Treatment of Postpartum Depression: Recommendations for the Clinician

O’Hara, Michael W.; Engeldinger, Jane

doi:10.1097/grf.0000000000000353

Cited by 19 publications

(21 citation statements)

References 30 publications

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“…A special consideration when discussing pharmacologic therapy in postpartum depression is whether mothers will be breastfeeding their child; “although there is not strong evidence that the amount of antidepressant medication in the breastmilk is sufficient to cause harm for the infant, many women prefer to avoid even this small potential risk” ( 32 ). Another consideration is the knowledge that pregnant women worry about the stigma of taking medication and the shame of taking antidepressants.…”

Section: Pathophysiology/presentationmentioning

confidence: 99%

Brexanolone, a GABAA Modulator, in the Treatment of Postpartum Depression in Adults: A Comprehensive Review

et al. 2021

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Postpartum depression (PPD) is one of the three major categories on the spectrum of postpartum psychiatric syndromes. Postpartum psychiatric syndromes are classified as either postpartum blues, postpartum depression, or postpartum psychosis. Postpartum depression is important to recognize clinically because of the effect it can have on the mother-child bond. The neurosteroid allopregnanolone, a progesterone derivative, is important for its role in positively modulating GABAA receptors. GABA-mediated signaling has been previously implicated in major depressive disorder. Allopregnanolone-mediated signaling has been identified as an important therapeutic target. Treatment with an allopregnanolone-analog, brexanolone, has been shown to improve depression scores in trials for the treatment of PPD. Brexanolone is a positive allosteric modulator of GABAA and is the first drug approved by the FDA to treat postpartum depression. Brexanolone enhances the inhibitory effects of GABAA, restores dysfunctional GABAA transmembrane channels, and mimics a naturally produced progesterone metabolite that fluctuates during pregnancy and postpartum. One open-label study and two phase two studies have some significant reduction in HAM-D scores after treatment and that the effect was still there 30 days post-treatment. Per the data reported, intravenous infusion of brexanolone could be efficacious and safe for the treatment of women suffering from postpartum depression.

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Section: Pathophysiology/presentationmentioning

confidence: 99%

Brexanolone, a GABAA Modulator, in the Treatment of Postpartum Depression in Adults: A Comprehensive Review

et al. 2021

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“…Perinatal depression (PND) is a term sometimes used interchangeably with postpartum depression (PPD), but it typically refers to major or minor depression that starts during pregnancy or up to 12 months postpartum (5). To date, no definition considers PPD to be truly distinct from major depressive disorder other than the timing of the depressive episode onset (6). Moreover, the varying definitions of PPD and PND conflict on the duration of time that defines the postpartum period, ranging from starting in pregnancy up to 4 weeks postpartum (4) to starting after childbirth up to 6 weeks postpartum (7) or even up to 12 months postpartum (7).…”

mentioning

confidence: 99%

Is Postpartum Depression Different From Depression Occurring Outside of the Perinatal Period? A Review of the Evidence

Batt¹,

Duffy²,

Novick³

et al. 2020

FOC

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“…Nordeng and Jettestad [ 53 ] Nordic Federation of Obstetrics and Gynecology (NFOG) Europe and Central Asia [Nordic region (Denmark, Finland, Iceland, Norway, Sweden)] 16. O’Hara and Engeldinger [ 55 ] Wolters Kluwer Health (WKH) Europe and Central Asia (Netherlands) 17. Postpartum Support International [ 56 ] Postpartum Support International (PSI) North America (United States) 18.…”

Section: Resultsmentioning

confidence: 99%

“…Nordeng and Jettestad [ 53 ] X X X 16. O’Hara and Engeldinger [ 55 ] X X X X X 17. PSI [ 56 ] X X 18.…”

Section: Resultsmentioning

confidence: 99%

Management of depression during the perinatal period: state of the evidence

Falek

Acri

Dominguez

et al. 2022

Int J Ment Health Syst

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Background Perinatal depression (PND) is a prevalent ailment that affects both the woman and her family. Addressing PND in primary health care, such as pediatrics and obstetric care settings, has been proposed as an effective way to identify and treat women. Objective The purpose of this study is to examine best practices for management of PND in obstetric and pediatric settings, as well as investigate the evidence that supports the guidelines. Methods Guidelines were identified through a literature search and discussion with experts in the field of perinatal depression, while evidence was examined through a literature search of reviews and thereafter experimental studies. Results Twenty-five guidelines, across 17 organizations were retained for analysis. Findings suggest that there is little or varied guidance on the management of PND, as well as a lack of specificity. Treatment was the topic most frequently reported, followed by screening. However best practices vary greatly and often contradict one another. Across all areas, there is inadequate or contrasting evidence to support these guidelines. Conclusions Although there was consensus on the key steps in the pathway to care, the review revealed lack of consensus across guidelines on specific issues relating to identification and management of depression during the perinatal period. Clinicians may use these recommendations to guide their practice, but they should be aware of the limitations of the evidence supporting these guidelines and remain alert to new evidence. There is a clear need for researchers and policymakers to prioritize this area in order to develop evidence-based guidelines for managing perinatal depression.

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Treatment of Postpartum Depression: Recommendations for the Clinician

Cited by 19 publications

References 30 publications

Brexanolone, a GABAA Modulator, in the Treatment of Postpartum Depression in Adults: A Comprehensive Review

Brexanolone, a GABAA Modulator, in the Treatment of Postpartum Depression in Adults: A Comprehensive Review

Is Postpartum Depression Different From Depression Occurring Outside of the Perinatal Period? A Review of the Evidence

Management of depression during the perinatal period: state of the evidence

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