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Recent Advances and Controversies in Peripartum Depression

  • High-risk Gestation and Prenatal Medicine (E Norwitz, Section Editor)
  • Published:
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Abstract

Purpose of Review

The purpose of this review is to update readers on recent controversies and findings on the underlying biology and clinical management of peripartum depression.

Recent Findings

Topics discussed include the discovery and replication of two epigenetic biomarkers of peripartum depression, two well controlled studies that do NOT find associations between in utero antidepressant exposure and cardiac defects and persistent pulmonary hypertension of the newborn and ongoing controversy on whether antidepressant use during pregnancy prevents peripartum depression and whether or not hormonal treatments have a place in the management of postpartum depression.

Summary

Peripartum depression, or depression during and/or immediately following pregnancy, is a unique psychiatric illness that not only may have unique biological underpinnings but demands unique and thoughtful approaches to management due to the developing neonate. A number of controversies exist in this area ranging from the recent terminology change in psychiatry’s Diagnostic and Statistical Manual from “postpartum” to “peripartum” depression, to the safety of antidepressant use during pregnancy, to whether or not antidepressants prevent or decrease peripartum depression. Research in this area is growing, and a number of exciting developments have occurred including the identification of two epigenetic biomarkers of peripartum depression that may eventually lead to early identification and intervention, the potential for hormonal treatments, and the recommendation for and early institution of universal screening for peripartum depression. These topics are explored and put into context from a clinical management perspective.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. O’Connor E, Rossom RC, Henninger M, Groom HC, Burda BU, Henderson JT, et al. U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. Screening for depression in adults: an updated systematic evidence review for the US Preventive Services Task Force. Rockville: Agency for Healthcare Research and Quality; 2016. This review provides support for the recommendation to screen all pregnant and postpartum women for depression.

    Google Scholar 

  2. Farr SL, Denk CE, Dahms EW, Dietz PM. Evaluating universal education and screening for postpartum depression using population-based data. J Womens Health (Larchmt). 2014;23(8):657–63.

    Article  Google Scholar 

  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

  4. Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry. 2008;65(7):805–15.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bloch M, Schmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR. Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry. 2000;157(6):924–30. This classic study provides the first evidence of mood sensitivity to hormonal fluctuation in women with postpartum depression.

    Article  CAS  PubMed  Google Scholar 

  6. Mahon PB, Payne JL, MacKinnon DF, Mondimore FM, Goes FS, Schweizer B, et al. Genome-wide linkage and follow-up association study of postpartum mood symptoms. Am J Psychiatry. 2009;166(11):1229–37.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Payne JL, MacKinnon DF, Mondimore FM, McInnis MG, Schweizer B, Zamoiski RB, et al. Familial aggregation of postpartum mood symptoms in bipolar disorder pedigrees. Bipolar Disord. 2008;10(1):38–44.

    Article  PubMed  Google Scholar 

  8. Kimmel M, Hess E, Roy PS, Palmer JT, Meltzer-Brody S, Meuchel JM, et al. Family history, not lack of medication use, is associated with the development of postpartum depression in a high-risk sample. Arch Womens Ment Health. 2015;18(1):113–21.

    Article  PubMed  Google Scholar 

  9. Forty L, Jones L, Macgregor S, Caesar S, Cooper C, Hough A, et al. Familiality of postpartum depression in unipolar disorder: results of a family study. Am J Psychiatry. 2006;163(9):1549–53.

    Article  PubMed  Google Scholar 

  10. Murphy-Eberenz K, Zandi PP, March D, Crowe RR, Scheftner WA, Alexander M, et al. Is perinatal depression familial? J Affect Disord. 2006;90(1):49–55.

    Article  PubMed  Google Scholar 

  11. Siu AL, Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(4):380–7.

    Article  CAS  PubMed  Google Scholar 

  12. Kozhimannil KB, Adams AS, Soumerai SB, Busch AB, Huskamp HA. New Jersey’s efforts to improve postpartum depression care did not change treatment patterns for women on Medicaid. Health Aff (Millwood). 2011;30(2):293–301.

    Article  Google Scholar 

  13. Byatt N, Biebel K, Moore Simas TA, Sarvet B, Ravech M, Allison J, et al. Improving perinatal depression care: the Massachusetts Child Psychiatry Access Project for Moms. Gen Hosp Psychiatry. 2016;40:12–7.

    Article  PubMed  Google Scholar 

  14. Avalos LA, Raine-Bennett T, Chen H, Adams AS, Flanagan T. Improved perinatal depression screening, treatment, and outcomes with a universal obstetric program. Obstet Gynecol. 2016;127(5):917–25.

    Article  PubMed  Google Scholar 

  15. Huybrechts KF, Palmsten K, Avorn J, Cohen LS, Holmes LB, Franklin JM, et al. Antidepressant use in pregnancy and the risk of cardiac defects. N Engl J Med. 2014;370(25):2397–407.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Huybrechts KF, Bateman BT, Palmsten K, Desai RJ, Patorno E, Gopalakrishnan C, et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. Jama. 2015;313(21):2142–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Chisolm MS, Payne JL. Management of psychotropic drugs during pregnancy. BMJ. 2016;532:h5918.

    Article  PubMed  Google Scholar 

  18. Wang S, Yang L, Wang L, Gao L, Xu B, Xiong Y. Selective serotonin reuptake inhibitors (SSRIs) and the risk of congenital heart defects: a meta-analysis of prospective cohort studies. Journal of the American Heart Association. 2015;4(5).

  19. Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med. 2006;354(6):579–87.

    Article  CAS  PubMed  Google Scholar 

  20. Andrade SE, McPhillips H, Loren D, Raebel MA, Lane K, Livingston J, et al. Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf. 2009;18(3):246–52.

    Article  PubMed  Google Scholar 

  21. Wichman CL, Moore KM, Lang TR, St Sauver JL, Heise Jr RH, Watson WJ. Congenital heart disease associated with selective serotonin reuptake inhibitor use during pregnancy. Mayo Clin Proc. 2009;84(1):23–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wilson KL, Zelig CM, Harvey JP, Cunningham BS, Dolinsky BM, Napolitano PG. Persistent pulmonary hypertension of the newborn is associated with mode of delivery and not with maternal use of selective serotonin reuptake inhibitors. Am J Perinatol. 2011;28(1):19–24.

    Article  PubMed  Google Scholar 

  23. Kallen B, Olausson PO. Maternal use of selective serotonin re-uptake inhibitors and persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf. 2008;17(8):801–6.

    Article  PubMed  Google Scholar 

  24. Kieler H, Artama M, Engeland A, Ericsson O, Furu K, Gissler M, et al. Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from the five Nordic countries. BMJ. 2012;344:d8012.

    Article  PubMed  Google Scholar 

  25. Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry. 2016. doi:10.1001/jamapsychiatry.2016.0934. This study compares outcomes for infants among pregnant women with depression who are taking antidepressants and pregnant women with depression who are not taking antidepressants. This is one of the first studies to attempt to examine the effect of depression on pregnancy outcomes for infants in the absence of antidepressant use.

    PubMed  Google Scholar 

  26. Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295(5):499–507.

    Article  CAS  PubMed  Google Scholar 

  27. Cohen LS, Nonacs RM, Bailey JW, Viguera AC, Reminick AM, Altshuler LL, et al. Relapse of depression during pregnancy following antidepressant discontinuation: a preliminary prospective study. Arch Womens Ment Health. 2004;7(4):217–21.

    Article  CAS  PubMed  Google Scholar 

  28. Yonkers KA, Gotman N, Smith MV, Forray A, Belanger K, Brunetto WL, et al. Does antidepressant use attenuate the risk of a major depressive episode in pregnancy? Epidemiol. 2011;22(6):848–54.

    Google Scholar 

  29. Osborne L, Clive M, Kimmel M, Gispen F, Guintivano J, Brown T, et al. Replication of epigenetic postpartum depression biomarkers and variation with hormone levels. Neuropsychopharmacol. 2015;41(6):1648–58.

    Article  Google Scholar 

  30. Bloch M, Rubinow DR, Schmidt PJ, Lotsikas A, Chrousos GP, Cizza G. Cortisol response to ovine corticotropin-releasing hormone in a model of pregnancy and parturition in euthymic women with and without a history of postpartum depression. J Clin Endocrinol Metab. 2005;90(2):695–9.

    Article  CAS  PubMed  Google Scholar 

  31. Gregoire AJ, Kumar R, Everitt B, Henderson AF, Studd JW. Transdermal oestrogen for treatment of severe postnatal depression. Lancet. 1996;347(9006):930–3.

    Article  CAS  PubMed  Google Scholar 

  32. Ahokas A, Kaukoranta J, Wahlbeck K, Aito M. Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17beta-estradiol: a preliminary study. J Clin Psychiatry. 2001;62(5):332–6.

    Article  CAS  PubMed  Google Scholar 

  33. Wisner KL, Sit DK, Moses-Kolko EL, Driscoll KE, Prairie BA, Stika CS, et al. Transdermal estradiol treatment for postpartum depression: a pilot, randomized trial. J Clin Psychopharmacol. 2015;35(4):389–95.

    CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Women’s Mood Disorders Center, The Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA

    Jennifer L. Payne

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  1. Jennifer L. Payne
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Correspondence to Jennifer L. Payne.

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Conflict of Interest

Jennifer L. Payne declares grant support from the NIH and Sage Therapeutics, as well as personal fees from Astra Zeneca, Eli Lilly, Johnson and Johnson, and Pfizer for legal consulting. She also declares a patent issued for DNA Methylation Biomarkers of Postpartum Depression Risk.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on High-risk Gestation and Prenatal Medicine

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Payne, J.L. Recent Advances and Controversies in Peripartum Depression. Curr Obstet Gynecol Rep 5, 250–256 (2016). https://doi.org/10.1007/s13669-016-0167-x

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  • DOI: https://doi.org/10.1007/s13669-016-0167-x

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