Postpartum Major Depression Research Articles

Efficacy Similar for SSRIs, TCAs In Postpartum Depression

Efficacy Similar for SSRIs, TCAs In Postpartum Depression

Postpartum Depression

Symptom reduction and improvement in functioning in women with postpartum major depression treated with a tricyclic antidepressant versus a serotonin reuptake inhibitor were compared. The design was a double-blind, 8-week comparative trial of nortriptyline (NTP) versus sertraline (SERT) with a 16-week continuation phase. Women aged 18 to 45 years with postpartum major depression and a 17-item Hamilton Rating Scale for Depression score of 18 or more were eligible. Subjects were randomized to NTP or SERT and treated with a fixed-dosing strategy. Of 420 women interviewed, 109 eligible women received medication, and 95 provided follow-up data. The proportion of women who responded and remitted did not differ between drugs at 4, 8, or 24 weeks. Times to response and remission also did not differ. Psychosocial functioning improved similarly in both drug-treated groups of mothers. The total side effect burden of each drug was similar, although side effect profiles differed between agents. No clinical or demographic variables differentiated responders by drug. Women who were responders and remitters at week 8 could be identified earlier if they were treated with SERT than with NTP. Breast-fed infant serum levels were near or below the level of quantifiability for both agents.

Preliminary evidence of reduced occipital GABA concentrations in puerperal women: a 1H-MRS study

Childbirth is associated with rapid neuroendocrine fluctuations, which are thought to contribute to the phatogenesis of postpartum major depression (PPD). The aim of this proton magnetic resonance spectroscopy (1H-MRS) study was two-fold; 1) to examine whether puerperium is associated with alterations in occipital cortex gamma-aminobutyric acid (GABA) concentrations and 2) to determine whether such alterations may be more prominent in women with PPD. Nine women with PPD, 14 postpartum healthy controls, and ten healthy follicular phase females underwent 1H-MRS at 2.1 Tesla to measure occipital cortex GABA concentrations. Postpartum women were scanned within 6 months of delivery and prior to resumption of menstruation. Healthy non-puerperal controls, drawn from a historical sample, were scanned during the early to mid-follicular phase when ovarian hormone levels would be similar to those found in the puerperium. GABA data were analyzed using analysis of covariance, and regression models were used to explore the relationship between cortical GABA concentrations and blood levels of estradiol, progesterone, and neurosteroids. Cortical GABA and plasma allopregnanolone (ALLO) concentrations were reduced in both groups of postpartum women, regardless of PPD diagnosis, compared to healthy follicular phase women. There was no correlation between cortical GABA concentrations and estradiol, progesterone, ALLO, or pregnenolone (PREG). This study is the first to describe reductions in occipital cortex GABA levels in the postpartum period, a time of increased vulnerability to mood disturbances in women. The concomitant reduction in peripheral ALLO levels provides further evidence of alterations in the balance between cortical excitation and inhibition during the puerperium. Women with PPD may represent a subgroup of women who fail to adequately adapt to this alteration in the neuroendocrine milieu.

Sleep, rhythms and women's mood. Part II. Menopause

This review summarizes studies of sleep and other biological rhythms in menopausal women with major depression compared with healthy control subjects. Where feasible, we focused on studies in women who met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for a major depressive episode (MDE) compared with matched normal control subjects and the Staging System for Reproductive Aging in Women (STRAW) criteria. The aim was to review supporting evidence for the hypothesis that a disruption of the normal temporal relationship between sleep and other biological rhythms, such as melatonin, cortisol, thyroid stimulating hormone (TSH) or prolactin, occur during the menopausal transition. As a result, depressive disorders occur in predisposed women. Treatment strategies, designed to correct these altered phase (timing) or amplitude abnormalities, thereby improve mood. Although there may be some common features to menopausal depression compared with other depressive disorders related to the reproductive cycle (e.g. premenstrual dysphoric disorder or postpartum major depression), such as increased morning melatonin secretion, a specific profile of sleep and biological rhythms may distinguish healthy from depressed women during menopause. Further work is needed to characterize more fully the particular abnormalities associated with well-defined menopausal depression in order to develop treatment strategies targeted more specifically to pathogenesis.

The Many Faces of Postpartum Depression

To provide a profile of women suffering from major postpartum depression as assessed by the Postpartum Depression Screening Scale (PDSS). A secondary analysis conducted on a portion of the data collected from an earlier psychometric testing of the PDSS. Private practice in the San Francisco Bay Area of a marriage and family therapist specializing in perinatal mood disorders. One hundred thirty-three women who were diagnosed with major postpartum depression. Each mother completed the PDSS followed by a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnostic interview. Seven dimensions of postpartum depression: sleeping/eating disturbances, anxiety/insecurity, emotional lability, mental confusion, loss of self, guilt/shame, and suicidal thoughts as measured by the PDSS. Scores on all seven dimensions of the PDSS were elevated. The three top dimensions were emotional lability, mental confusion, and anxiety/insecurity. The mean total PDSS score of 120 was well beyond the recommended cutoff score of 80 for a positive screen for major postpartum depression. Clinicians who come in contact with new mothers need to be alert to the range of possible symptoms that postpartum depressed mothers may experience so that these women are not left to suffer in silence.

Weight Changes in Postpartum Women With Remitted Depression

To compare weight loss after birth in women who took the antidepressants nortriptyline or sertraline or placebo in 2 clinical studies designed to prevent recurrent postpartum major depression. Data were collected from 1995 to 2001. All subjects had at least 1 prior episode of Research Diagnostic Criteria- or DSM-IV-defined major depressive disorder. Data on weight were available for 467 weeks from 60 women who were weighed 8 times from 2 to 17 weeks postpartum. The dependent measures were weight at weeks 11 and 17 and weight change from weeks 2 to 17 postpartum. At week 17, the women's weights ranged from 109 to 268 lb. Their weight change ranged from +14 to -19 lb over the 15-week postpartum period (mean = -1.8, SD = 5.1 lb). After controlling for week 2 weights, the mean weights at week 17 for the women treated with nortriptyline, sertraline, or placebo were not significantly different. Of 60 women with 3 or more weight assessments, those who were randomly assigned to nortriptyline lost weight more rapidly than the other 2 groups; however, the mean weight change across all groups was only -1.8 lb (SD = 5.1 lb). Weight loss was not compromised by antidepressant pharmacotherapy. Postpartum weight retention occurred in this group of nondepressed women with previous histories of major depression independent of drug treatment.

Étude de l’EPDS (Échelle postnatale d’Edinburgh) chez 859 mères : dépistage des mères à risque de développer une dépression du post-partum

The postpartum is a high-risk period for the occurrence of anxious and depressive episodes. Indeed, during the first few days after delivery, mothers can present postpartum blues symptomatology: fatigue, anxiety, disordered sleeping and a changing mood. Postpartum depression is characterised by a changing mood, anxiety, irritability, depression, panic and obsessional phenomena. It occurs in approximately 10 to 20% mothers. The exact prevalence depending on the criteria used for detection. The first symptoms usually appear between the fourth and sixth week postpartum. However, postpartum depression can start from the moment of birth, or may result from depression evolving continuously since pregnancy. We can add that the intensity of postpartum blues is a risk factor that can perturb maternal development. So it is important for health professionals to dispose of predictive tools. This study is a validation of the French version of the EPDS. The aims of the study were to evaluate the postpartum depression predictive value at 3 days postpartum and to determine a cut-off score for major depression. Subjects participating in this study were met in 3 obstetrical clinics in, or in the vicinity of, Toulouse. Mothers with psychological problems, under treatment for psychological problems or mothers whose babies present serious health problems were excluded from the study. The EPDS was presented to 859 mothers (mean age=30.3; SD=4.5) met at one of the clinics at 3 days postpartum (period 1). They had an EPDS mean score of 6.4 (SD=4.6); 258 (30%) mothers had an EPDS score 9. 82.6% of these mothers experienced a natural childbirth and 17.3% a caesarean section; 51.5% gave birth to their first child, 36.2% to their second child and 12.3% to their third or more. All subjects were given a second EPDS with written instructions to complete the scale during the period 4 to 6 weeks postpartum and return it for analysis (period 2). Between the 4 to 6 weeks postpartum period, 722 mothers replied again to the EPDS. 131 mothers had an EPDS score 11 (mean age=30.3; SD=4.8). They had an EPDS mean score of 13.6 (SD=3.3). Mothers with probable depression were interviewed and assessed, using the Mini (Mini Neuropsychiatric Interview, Lecrubier et al. 1997), the SIGH-D (Structured Interview Guide for the Hamilton Depression Scale) and the BDI (Beck Depression Inventory) in order to diagnose a major depressive episode. They had a HDRS mean score of 13.7 (SD=5.1) and a BDI mean score of 13.6 (SD=5). At 3 days postpartum, we observed that 258 mothers (30%) had an EPDS scores 9 and 164 mothers (19%) had an EPDS scores 11. Between 4 and 6 weeks postpartum, we observed 18.1% of postpartum depression (EPDS 11) and 16.8% (EPDS 12) of major postpartum depression. The analysis of the sensitivity and the specificity at 3 days postpartum provides a cut-off score of 9 (Sensibility: 0.88) (Specificity: 0.50) as predictive of postpartum depression, for this cut-off score, the type I error is low (5.8%) but the type II error is more higher (18.9%). The analysis of the sensitivity and the specificity between 4 and 6 weeks postpartum provides a cut-off score of 12 (Sensibility: 0.91) (Sensibility: 0.74) for the detection of major postpartum depression. Factor analysis shows at 3 days postpartum that the internal structure of the scale is composed of two subscales. The first factor F1 "anxiety" accounts 28% of the variance and the second factor F2 "depression" accounts 20% of the variance. Between 4 and 6 weeks postpartum, factor analysis suggests an unidimensional model in the evaluation of postpartum depression which is better than a two factor model. This factor accounts 40% of the variance. The scale has a good predictive value, and we can observe a significant correlation with the EPDS periods 1 and 2 (r=0.56; p<0.05). This result shows that the depressive mothers mood intensity predicts a future depressive risk. Furthermore, correlations between EPDS and BDI (r=0.68; p<0.05) and EPDS and HDRS (r=0.67; p<0.05) show a good convergent validity. The reliability study confirms the good internal consistency of the EPDS, at 3 days postpartum and in the postpartum depression -symptomatology evaluation (Cronbach's Alpha>0.80). In conclusion, this scale demonstrates good validity and is fast and easy use in obstetrical services, allowing early detection of women who risk to develop postpartum depression and, in the first week of postpartum, of mothers who suffer from a major postpartum depression. The use of the EPDS for an early screening of the risk of postnatal depression which is essential considering the consequences that postnatal depression can have on the development of the infant, on the quality of the relationship within the couple and on other social relationships. Mothers at risk for postnatal depression should be controlled and surveyed by the health professionals in obstetrical clinics.

Maternal fluoxetine treatment in the postpartum period: effects on platelet serotonin and plasma drug levels in breastfeeding mother-infant pairs.

Postpartum major depression, a frequently (10%) occurring complication of childbirth, adversely affects the mother's functioning, the mother-infant relationship, and the child's subsequent development and propensity for later psychopathology. Although selective serotonin reuptake inhibitors (SSRIs) are effective in treating postpartum depression, concerns have been raised regarding their use in lactating women. Although plasma drug levels of infants who are exposed to SSRIs through breast milk are low compared with those typically seen in patients, infant levels in some reports do seem to be at or near the drugs' reported affinities (K(D)s) and IC(50)s for inhibition at the serotonin (5-hydroxytryptamine [5-HT]) transporter. The impact of central serotonin 5-HT modulation by SSRIs during critical periods of brain development is unknown. These concerns have led our group to examine whether exposure through breast milk has a discernible effect on platelet 5-HT uptake. Taking advantage of the similarities between platelet and neuronal serotonin transporters, we previously used measurements of platelet 5-HT before and during maternal sertraline treatment to determine the degree of 5-HT transporter blockade in breastfed infants. We found that infants who were exposed to sertraline through their mothers' breast milk experienced little to no change in platelet 5-HT levels, suggestive of minimal effects on peripheral and central 5-HT transporter blockade. Compared with sertraline and most other SSRIs, fluoxetine and its active metabolite, norfluoxetine, have substantially longer plasma half-lives, and both compounds have been found in measurable quantities in plasma of nursing infants. Thus, to extend our previous work in this area, we measured platelet 5-HT levels and plasma drug levels in breastfeeding mother-infant pairs before and during maternal treatment with fluoxetine. Maternal and infant transporter blockade was assessed by measurement of platelet 5-HT in 11 breastfeeding mother-infant pairs before and after 4 to 12 weeks of maternal fluoxetine (20-40 mg/d) treatment for postpartum depression. The study was approved by the Human Investigation Committee of Yale University School of Medicine, and each mother (mean age: 34.5 years; standard deviation [SD]: 5.3) gave written informed consent. Whole-blood 5-HT levels and plasma fluoxetine and norfluoxetine levels were determined by high-performance liquid chromatography. Five mothers were taking 20 mg of fluoxetine daily, 4 were taking 30 mg daily, and 2 were taking 40 mg daily. Mean infant age at the start of the study was 16.8 (SD: 8.8) weeks. All infants except 1 were <6 months of age and 4 were <3 months of age when their mothers began treatment. Six infants were breastfed exclusively; the remaining were breastfed between 3 and 8 times daily and were given supplemental feedings. Mean maternal postexposure 5-HT levels of 22.9 ng/mL (SD: 12.5) were markedly lower than mean preexposure (baseline) levels of 156.6 ng/mL (SD: 71.4; paired t = 6.9, df = 10). In contrast, the mean infant pre- and postexposure 5-HT concentrations of 217.1 (SD: 66.5) and 229.9 (SD: 83.5) ng/mL, respectively, were similar (paired t = -0.24, df = 10). However, the 1 infant with measurable plasma fluoxetine had a substantial decline in 5-HT to 40% of baseline. In samples obtained from the same infant 4 months later, plasma drug levels were undetectable (<1 ng/mL) and the platelet serotonin levels were no longer reduced (12% increase from baseline). The marked declines (to 9%-28% of baseline) in platelet 5-HT concentrations seen in mothers who were treated with the SSRI fluoxetine were similar to those observed in our study of sertraline in breastfeeding and other previous studies. In contrast, all but 1 infant experienced little or no decline in whole-blood (platelet) 5-HT concentrations after exposure to fluoxetine through breast milk. The substantial drop in platelet 5-HT seen in 1 infant and the coupling of this drop with measurable plasma fluoxetine leves drop with measurable plasma fluoxetine level raises some concern. Possible reasons for the infant's measurable plasma fluoxetine level include his mother's high plasma drug level and his being breastfed exclusively. However, the observations may be coincidental, and the infant experienced no discernible adverse effects. These data suggest that most infants may continue to breastfeed without experiencing meaningful changes in platelet 5-HT transport while their mothers are treated with 20 to 40 mg of fluoxetine daily. Given the limited data regarding occurrence and extent of SSRI exposure and the uncertainties concerning the possible effects of exposure, it is premature to propose treatment guidelines. Our own advice to women who are thinking of combining breastfeeding and SSRI treatment will weigh a range of factors, including severity of postpartum depression, any demonstrated preferential response to a specific SSRI, and the mother's commitment to breastfeeding. Additional research is needed to establish more definitively the frequency of physiologically meaningful infant SSRI exposure during breastfeeding and to determine the behavioral consequences of such exposure.

Successful recruitment strategies for women in postpartum mental health trials

Recruiting women into research protocols allows investigators to examine the efficacies of treatments and to study other outcomes among women with mental illnesses. However, achieving recruitment goals has been difficult for researchers. The objective of this study was to examine the success rates of different strategies for recruiting women into clinical trials for the prevention and treatment of postpartum major depression. This is a descriptive study designed to examine which recruitment efforts, over a 4-year period, yielded women who participated in the studies. It was conducted in an outpatient clinic affiliated with a major urban teaching hospital where women of childbearing age sought treatment for affective disorders. All women ( n=589) who called about our research studies were systematically screened. The women were either pregnant or in the postpartum period. Our results show that in both studies, obstetricians and other healthcare professionals referred a large number of women. These referrals yielded relatively high rates of participation. However, other methods were differentially successful for the two studies: media appearances and advertising resulted in almost 50% of the screening calls for the prevention study, whereas mass mailings and other promotional materials were more effective for the treatment study. Those materials contributed 44% of screening calls for the treatment study. Our conclusions were that women were most likely to enter the research studies when referred by an obstetrician or other professional.

Screening women for postpartum depression at well baby visits: resistance encountered and recommendations.

Postpartum major depression afflicts 10-15% of childbearing women and can have serious consequences. Unrecognized and therefore untreated episodes of postpartum major depression can predispose women to future depressive episodes, especially those related to other reproductive events. In the United States, women typically have one visit at six weeks postpartum with their obstetrician which is focused on physical recovery from delivery. Pediatricians typically see new mothers 4-6 times per year at well baby visits. Therefore, our objective is to test the utility of screening women for postpartum depression at each well baby visit over the course of the first postpartum year as compared with controls derived from clinical practice and chart review. Subjects for this prospective study were recruited at their first well baby visit at the UCSD Primary Care Pediatric Clinic and interviewed by telephone. Subjects then were asked to complete the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Depression Inventory (BDI) at intervals consistent with the timing of well baby visits. If scores on the EPDS or the BDI exceeded the thresholds (EPDS >or= 12 and BDI >or= 10) then subjects were assessed further with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (SCID-DSM IV). If diagnosed with postpartum major depression, subjects were referred for appropriate treatment. Out of 160 study packets distributed, only 7 women volunteered for the study, despite endorsement and presentation of the study by their pediatricians. Of those participants, five scored above threshold values at some point in the interval studied. The difficulty in recruitment in this study highlights some of the problems encountered in clinical practice in terms of identifying and referring women with postpartum mental illnesses. We recommend further study be focused on how to attract potentially affected women while simultaneously addressing their fears of stigma. Since resistance also was encountered in other physicians, we recommend that educational efforts be aimed at increasing knowledge and awareness of postpartum mental illnesses in both the lay and professional spheres.

Antidepressants Reduce Hot Flashes, May Be Estrogen Alternative

Antidepressants Reduce Hot Flashes, May Be Estrogen Alternative

Venlafaxine in the Treatment of Postpartum Depression

Although postpartum depression is a highly prevalent illness, antidepressant treatment studies of postpartum depression are sparse. Incomplete recognition and treatment of puerperal illness place women at risk for chronic depression and may have adverse effects on child development. An 8-week, flexible-dose, open study of venlafaxine (immediate release; mean dose = 162.5 mg/day) was performed in a group of 15 women who met DSM-III-R criteria for major depressive disorder with onset within the first 3 months postpartum. Patients were assessed at baseline and every 2 weeks across the study. Measurements of outcome included the 17-item Hamilton Rating Scale for Depression (HAM-D), the Kellner Symptom Questionnaire, and the Clinical Global Impressions scale (CGI). Despite baseline scores of depression that were particularly high, response to treatment was robust. Twelve of 15 patients experienced remission of major depression (HAM-D score < or = 7 or CGI score < or = 2). Dramatic decrease in anxiety paralleled the decrease in depression across the sample. Venlafaxine is effective in the treatment of postpartum major depression. Early identification of women who suffer from postpartum mood disturbance is critical to minimize the morbidity associated with untreated mood disturbance and the effect of depression on children and families.

Further validation of the Postpartum Depression Screening Scale.

Up to 50% of all cases of postpartum depression go undetected. The Edinburgh Postnatal Depression Scale (EPDS) has been the only instrument available that was specifically designed to screen for this mood disorder. None of the items on the EPDS, however, are written in the context of new motherhood. The purpose of this study was to further assess the construct validity of the newly designed Postpartum Depression Screening Scale (PDSS) along with its sensitivity, specificity, and predictive values. A total sample of 150 mothers within 12 weeks postpartum participated in the study. Each mother completed in random order three questionnaires: The PDSS, EPDS, and The Beck Depression Inventory-II (BDI-II). Immediately after completing these three questionnaires, each woman was interviewed by a nurse psychotherapist using the Structural Clinical Interview for DSM-IV Axis 1 Disorders. Twelve percent (n = 18) of the mothers were diagnosed with major postpartum depression, 19% (n = 28) with minor postpartum depression, and 69% (n = 104) with no depression. The PDSS was strongly correlated with both the BDI-II (r = 0.81) and the EPDS (r = 0.79). The ability of the PDSS to explain variance in diagnostic classification of postpartum depression above that explained by the BDI-II and EPDS (i.e., incremental validity) was assessed using hierarchical regression. After explaining variance in group classification by the other two depression instruments, the PDSS explained an additional 9% of the variance in depression diagnosis. Using receiver operating characteristic (ROC) curves, a PDSS cut-off score of 80 (sensitivity 94% and specificity 98%) is recommended for major postpartum depression and a cut-off score of 60 (sensitivity 91% and specificity 72%) for major or minor depression. Based on the results of this psychometric testing, the PDSS is considered ready for use in routine screening of mothers.

Effects of pregnancy and delivery on serum prolyl endopeptidase (PEP) activity: alterations in serum PEP are related to increased anxiety in the early puerperium and to postpartum depression

Background: There is now some evidence that anxiety or anxiety disorders are related to increased activity of serum prolyl endopeptidase (PEP) and that major depression is related to lower serum PEP. The aims of the present study were to examine (i) the effects of pregnancy and delivery on serum PEP and (ii) the relationships between serum PEP and postpartum depression, anxiety in the early puerperium and a past history of depression. Methods: Serum PEP activity was measured in 11 healthy nonpregnant and in 98 pregnant women 3 days before delivery and 1 and 3 days after delivery. On the same occasions, pregnant females completed the Spielberger State Anxiety Inventory (STAI) and were divided into high and low anxiety responders, as defined by changes in the STAI. The presence of a previous depression and postpartum depression within 3 months of delivery was assessed by means of DSM-IV criteria. Results: Serum PEP activity was significantly higher 1 and 3 days after delivery than before. Women with a past history of depression as well as anxiety responders had significantly increased serum PEP activity over nonpregnant women and puerperae with a negative history and anxiety nonresponders, respectively. Parturients who developed a postpartum major, but not minor, depression had significantly lower serum PEP than parturients without postpartum depression. The results were controlled for maternal and labor variables, such as type of analgesia and delivery, induction of labor, breast feeding, parity, and duration of pregnancy and labor. Conclusions: Our results show that, in puerperae, increased serum PEP is related to increased state anxiety in the early puerperium and that lowered serum PEP is related to a subsequent postpartum major depression. Interpretation: The results suggest that increased serum PEP may be related to postpartum anxious blues and that lowered serum PEP may predispose toward postpartum major depression.

Postpartum and nonpostpartum depression: differences in presentation and response to pharmacologic treatment.

Following childbirth, major depression (postpartum depression) affects approximately 8-12% of new mothers. However, little is known about the pharmacological management of postpartum depression, and no studies to date have assessed differences in treatment response between women with postpartum and nonpostpartum major depression. The authors reviewed the records of 26 women with postpartum major depression and 25 women with major depression unrelated to childbearing (nonpostpartum depression) who presented to them for treatment over a 4-year period. Compared with the nonpostpartum depressed patients, the postpartum depressed women were significantly more likely to present with anxious features. Also, cases of postpartum depression were more severe than cases of nonpostpartum depression. While the postpartum patients were equally as likely to recover (as defined by a Clinical Global Impression score of 1 or 2) compared to the nonpostpartum-depressed patients, their time to response was significantly longer. By 3 weeks of pharmacotherapy, 75% of the nonpostpartum cases had recovered, in contrast to only 36% of the postpartum cases. Further, postpartum patients were significantly more likely to be receiving more than one antidepressant agent at the time of response to treatment. Length of depression prior to treatment did not explain the difference in treatment response. Presence of depressive symptoms during pregnancy and timing of onset of the depression (before vs. after 4 weeks of delivery) did not affect likelihood of treatment response in this sample. Women with postpartum depression appear to be significantly more likely than the nonpostpartum women to present with anxious features, take longer to respond to pharmacotherapy for depression, and require more antidepressant agents at the time of response to treatment.

Childhood abuse, postpartum depression and parenting difficulties: a literature review of associations.

The aim of this paper is to obtain an understanding of the links between maternal postpartum depression, poor parenting and childhood abuse, and the subsequent development of adult psychopathology in children from these families. A literature review was undertaken of studies on postpartum depression looking at parental childhood abuse, parenting and child outcomes, as well as childhood abuse and its association with adult depression and parenting difficulties. Considerable overlap is noted in predisposing factors for major depression, postpartum depression, inadequate parenting and childhood abuse. Links appear to begin in early infancy, suggesting postpartum depression as a possible mechanism for intergenerational transmission of psychopathology. Further research is required to look at the outcome of children of women who are at high risk of chronic or recurrent depression and of difficulties parenting; the postpartum period is the optimum time for identification and intervention.

Sertraline effective in postpartum major depression

Sertraline effective in postpartum major depression

Preventing Recurrent Postpartum Major Depression

Postpartum major depression affects up to 15% of new mothers and the estimated risk of recurrence with subsequent births is 25% to 35%. Although the

Sertraline in the treatment of women with postpartum major depression

AbstractNo consensus has yet been reached as to whether or not postpartum depression (PPD) represents a distinct clinical entity. Despite the increasing evidence that gender differences may exist in antidepressant treatment response, there is an absence of studies in women with postpartum onset of major depression. The aim of this study was to assess the clinical efficacy of the selective serotonin reuptake inhibitor (SSRI), sertraline, in the treatment of women with a major depressive episode (MDE) that occurred within 6 months of childbirth using an 8 week, prospective, open‐labelled design. Further, we sought to determine if the Edinburgh Postnatal Depression Scale (EPDS) was a useful instrument to monitor the clinical response to drug treatment. Twenty‐six postpartum women who fulfilled DSM‐IIIR criteria for major depressive episode, non‐psychotic, with symptom onset within 6 months postpartum were enrolled in the study. Biweekly assessments included physician and self‐rated depression measures. Twenty‐one of the women (81%) completed the 8 week study; 20 women exhibited a salutary response as defined by &gt; 50% reduction from baseline in SIGH‐D scores (mean reduction = 15.7 points). Fourteen women demonstrated complete symptom remission with recovery of function (SIGH‐D &lt; 7, CGI = 1, GAP &gt; 80) upon completion of the 8 week study. Three women experienced significant side effects; these included gastrointestinal disturbance (n =1) and anorgasmia (n = 2). Our results indicate that: (1) sertraline is a highly efficacious and well‐tolerated treatment for women with postpartum depression; (2) the EPDS is comparable to the BDI and SIGH‐D for monitoring treatment response in women with postpartum onset MDE; (3) PPD (MDE onset within 4 weeks postpartum, as defined by DSM IV) required significantly less medication and tended to respond faster than MDE onset after 4 weeks postpartum; and (4) the rapid response rate underscores the need to conduct placebo‐controlled studies in this population. Depression 3:49–55 (1995). © 1995 Wiley‐Liss, Inc.