Treatment Of Postpartum Depression Research Articles

Guided web app intervention for reducing symptoms of depression in postpartum women: Results of a feasibility randomized controlled trial

BackgroundChile faces a significant postpartum depression prevalence and treatment gap, necessitating accessible interventions. While cognitive-behavioral internet-based interventions have proven effective in high-income countries, this field is underdeveloped in Chile. Based on the country's widespread use of digital technology, a guided 8-week cognitive-behavioral web app intervention named “Mamá, te entiendo” was developed. ObjectiveThis study aimed to assess the acceptability and feasibility of “Mamá, te entiendo”, for reducing depressive symptomatology in postpartum women. MethodsSixty-five postpartum women with minor or major depression were randomly assigned to either intervention or waitlist. Primary outcomes centered on study feasibility, intervention feasibility, and acceptability. Semi-structured interviews with a sub-sample enriched the understanding of participants' experiences. Secondary outcomes included mental health variables assessed at baseline, post-intervention, and 1-month follow-up. ResultsChilean women displayed great interest in the intervention. 44.8 % of participants completed the intervention. Participants reported high satisfaction and engagement levels, with interviewees highlighting the value of the intervention's content, exercises, and therapist's feedback. However, preliminary efficacy analysis didn't reveal a significant interaction between group and time for outcome measures. DiscussionThis research represents a pioneering effort in Chile to evaluate an internet-based intervention for postpartum depression symptoms. The demonstrated feasibility and acceptability highlight the potential of integrating technology-driven approaches into mental health interventions. However, the intervention did not demonstrate superiority, as both groups exhibited similar positive progress in several outcomes. Therefore, the following research phase should involve a larger and more diverse sample to assess the intervention's effectiveness, identify influencing factors, and determine the individuals who benefit the most.

An Evaluation of the Health Economics of Postnatal Depression Prevention and Treatment Strategies in China: A Cost-Effectiveness Analysis

Objective: The primary objectives of this study are to assess the cost-effectiveness of early postnatal screening and prenatal psychological interventions for the prevention and treatment of postpartum depression (PPD) among Chinese pregnant women. Additionally, we aim to explore the most cost-effective prevention and treatment strategies for PPD in China. Methods: We used TreeAge 2019 to construct a decision tree model, with the model assuming a simulated queue size of 10,000 people. The model employed Monte Carlo simulation to assess the cost-effectiveness of PPD prevention and treatment strategies. Transfer probabilities were derived from published studies and meta-analyses. Cost and effectiveness data were obtained from published sources and relevant studies. Incremental cost-effectiveness ratios (ICERs) were used to describe the results, with willingness-to-pay (WTP) thresholds set at China’s gross domestic product (GDP) per capita. Results: Compared to the usual care group, the cost per additional quality-adjusted life year (QALY) for the early postnatal screening group and the prenatal psychological interventions is USD 6840.28 and USD 3720.74, respectively. The cure rate of mixed treatments for PPD has the greatest impact on the model, while patient participation in treatment has a minor impact on the cost-effectiveness of prevention and treatment strategies. Conclusion: Both early postnatal screening and prenatal psychological interventions are found to be highly cost-effective strategies for preventing and treating PPD in China. Prenatal psychological interventions for pregnant women are the most cost-effective prevention and treatment strategy. As such, from the perspective of national payers, we recommend that maternal screening for PPD be implemented in China to identify high-risk groups early on and to facilitate effective intervention.

Favorable Lifestyle Behaviors as Reverse Risk Factors and Treatment for Postpartum Depression

Background. Lifestyle behaviors such as sleep, sedentary behavior, physical activity (PA) or exercise, and diet may influence risk for postpartum depression (PPD) or serve as treatment options for those diagnosed with PPD. The purpose of this review was to summarize existing research about four key lifestyle behaviors (sleep, sedentary behavior, PA and exercise, and diet) and their potential influence on PPD. Methods. Studies that were published in English after 2000 were drawn from the PubMed database. Observational studies, systematic reviews, meta-analyses, and randomized, controlled trials that enrolled >50 participants were considered for inclusion. Results. Quality sleep and PA or exercise during pregnancy and the postpartum period may reduce PPD risk or help improve PPD symptoms. Data regarding the utility of intervening on diet patterns or specific nutrients for lessening PPD risk or serving as PPD treatment are inconsistent. Evidence for vitamin D supplementation is extensive, while evidence supporting other vitamins, nutrients, and minerals remains inconclusive. Research linking sedentary behavior and PPD is extremely limited. Conclusion. Sleep quality and PA or exercise may reduce the risk of PPD or mitigate its symptoms. Further high- quality research studies examining the relationship between sedentary behavior and PPD risk are necessary. Healthy lifestyle behaviors, alone or in conjunction with other evidence-based strategies recommended by healthcare providers, may serve as effective preventive measures and treatments for PPD in the pregnancy and postpartum periods.

Allopregnanolone in the peripartum: Correlates, concentrations, and challenges – A systematic review

BackgroundAllopregnanolone (ALLO) is a metabolite of progesterone and a neuroactive steroid hormone. As a positive allosteric modulator of gamma-aminobutyric acid (GABA) receptors, ALLO seems to have antidepressant and anxiolytic effects, and was therefore approved as a specific medication for the treatment of postpartum depression in 2019. Despite the growing number of publications investigating ALLO levels, results on the biological and psychological correlates in the peripartum period remain inconsistent, possibly due to methodological challenges regarding measurement. To date, however, there is no systematic review examining the correlates, concentrations, and challenges in measuring ALLO in peripartum women. MethodA systematic literature search of PubMed and PsycINFO was conducted in August 2023. Original research articles that measured ALLO concentrations in peripartum women were included. Reports were excluded if they were not original research, included non-human subjects, did not include peripartum women, did not include ALLO measurement as an outcome, included (pharmacological) interventions, constituted method validations, or used the same cohort as another study. ResultsThe literature search yielded 234 articles, and two articles were identified from other sources. After full-text screening, 19 articles (N = 1401) met the inclusion criteria, of which seven focused on biological correlates of ALLO and 12 on mood correlates. Of the latter, six found no association between ALLO and mood, four found a negative association, and two found a positive association. Overall, the results show an increase in ALLO levels during pregnancy and a decrease after birth, with levels then remaining low until six months postpartum. ALLO was most commonly measured in blood plasma and by gas chromatography-mass spectrometry (GC-MS). A significant matrix effect was found for blood serum and a significant method effect for radioimmunoassays (RIAs). A significant effect of time of measurement was found. ConclusionALLO measurement shows method and matrix effects. ALLO levels are higher when measured in serum compared to in plasma, and when measured using RIA compared to other methods. Time of measurement, study design, and standardization of measurement also influence the reliability of measurement and the interpretation of results.

First Oral Treatment Specific for Postpartum Depression

Postpartum depression is one of the most common perinatal mood disorders. The U.S. Food and Drug Administration approved the first oral medication developed specifically for the treatment of postpartum depression in August 2023. Zuranolone, marketed under the brand name Zurzuvae, is thought to work similarly to other positive allosteric modulators of gamma-aminobutyric acid A receptors such as benzodiazepines. It can be used alone or as an adjunct to other oral antidepressant medication. Its 2-week regimen of once-daily oral administration provides women with postpartum depression the opportunity to maintain their daily routines in an outpatient setting. This article provides an overview of zuranolone, including indications, mechanism of action, potential adverse reactions, and implications for nursing practice.

Nexus between postpartum depression and exclusive breastfeeding practices among lactating mothers in Assosa Town, West Ethiopia.

Across the globe, breastfeeding stands out as a highly effective strategy for reducing infant and child morbidity and mortality. Concurrently, postpartum depression (PPD) emerges as a notable public health issue, adversely affecting both exclusive breastfeeding (EBF) practices for infants and the fulfillment of parenting roles. Despite the lack of substantial evidence in Ethiopia and the specific study areas, indicating the association between PPD and EBF practices, this study endeavors to fill this gap. The primary objective is to examine the correlation between PPD and EBF practices, along with exploring other pertinent factors, in Assosa Town, West Ethiopia. A community-based cross-sectional study was carried out from 7 March to 5 April 2019. The study involved the recruitment of 462 participants through a systematic random sampling method. Data collection was facilitated by conducting a structured and pre-tested questionnaire. To screen for PPD, we used the Edinburgh Postnatal Depression Scale (EPDS) tool. This tool, EPDS, was used solely as a screening tool and not for diagnostic purposes. The collected data were entered into Epi-Data version 3.1 and subsequently exported to SPSS version 24 for comprehensive statistical analysis. Bivariate and multivariate logistic regression analyses were performed to assess the association between independent variables and dependent variables. Odds ratios, along with their 95% confidence intervals (CIs), were calculated to ascertain the presence and strength of any associations. Statistical significance was acknowledged at a p-value of <0.05. The overall prevalence of EBF practices was found to be 58.2% (95% CI: 51.4-65.7), while the prevalence of PPD was 18.7% (95% CI: 15.94-26.7). Among mothers without PPD, the prevalence of EBF practices was notably higher at 62.4% (95% CI: 55.9-65.2%) compared to mothers experiencing PPD, where the prevalence was 31.3% (95% CI: 24.7-32.5%). Mothers who experienced PPD exhibited 51% reduced odds of practicing EBF compared to their counterparts (AOR = 0.49. 95% CI: 0.25-0.8). Furthermore, factors such as having a higher family monthly income (AOR = 8.7, 95% CI: 4.2-17.2), being multiparous (AOR = 5.8, 95% CI 4.9-10.8), attending antenatal care (ANC) visits (AOR = 4.9, 95% CI: 3.4-14.1), opting for vaginal delivery (AOR = 9.8, 95% CI: 5.6-17.4), and receiving husband's support (AOR = 5.3, 95% CI: 4.6-12.7) demonstrated a statistically significant positive association with EBF practices. In this study, a substantial number of mothers demonstrated suboptimal EBF practices during the first 6 months of their infants' lives. Consequently, the findings underscore a clear association between PPD and EBF. Thus, it is imperative to intensify efforts in the early detection and treatment of PPD, enhance household income, advocate for ANC, and encourage active husband involvement to bolster EBF practices.

Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low- and middle-income countries: A systematic review.

Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low- and middle-income countries: A systematic review.

919 granules improve postpartum depression through the regulation of abnormal peripheral blood IL-1β

Postpartum depression (PPD) has a significant impact on the physical and mental health of mothers, potentially leading to symptoms such as low mood, fatigue, and decreased appetite. It may also affect the healthy growth of the infant. The onset of PPD is closely related to abnormalities in inflammation and the immune system. PPD patients exhibit abnormalities in the proportion of peripheral blood immune cells, along with an increase in pro-inflammatory cytokines. Excessive pro-inflammatory cytokines in peripheral blood can disrupt the blood-brain barrier (BBB) by activating astrocytes and reducing transendothelial electrical resistance (TEER), allowing peripheral immune cells or cytokines to enter the brain and trigger inflammation, ultimately leading to the onset of depression. In addition, PPD lacks safe and effective treatment medications. In this study, we collected peripheral blood from both healthy postpartum women and those with PPD, conducted single cell RNA sequencing (scRNA-seq), and used an in-house analytical tool scSTAR to reveal that PPD patients exhibit elevated proportions of peripheral blood cDC2 and Proliferation B cells, which are significantly correlated with IL-1β. Additionally, animal experiments were designed to validate that 919 granules can improve PPD by modulating the levels of peripheral blood IL-1β, providing a potential therapeutic mechanism for PPD treatment.

Brexanolone Treatment in a Real-World Patient Population: A Case Series and Pilot Feasibility Study of Precision Neuroimaging.

Brexanolone is approved for postpartum depression (PPD) by the United States Food and Drug Administration. Brexanolone has outperformed placebo in clinical trials, but less is known about the efficacy in real-world patients with complex social and medical histories. Furthermore, the impact of brexanolone on large-scale brain systems such as changes in functional connectivity (FC) is unknown. We tracked changes in depressive symptoms across a diverse group of patients who received brexanolone at a large medical center. Edinburgh Postnatal Depression Scale (EPDS) scores were collected through chart review for 17 patients immediately prior to infusion through approximately 1 year postinfusion. In 2 participants, we performed precision functional neuroimaging (pfMRI), including before and after treatment in 1 patient. pfMRI collects many hours of data in individuals for precision medicine applications and was performed to assess the feasibility of investigating changes in FC with brexanolone. The mean EPDS score immediately postinfusion was significantly lower than the mean preinfusion score (mean change [95% CI]: 10.76 [7.11-14.40], t (15) = 6.29, P < 0.0001). The mean EPDS score stayed significantly lower at 1 week (mean difference [95% CI]: 9.50 [5.23-13.76], t (11) = 4.90, P = 0.0005) and 3 months (mean difference [95% CI]: 9.99 [4.71-15.27], t (6) = 4.63, P = 0.0036) postinfusion. Widespread changes in FC followed infusion, which correlated with EPDS scores. Brexanolone is a successful treatment for PPD in the clinical setting. In conjunction with routine clinical care, brexanolone was linked to a reduction in symptoms lasting at least 3 months. pfMRI is feasible in postpartum patients receiving brexanolone and has the potential to elucidate individual-specific mechanisms of action.

Indirect comparisons of relative efficacy estimates of zuranolone and selective serotonin reuptake inhibitors for postpartum depression

Aims Estimate relative efficacy of zuranolone, a novel oral, Food and Drug Administration-approved treatment for postpartum depression (PPD) in adults vs. selective serotonin reuptake inhibitors (SSRIs) and combination therapies used for PPD in the United States. Materials and methods Randomized controlled trials (RCTs) for zuranolone and SSRIs, identified from systematic review, were used to construct evidence networks, linking via common comparator arms. Due to heterogeneity in placebo responses, matching-adjusted indirect comparison (MAIC) was applied, statistically weighting the zuranolone treatment arm of Phase 3 SKYLARK Study (NCT04442503) to the placebo arm of RCTs investigating SSRIs for PPD. MAIC outputs were applied in Bucher indirect treatment comparisons (ITCs) and network meta-analysis (NMA), using Edinburgh Postnatal Depression Scale (EPDS) and 17-item Hamilton Rating Scale for Depression (HAMD-17) change from baseline (CFB) on Days 3, 15, 28 (Month 1), 45, and last observation (Day 45, Week 12/18). Results Larger EPDS CFB was observed among zuranolone-treated vs. SSRI-treated patients from Day 15 onward. Zuranolone-treated (vs. SSRI-treated) patients exhibited 4.22-point larger reduction in EPDS by Day 15 (95% confidence interval: −6.16, −2.28) and 7.43-point larger reduction at Day 45 (−9.84, −5.02) with Bucher ITC. NMA showed EPDS reduction for zuranolone was 4.52 (−6.40, −2.65) points larger than SSRIs by Day 15 and 7.16 (−9.47, −4.85) larger at Day 45. Lack of overlap between study populations substantially reduced effective sample size post-matching, making HAMD-17 CFB analysis infeasible. Limitations Limited population overlap between SKYLARK Study and RCTs reduced feasibility of undertaking HAMD-17 CFB ITCs and may introduce uncertainty to EPDS CFB ITC results. Conclusions Analysis showed zuranolone-treated patients with PPD experienced greater symptom improvement than SSRI-treated patients from Day 15 onward, with largest mean difference at Day 45. Adjusting for differences between placebo arms, zuranolone may be associated with greater PPD symptom improvement (measured by EPDS) vs. SSRIs.

The efficacy of zuranolone versus placebo in postpartum depression and major depressive disorder: a systematic review and meta-analysis.

Zuranolone, an oral version of allopregnanolone and neurosteroid, is a novel drug for the treatment of major depressive disorder (MDD) and postpartum depression (PPD). The purpose of this systematic review and meta-analysis was to assess the efficacy of zuranolone in the treatment of MDD and PPD. A systematic search was conducted using EBSCOhost to simultaneously search Academic Search Premier, APA PsycArticles, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL Ultimate, and MEDLINE with Full Text. Two independent reviewers screened the articles and completed a full-text review using Covidence. The quality of each study was assessed using the Cochrane Risk of Bias tool for randomized trials (RoB 2). A meta-analysis was then conducted using Review Manager (RevMan v5.4) software. The initial search yielded 127 results, with 6 articles fitting our inclusion and exclusion criteria. All 6 studies, comprising 1707 participants, had an overall low risk of bias. There was a significant decrease in HAM-D scores for MDD at 15days versus placebo (MD - 2.40, 95% CI - 3.07 to - 1.63; p < .001). When pooling data for PDD, there was an overall significant decrease in HAM-D scores at 15days versus placebo (MD - 4.06, 95% CI - 4.25 to - 3.87; p < .001). The results suggest that zuranolone can improve symptoms of PPD at 15days; however, results were not clinically significant for MDD. Future research is needed to evaluate the long-term efficacy of zuranolone in PPD and the treatment efficacy in MDD.

Overview of the symptoms, diagnostics and treatment of postpartum depression

Overview of the symptoms, diagnostics and treatment of postpartum depression

The cost-effectiveness of zuranolone versus selective serotonin reuptake inhibitors for the treatment of postpartum depression in the United States

Aims The objective of this research is to evaluate the cost-effectiveness of zuranolone, the first oral treatment indicated for postpartum depression (PPD) in adults approved by the United States Food and Drug Administration. Methods Zuranolone and selective serotonin reuptake inhibitor (SSRI) trial-based efficacy was derived from an indirect treatment comparison. Long-term efficacy outcomes were based on a large longitudinal cohort study. Maternal health utility values were derived from trial-based, short-form 6-D responses. Other inputs were derived from literature and economic data from the U.S Bureau of Labor Statistics. We estimated costs (2023 US dollars) and quality-adjusted life-years (QALYs) for patients with PPD treated with zuranolone (14-day dosing) or SSRIs (chronic dosing). The indirect costs and QALYs of the children and partners were also estimated. Results The incremental cost-effectiveness ratio for zuranolone versus SSRIs was $94,741 per QALY gained over an 11-year time horizon. Maternal total direct medical costs averaged $84,318 in the zuranolone arm, compared to $86,365 in the SSRI arm. Zuranolone-treated adults averaged 6.178 QALYs compared to 6.116 QALYs for the SSRI arm. Costs and utilities for the child and partner were also included in the base case. Drug and administration costs for zuranolone averaged $15,902, compared to $30 for SSRIs over the studied time horizon. Results were sensitive to the model time horizon. Limitations As head-to-head trials were not available to permit direct comparison, efficacy inputs were derived from an indirect treatment comparison which can be confounded by cross-trial differences. The data used are reflective of a general PPD population rather than marginalized individuals who may be at a greater risk for adverse PPD outcomes. The model likely excludes unmeasured effects for patient, child, and partner. Conclusions This economic model’s results suggest that zuranolone is a more cost-effective therapy compared to SSRIs for treating adults with PPD.

Zurzuvae (zuranolone) for postpartum depression in Pakistan

Postpartum depression (PPD) is a condition that affects some women after giving birth, characterized by feelings of sadness, hopelessness, and emotional distress. Around 30% of Pakistani women suffer from PPD and although multiple treatment options are available, none of these are feasible for Pakistan, a lower-middle-income country with a subpar healthcare system. In August 2023, the Food and Drug Administration (FDA) approved Zurzuvae (zuranolone), the first oral medication for the treatment of PPD. As a low-cost, self-administered oral drug, independent of the need for a healthcare professional, Zuranolone emerges as an efficacious and long-term approach to address PPD in Pakistan.

Incidence of Postpartum Depression and Associated Risk Factors in Antenatal Women: A Cohort Study

Abstract Background: The incidence of postpartum depression (PPD) varies across cultures, regions, and communities, and there are very few studies addressing this issue, henceforth making it difficult to estimate the actual burden of the disease. Aims: The aim of this study was to evaluate the incidence and identify potential risk factors for PPD in a cohort of antenatal women. Methods: This study conducted in a tertiary hospital included 105 participants in their second or third trimester of pregnancy. Relationship with and support from the family were assessed. The scales applied were the Perceived Stress Scale, Ardell Wellness Stress Scale, State-Trait Anxiety Inventory, and Pittsburgh Sleep Quality Index. Participants were followed up 4 weeks postnatally. They were asked about the gender of their baby, and the Edinburgh Postnatal Depression Scale (EPDS) was applied. PPD was evaluated using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria and International Classification of Diseases-10 criteria. Results: Of the 105 participants, 6 were lost to follow-up. Among the 99 women, an EPDS score of ≥10 was identified in 17 women who were diagnosed with PPD. The risk factors according to our study were sleep disturbances, state anxiety, stress, and obstetrical complications antenatally and female sex of the newborn. These risk factors are likely to be interactive as well as multiplicative in effect. Conclusion: The study shows a high prevalence of PPD in Indian mothers. There is enough evidence suggesting that intervention for PPD is crucial for the care of the mother as well as for the well-being of the infant, hence an integrated approach is required for its screening.

Acceptability of a Randomized Trial of Anti-depressant Medication or Interpersonal Therapy for Treatment of Perinatal Depression in Women with HIV

Postpartum depression (PPD) affects nearly 20% of postpartum women in Sub-Saharan Africa (SSA), where HIV prevalence is high. Depression is associated with worse HIV outcomes in non-pregnant adults and mental health disorders may worsen HIV outcomes for postpartum women and their infants. PPD is effectively treated with psychosocial or pharmacologic interventions; however, few studies have evaluated the acceptability of treatment modalities in SSA. We analyzed interviews with 23 postpartum women with HIV to assess the acceptability of two depression treatments provided in the context of a randomized trial. Most participants expressed acceptability of treatment randomization and study visit procedures. Participants shared perceptions of high treatment efficacy of their assigned intervention. They reported ongoing HIV and mental health stigma in their communities and emphasized the importance of social support from clinic staff. Our findings suggest a full-scale trial of PPD treatment will be acceptable among women with HIV in Zambia.

A novel tool for risk assessment, screening, diagnosis, assessment, and therapy in postpartum depression.

Postpartum depression (PPD), as a common condition occurring in women in the postnatal period, is underdiagnosed, seldom identified, and infrequently treated. Undiagnosed PPD can have negative consequences for overall quality-of-life outcomes in the mother, psychological growth of the infant, and bonding between the infant and its mother. However, early diagnosis and prompt treatment of PPD can lead to an improvement in postpartum maternal health and a healthier relationship between the mother and her infant. Additionally, early identification of risk factors in the prenatal and antenatal period can enable preventive treatment and ensure that the expectant or pregnant woman remains free of disease after giving birth. Therefore, we propose a protocol for the risk assessment, screening, diagnosis, assessment, and therapy of postnatal depression (RASDAT). The RASDAT protocol recommends assessment of risk factors for PPD in the perinatal period as well as early diagnosis and treatment in the early-to-mid postpartum period. It also recognizes, for the first time, insomnia and anxiety as important predictors, comorbidities, and poor prognostic factors in postpartum depression. Further studies are necessary to determine the feasibility and applicability of this novel tool, including costs of availing health facilities, burden on the health system, and knowledge, attitudes, and practices among physicians and clinical pharmacists regarding PPD and its resolution.

Efficacy of esketamine for the treatment of postpartum depression and pain control following cesarean section: a randomized, double-blind, controlled clinical trial

BackgroundPostpartum depression (PPD) following a cesarean delivery is a frequently seen complication. Despite the prophylactic effects of ketamine, the impact of esketamine on PPD in women undergoing cesarean section remains uncertain. This study aimed to assess the effectiveness of esketamine as an adjunct to patient-controlled intravenous analgesia (PCIA) in preventing PPD in women undergoing caesarean section.MethodsA total of 275 parturients undergoing caesarean section and subsequent patient-controlled intravenous analgesia (PCIA) were randomly assigned to receive either the control treatment (sufentanil 2 µg/kg + tropisetron 10 mg) or the experimental treatment with additional esketamine (1.5 mg/kg). The primary outcome measured was the incidence of postpartum depression (PPD), classified by Edinburgh Postnatal Depression Scale (EPDS) scores equal to or greater than 13 indicating PPD. Secondary outcomes included cumulative sufentanil consumption during specific time periods (0–24 h, 24–48 h, and 0–48 h) after the surgical procedure and numerical rating scale (NRS) scores at rest and during movements.ResultsThe final analysis included a total of 246 postpartum women who had undergone caesarean delivery. On postoperative day 42, the incidence of depression among the control group was 17.6%, which was significantly higher compared to the esketamine group with a rate of 8.2% (P = 0.02). The EPDS scores also showed a significant difference between the two groups, with a mean score of 9.02 ± 2.21 in the control group and 6.87 ± 2.14 in the esketamine group (p < 0.0001). In terms of pain management, the esketamine group showed lower sufentanil consumption in the 0–24 h (42.5 ± 4.58 µg vs. 50.15 ± 5.47 µg, P = 0.04) and 0–48 h (87.40 ± 9.51 µg vs. 95.10 ± 9.36 µg, P = 0.04) postoperative periods compared to the control group. Differences in movement were also observed between the two groups at 24 and 48 h after the cesarean Sect. (3.39 ± 1.57 vs. 4.50 ± 0.80, P = 0.02; 2.43 ± 0.87 vs. 3.56 ± 0.76, P = 0.02). It is worth noting that the frequency of side effects observed in both groups was comparable.ConclusionsEsketamine at a dose of 1.5 mg/kg, when used as a supplement in PCIA, has been shown to significantly reduce the occurrence of PPD within 42 days. Additionally, it has been found to decrease cumulative consumption of sufentanil over a 48-hour period following cesarean operation, all without increasing the rate of adverse effects.Trial registrationRegistered in the Chinese Clinical Trial Registry (ChiCTR2200067054) on December 26, 2022.

Zuranolone: A Breakthrough in the Treatment of Postpartum Depression.

Zuranolone: A Breakthrough in the Treatment of Postpartum Depression.

Healthcare utilization before and during the COVID-19 pandemic among mothers and birthing parents with elevated levels of postpartum depression symptoms

ABSTRACT Little is known about the healthcare utilization of mothers and birthing parents experiencing elevated levels of symptoms of postpartum depression (PPD), particularly during the COVID-19 pandemic. This study examined how healthcare utilization changed in these individuals during COVID-19. Individuals living in Ontario, Canada, with Edinburgh Postnatal Depression Scale Scores ≥ 10 were recruited into two separate randomized controlled trials of a 1-day intervention for PPD before (pre-COVID-19, n = 441) and during the pandemic (COVID-19, n = 287). Participants in both samples completed the same health resource use questionnaire, self-reporting the number of virtual and/or in-person visits to specific healthcare services over the three months preceding their treatment intervention. Use of medications, mental health care, primary care, hospital-based care, allied health care, and overall healthcare utilization were compared between the pre-COVID-19 and COVID-19 groups. While participants had higher levels of PPD symptoms during COVID-19, differences were not seen in the use of specific categories of care (e.g. mental health and primary care). However, before and after statistically adjusting for covariates, overall healthcare utilization decreased from an average of 9.5 visits prior to COVID-19 to 6.9 during COVID-19 (p < .001), a change that was at least partly contributed to by reductions in visits to allied health professionals (e.g. dentists and physiotherapists). Overall healthcare utilization decreased by 27 % in mothers and birthing parents seeking treatment for elevated levels of PPD symptoms during the COVID-19 pandemic in Ontario, Canada – despite higher levels of PPD symptoms – highlighting the need to support and address barriers to postpartum care.