Systematic Review of the Relationship Between Oxytocin and Postpartum Depression

Abstract

To describe the relationship between the hormone oxytocin (OT), which is often used in labor and birth, and postpartum depression symptoms. Systematic review of literature. Emory University School of Nursing. Limited to participants who were in the postpartum period. Five databases (PubMed, Web of Science, Embase, PsycInfo, and CINAL) were searched in December 2018 using keywords postpartum depression, postnatal depression, oxytocin, synthetic oxytocin, Syntocinon, Duratocin, and Pitocin. Articles were eligible for inclusion if they included peer-reviewed quantitative findings from human studies detailing any relationship between the OT system and postpartum (1-year postbirth) and depression symptoms. Exclusion criteria included abstracts without full peer-reviewed publication; theoretical, case study, or review articles; exclusively prenatal; included depression measurements for more than 1-year postpartum or explored only the OTX genotype. The Newcastle-Ottawa Scale assessed quality of nonrandomized studies, and the revised Cochrane Collaboration risk-of-bias (RoB 2) tool assessed randomized, controlled trials. The initial search yielded 618 records. After removing duplicates and applying inclusion–exclusion criteria, 19 remained. Three study areas emerged: correlation of maternal endogenous OT levels with postpartum depression symptoms, association of peripartum intravenous synthetic OT (Pitocin) exposure with postpartum depression symptoms, and postpartum intranasal OT exposure as treatment for postpartum depression. In the endogenous correlation group (n = 12), 9 studies reported plasma OT levels inversely correlated with postpartum depression symptoms, 1 found a positive relationship, and 1 no association. Oxytocin administration in labor had a positive correlation with postpartum depression symptoms in 2 studies, a negative in 1, and no relationship in a 3rd. Three randomized, controlled trials of intranasal synthetic oxytocin as a treatment modality were nonsignificant. Overall, it appears that higher endogenous oxytocin levels are associated with fewer postpartum depression symptoms. Hospital and office nurses can educate and encourage activities already established as increasing oxytocin, including breastfeeding, skin-to-skin contact, and other bonding activities. More research is needed to know effects of peripartum oxytocin administration on mood, but nurses should use only as medically indicated. Last, there is no currently evidence to suggest intranasal OT as an effective treatment modality.