella reviews, compiling all risk factors for postpartum depression, often have not.ObjectiveTo investigate the association between family history of psychiatric disorders and risk of developing postpartum depression within 12 months post partum.Data SourcesLiterature searches were conducted in PubMed, Embase, and PsycINFO in September 2021 and updated in March 2022, accompanied by citation and reference search.Study SelectionStudies eligible for inclusion comprised peer-reviewed cohort and case-control studies reporting an odds ratio (OR) or sufficient data to calculate one for the association between family history of any psychiatric disorder and postpartum depression. Study selection was made by 2 independent reviewers: title and abstract screening followed by full-text screening.Data Extraction and SynthesisReporting was performed using the MOOSE checklist. Two reviewers independently extracted predefined information and assessed included studies for risk of bias using the Newcastle-Ottawa Scale. Data were pooled in a meta-analysis using a random-effects model. Heterogeneity was investigated with meta-regression, subgroup, and sensitivity analyses. Publication bias was investigated using a funnel plot, and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to evaluate the overall certainty of the findings.Main Outcomes and MeasuresThe primary outcome was the pooled association between family history of psychiatric disorders and postpartum depression.ResultsA total of 26 studies were included, containing information on 100 877 women. Meta-analysis showed an increased OR of developing postpartum depression when mothers had a family history of psychiatric disorders (OR, 2.08; 95% CI, 1.67-2.59; I2 = 57.14%) corresponding to a risk ratio of 1.79 (95% CI, 1.52-2.09), assuming a 15% postpartum depression prevalence in the general population. Subgroup, sensitivity, and meta-regression analyses were in line with the primary analysis. The overall certainty of evidence was deemed as moderate according to GRADE.Conclusions and RelevanceIn this study, there was moderate certainty of evidence for an almost 2-fold higher risk of developing postpartum depression among mothers who have a family history of any psychiatric disorder compared with mothers without.

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Family History of Psychiatric Disorders as a Risk Factor for Maternal Postpartum Depression

et al. 2022

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“…Pharmacological treatment for PND is contraindicated mainly due to the issues of teratogenicity [15]. Fortunately, research on psychosocial interventions to treat PND and other common mental disorders has gained momentum in recent years [13], leading to innovations in screening, prevention, and treatment [13].…”

Section: Introductionmentioning

confidence: 99%

Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings

Ahmed¹,

Sikander²,

Malik³

et al. 2022

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Task sharing approaches are challenged by the barriers fundamental to the use of non-specialists who lack specialist mental health training required to triage the candidates who could benefit from task-shared treatments. However, these challenges could be offset by using standardized and easy-to-implement algorithmic devices (e.g., nomograms) to help with the targeted dissemination of interventions. Therefore, the present investigation posits a prognostic model and a nomogram to predict the prognosis of perinatal depression among women in rural Pakistan. This secondary analysis utilizes data based on 903 pregnant women with depression who participated in a cluster randomized controlled trial that tested the effectiveness of the Thinking Healthy Program in rural Rawalpindi, Pakistan. The participants were recruited from 40 union councils in two sub-districts of Rawalpindi and randomly assigned to intervention and enhanced usual care. Sixteen sessions of the THP intervention were delivered by trained community health workers to women with depression over pregnancy and the postnatal period. A trained assessment team used the Structured Clinical Interview for the DSM-4 current major depressive episode module to diagnose depression at the baseline and post-intervention. The intervention received by the participants emerged as the most significant predictor in the model. Among clinical factors, baseline severity of core-emotional symptoms emerged as an essential predictor, followed by atypical symptoms and insomnia. Higher severity of these symptoms was associated with a poorer prognosis. Other important predictors of a favorable prognosis included living with paternal and maternal grandmothers, financial empowerment, higher socioeconomic class, and living in a joint family system. This prognostic model yielded acceptable discrimination (c-statistic =0.75) and calibration to aid in personalized delivery of psychological treatment.

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“…The treatment of PND also poses several challenges specific to the perinatal period [ 14 ]. Pharmacological treatment for PND is discouraged by perinatal women mainly due to concerns of teratogenicity [ 15 ]. Furthermore, there is a dearth of clinical trials on the effectiveness of antidepressants in the perinatal period due to ethical concerns [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Pharmacological treatment for PND is discouraged by perinatal women mainly due to concerns of teratogenicity [ 15 ]. Furthermore, there is a dearth of clinical trials on the effectiveness of antidepressants in the perinatal period due to ethical concerns [ 15 ]. The limited clinical trial evidence for antidepressants available has shown only small improvements in perinatal depressive symptoms, sometimes accompanied by side effects and poor adherence [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, there is a dearth of clinical trials on the effectiveness of antidepressants in the perinatal period due to ethical concerns [ 15 ]. The limited clinical trial evidence for antidepressants available has shown only small improvements in perinatal depressive symptoms, sometimes accompanied by side effects and poor adherence [ 15 ]. Fortunately, research on psychosocial interventions to treat PND and other common mental disorders has gained momentum in recent years [ 13 ], leading to innovations in screening, prevention, and treatment [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings

Ahmed

Sikander

Malik

et al. 2022

JPM

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Perinatal depression is highly prevalent in low- and middle-income countries (LMICs) and is associated with adverse maternal and child health consequences. Task-shared psychological and psychosocial interventions for perinatal depression have demonstrated clinical and cost-effectiveness when delivered on a large scale. However, task-sharing approaches, especially in LMICs, require an effective mechanism, whereby clients who are not likely to benefit from such interventions are identified from the outset so that they can benefit from higher intensity treatments. Such a stratified approach can ensure that limited resources are utilized appropriately and effectively. The use of standardized and easy-to-implement algorithmic devices (e.g., nomograms) could help with such targeted dissemination of interventions. The present investigation posits a prognostic model and a nomogram to predict the prognosis of perinatal depression among women in rural Pakistan. The nomogram was developed to deliver stratified model of care in primary care settings by identifying those women who respond well to a non-specialist delivered intervention and those requiring specialist care. This secondary analysis utilized data from 903 pregnant women with depression who participated in a cluster randomized, controlled trial that tested the effectiveness of the Thinking Healthy Program in rural Rawalpindi, Pakistan. The participants were recruited from 40 union councils in two sub-districts of Rawalpindi and randomly assigned to intervention and enhanced usual care. Sixteen sessions of the THP intervention were delivered by trained community health workers to women with depression over pregnancy and the postnatal period. A trained assessment team used the Structured Clinical Interview for DSM-IV current major depressive episode module to diagnose major depressive disorder at baseline and post-intervention. The intervention received by the participants emerged as the most significant predictor in the prognostic model. Among clinical factors, baseline severity of core-emotional symptoms emerged as an essential predictor, followed by atypical symptoms and insomnia. Higher severity of these symptoms was associated with a poorer prognosis. Other important predictors of a favorable prognosis included support from one’s mother or mother-in-law, financial empowerment, higher socioeconomic class, and living in a joint family system. This prognostic model yielded acceptable discrimination (c-statistic = 0.75) and calibration to aid in personalized delivery of the intervention.

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Antidepressant treatment for postnatal depression

Abstract: This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the effectiveness and safety of antidepressant drugs in comparison with any other treatment (psychological, psychosocial, or pharmacological), placebo, or treatment as usual for PND.

Cited by 9 publications

References 37 publications

Family History of Psychiatric Disorders as a Risk Factor for Maternal Postpartum Depression

Family History of Psychiatric Disorders as a Risk Factor for Maternal Postpartum Depression

Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings

Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings

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