Innovations in the Treatment of Perinatal Depression: the Role of Yoga and Physical Activity Interventions During Pregnancy and Postpartum

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

1. 1.
   Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5 Pt 1):1071–83.  https://doi.org/10.1097/01.AOG.0000183597.31630.db.CrossRefPubMedGoogle Scholar
2. 2.
   Underwood L, Waldie K, D'Souza S, Peterson ER, Morton S. A review of longitudinal studies on antenatal and postnatal depression. Arch Women Ment Health. 2016;19(5):711–20.CrossRefGoogle Scholar
3. 3.
   Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017;219:86–92.CrossRefGoogle Scholar
4. 4.
   Hobfoll SE, Ritter C, Lavin J, Hulsizer MR, Cameron RP. Depression prevalence and incidence among inner-city pregnant and postpartum women. J Consult Clin Psychol. 1995;63(3):445–53.CrossRefGoogle Scholar
5. 5.
   Scholle SH, Haskett RF, Hanusa BH, Pincus HA, Kupfer DJ. Addressing depression in obstetrics/gynecology practice. Gen Hosp Psychiatry. 2003;25(2):83–90.CrossRefGoogle Scholar
6. 6.
   Doe S, LoBue S, Hamaoui A, Rezai S, Henderson CE, Mercado R. Prevalence and predictors of positive screening for postpartum depression in minority parturients in the South Bronx. Arch Women Ment Health. 2017;20(2):291–5.CrossRefGoogle Scholar
7. 7.
   O'Higgins M, Roberts IS, Glover V, Taylor A. Mother-child bonding at 1 year; associations with symptoms of postnatal depression and bonding in the first few weeks. Arch Women Ment Health. 2013;16:381–9.CrossRefGoogle Scholar
8. 8.
   Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O. Consequences of maternal postpartum depression: a systematic review of maternal and infant outcomes. Womens Health (Lond). 2019;15.  https://doi.org/10.1177/1745506519844044.CrossRefGoogle Scholar
9. 9.
   Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–24.  https://doi.org/10.1001/archgenpsychiatry.2010.111.CrossRefPubMedPubMedCentralGoogle Scholar
10. 10.
    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.  https://doi.org/10.1001/jama.2015.18392.CrossRefPubMedGoogle Scholar
11. 11.
    O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and postpartum women: evidence report and systematic review for the US preventive services task force. JAMA. 2016;315(4):388–406.  https://doi.org/10.1001/jama.2015.18948.CrossRefPubMedGoogle Scholar
12. 12.
    Cox EQ, Sowa NA, Meltzer-Brody SE, Gaynes BN. The perinatal depression treatment cascade: baby steps toward improving outcomes. The Journal of clinical psychiatry. 2016;77(9):1189–200.  https://doi.org/10.4088/JCP.15r10174.CrossRefPubMedGoogle Scholar
13. 13.
    Flynn HA, Blow, F.C., Marcus, S.M. Rates and predictors of depression treatment among pregnant women in hospital-affiliated obstetrics practices. Gen Hosp Psychiatry 2006(28):289–295.CrossRefGoogle Scholar
14. 14.
    Goodman JH, Tyer-Viola, Lynda. Detection, treatment and referral of perinatal depression and anxiety by obstetrical providers. J Women's Health 2010;19(3):477–490.Google Scholar
15. 15.
    Battle CL, Salisbury AL, Schofield CA, Ortiz-Hernandez S. Perinatal antidepressant use: understanding women’s preferences and concerns. J Psychiatr Pract. 2013;19(6):443–53.  https://doi.org/10.1097/01.pra.0000438183.74359.46.CrossRefPubMedPubMedCentralGoogle Scholar
16. 16.
    Goodman JH. Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth: Issues in Perinatal Care. 2009;36:60–9.CrossRefGoogle Scholar
17. 17.
    Sockol LE, Epperson CN, Barber JP. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev. 2011;31(5):839–49.  https://doi.org/10.1016/j.cpr.2011.03.009.CrossRefPubMedPubMedCentralGoogle Scholar
18. 18.
    Dennis CL, Chung-Lee L. Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth (Berkeley, Calif. 2006;33(4):323–331.CrossRefGoogle Scholar
19. 19.
    Kessler RC, Davis RB, Foster DF, Van Rompay MI, Walters EE, Wilkey SA, et al. Long-term trends in the use of complementary and alternative medical therapies in the United States. Ann Intern Med. 2001;135(4):262–8.CrossRefGoogle Scholar
20. 20.
    Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002–2012. National Health Statistics Reports, No 79. 2015.Google Scholar
21. 21.
    Cramer H, Ward L, Steel A, Lauche R, Dobos G, Zhang Y. Prevalence, patterns, and predictors of yoga use: results of a U.S. nationally representative survey. Am J Prev Med. 2016;50(2):230–5.  https://doi.org/10.1016/j.amepre.2015.07.037.CrossRefPubMedGoogle Scholar
22. 22.
    Reza N, Deligiannidis KM, Eustis EH, Battle CL. Complementary health practices for treating perinatal depression. Obstet Gynecol Clin N Am. 2018;45(3):441–54.  https://doi.org/10.1016/j.ogc.2018.04.002.CrossRefGoogle Scholar
23. 23.
    Deligiannidis KM, Freeman MP. Complementary and alternative medicine therapies for perinatal depression. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):85–95.  https://doi.org/10.1016/j.bpobgyn.2013.08.007.CrossRefPubMedGoogle Scholar
24. 24.
    • Matthews J, Huberty JL, Leiferman JA, McClain D, Larkey LK. Perceptions, uses of, and interests in complementary health care approaches in depressed pregnant women. J Evidence-Based Complement Altern Med. 2016;22(1):81–95.  https://doi.org/10.1177/2156587216641829 This paper reports results of a survey of pregnant women with the without depression symptom elevations regarding their use of complementary health care approaches. CrossRefGoogle Scholar
25. 25.
    Hall HG, Griffiths DL, McKenna LG. The use of complementary and alternative medicine by pregnant women: a literature review. Midwifery. 2011;27:817–24.  https://doi.org/10.1016/j.midw.2010.08.007.CrossRefPubMedGoogle Scholar
26. 26.
    Adams J, Lui CW, Sibbritt D, Broom A, Wardle J, Homer C et al. Women’s use of complementary and alternative medicine during pregnancy: a critical review of the literature. Birth (Berkeley, Calif. 2009;36(3):237–245. doi: https://doi.org/10.1111/j.1523-536X.2009.00328.x.CrossRefGoogle Scholar
27. 27.
    Kronenberg F, Cushman LF, Wade CM, Kalmuss D, Chao MT. Race/ethnicity and women’s use of complementary and alternative medicine in the United States: results of a national survey. Am J Public Health. 2006;96(7):1236–42.CrossRefGoogle Scholar
28. 28.
    Upchurch DM, Chyu L, G.A. G, Utts J, Bair YA, Zhang G, et al. Complementary and alternative medicine use among American women: findings from The National Health Interview Survey, 2002. J Women’s Health. 2007;16(1):102–13.CrossRefGoogle Scholar
29. 29.
    Johnson PJ, Kozhimannil KB, Jou J, Ghildayal N, Rockwood TH. Complementary and alternative medicine use among women of reproductive age in the United States. Womens Health Issues. 2016;26(1):40–7.  https://doi.org/10.1016/j.whi.2015.08.009.CrossRefPubMedGoogle Scholar
30. 30.
    Cox JL, Holden, J.M., & Sagovsky, R. Detection of postnatal depression: development of the Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987(150):782–786.Google Scholar
31. 31.
    Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.CrossRefGoogle Scholar
32. 32.
    Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, et al. The 16-item Quick Inventory of Depressive Symptomatology (QIDS) Clinician Rating (QIDS-C) and Self-Report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54:573–83.CrossRefGoogle Scholar
33. 33.
    Hamilton M. Rating depressive patients. J Clin Psychiatry. 1980;41:21–4.PubMedGoogle Scholar
34. 34.
    Farris SG, Abrantes AM, Uebelacker LA, Weinstock LM, Battle CL. Exercise as a nonpharmacological treatment for depression. Psychiatr Ann. 2019;49(1):6–10.  https://doi.org/10.3928/00485713-20181204-01.CrossRefGoogle Scholar
35. 35.
    • Schuch FB, Vancampfort D, Richards J, Rosenbaum S, Ward PB, Stubbs B. Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiatr Res. 2016;77:42–51 This is a recent meta-analysis on the efficacy of exercise and PA interventions for depression in the general population. CrossRefGoogle Scholar
36. 36.
    Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR et al. Exercise for depression. The Cochrane database of systematic reviews 2013(9):CD004366. doi: https://doi.org/10.1002/14651858.CD004366.pub6.
37. 37.
    Committee Opinion No ACOG. 650: physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015;126(6):e135–42.  https://doi.org/10.1097/AOG.0000000000001214.CrossRefGoogle Scholar
38. 38.
    Artal R, O’Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med. 2003;37(1):6–12 discussion.CrossRefGoogle Scholar
39. 39.
    McCurdy AP, Boule NG, Sivak A, Davenport MH. Effects of exercise on mild-to-moderate depressive symptoms in the postpartum period: a meta-analysis. Obstet Gynecol. 2017;129:1087–97.CrossRefGoogle Scholar
40. 40.
    • Battle CL, Abrantes AM, Schofield CA, Kraines MA. Physical activity as an intervention for antenatal depression: rationale for developing tailored exercise programs for pregnant women with depression. J Midwifery Womens Health. 2015.  https://doi.org/10.1111/jmwh.12271 This paper presents a rationale for developing PA programs for women with depression during pregnancy, including a list of characteristics of PA programs that make them more suitable for pregnant women. CrossRefGoogle Scholar
41. 41.
    Battle CL, Abrantes AM. Tailored physical activity interventions as innovative means to address women’s perinatal mental health. Swansea, Wales: International Marce Society; 2014.Google Scholar
42. 42.
    First MB, Williams JBW, Karg RS, Spitzer RL. Structured clinical interview for DSM-5: research version. Arlington, VA: American Psychiatric Association; 2015.Google Scholar
43. 43.
    Armstrong K, Edwards H. The effects of exercise and social support on mothers reporting depressive symptoms: a pilot randomized controlled trial. Int J Ment Health Nurs. 2003;12(2):130–8.CrossRefGoogle Scholar
44. 44.
    Armstrong K, Edwards H. The effectiveness of a pram-walking exercise programme in reducing depressive symptomatology for postnatal women. Int J Nurs Pract. 2004;10(4):177–94.CrossRefGoogle Scholar
45. 45.
    Daley A, Winter H, Grimmett C, McGuinness M, McManus R, MacArthur C. Feasibility of an exercise intervention for women with postnatal depression: a pilot randomised controlled trial. The British journal of general practice : the journal of the Royal College of General Practitioners. 2008;58(548):178–83.CrossRefGoogle Scholar
46. 46.
    • Daley AJ, Blamey RV, Jolly K, Roalfe AK, Turner KM, Coleman S, et al. A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial. Psychological Medicine. 2015;45(11):2413–25.  https://doi.org/10.1017/S0033291715000409 Results from this RCT indicated that postpartum women randomized to a PA intervention reported significantly lower symptoms of depression compared with usual care after controlling for baseline depression and demographic variables. CrossRefPubMedGoogle Scholar
47. 47.
    Daley AJ, Jolly K, Sharp DJ, Turner KM, Blamey RV, Coleman S, et al. The effectiveness of exercise as a treatment for postnatal depression: study protocol. Biomed Central Pregnancy and Childbirth. 2012;12:45.CrossRefGoogle Scholar
48. 48.
    Heh SS, Huang LH, Ho SM, Fu YY, Wang LL. Effectiveness of an exercise support program in reducing the severity of postnatal depression in Taiwanese women. Birth (Berkeley, Calif. 2008;35(1):60–65. doi: https://doi.org/10.1111/j.1523-536X.2007.00192.x.CrossRefGoogle Scholar
49. 49.
    DaCosta D, Lowensteyn I, Abrahamowicz M, Ionescu-Ittu R, Dritsa M, Rippen N, et al. A randomized clinical trial of exercise to alleviate postpartum depressed mood. J Psychosom Obstet Gynaecol. 2009;30(3):191–200.CrossRefGoogle Scholar
50. 50.
    Forsyth J, Boath E, Henshaw C, Brown H. Exercise as an adjunct treatment for postpartum depression for women living in an inner city-a pilot study. Health Care Women Int. 2017;38(6):635–9.  https://doi.org/10.1080/07399332.2017.1295049.CrossRefPubMedGoogle Scholar
51. 51.
    Teychenne M, van der Pligt P, Abbott G, Brennan L, Olander EK. Feasibility and acceptability of a home-based physical activity program for postnatal women with depressive symptoms: a pilot study. Ment Health Phys Act. 2018;14:82–9.  https://doi.org/10.1016/j.mhpa.2018.02.007.CrossRefGoogle Scholar
52. 52.
    Vargas-Terrones M, Barakat R, Santacruz B, Fernandez-Buhigas I, Mottola MF. Physical exercise programme during pregnancy decreases perinatal depression risk: a randomised controlled trial. Br J Sports Med. 2018.  https://doi.org/10.1136/bjsports-2017-098926.CrossRefGoogle Scholar
53. 53.
    • Aguilar-Cordero MJ, Sanchez-Garcia JC, Rodriguez-Blanque R, Sanchez-Lopez AM, Mur-Villar N. Moderate physical activity in an aquatic environment during pregnancy (SWEP study) and its influence in preventing postpartum depression. J Am Psychiatr Nurses Assoc. 2019;25(2):112–21.  https://doi.org/10.1177/1078390317753675 This recent prevention RCT found that asymptomatic pregnant women who were randomized to an aquatic physical activity intervention reported significantly lower symptoms of depression postpartum compared with women in the control condition, suggesting that this PA intervention may be able to prevent symptoms of postpartum depression. CrossRefPubMedGoogle Scholar
54. 54.
    Songoygard KM, Stafne SN, Evensen KA, Salvesen KA, Vik T, Morkved S. Does exercise during pregnancy prevent postnatal depression? A randomized controlled trial. Acta Obstet Gynecol Scand. 2012;91(1):62–7.  https://doi.org/10.1111/j.1600-0412.2011.01262.x.CrossRefPubMedGoogle Scholar
55. 55.
    Dunn AL. The effectiveness of lifestyle physical activity interventions to reduce cardiovascular disease. Am J Lifestyle Med. 2009;3:11S–8S.CrossRefGoogle Scholar
56. 56.
    • Cramer H, Anheyer D, Lauche R, Dobos G. A systematic review of yoga for major depressive disorder. Journal of Affective Disorders. 2017;213:70–7.  https://doi.org/10.1016/j.jad.2017.02.006 This paper provides a recent systematic review of the efficacy of yoga for depression in the general population. CrossRefPubMedGoogle Scholar
57. 57.
    Uebelacker LA, Epstein-Lubow G, Gaudiano BA, Tremont G, Battle CL, Miller IW. Hatha yoga for depression: critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. J Psychiatr Pract. 2010;16(1):22–33.  https://doi.org/10.1097/01.pra.0000367775.88388.96.CrossRefPubMedGoogle Scholar
58. 58.
    Battle CL, Uebelacker LA, Magee SR, Sutton KA, Miller IW. Potential for prenatal yoga to serve as an intervention to treat depression during pregnancy. Womens Health Issues. 2015;25(2):134–41.  https://doi.org/10.1016/j.whi.2014.12.003.CrossRefPubMedPubMedCentralGoogle Scholar
59. 59.
    • Uebelacker LA, Battle CL, Sutton KA, Magee SR, Miller IW. A pilot randomized controlled trial comparing prenatal yoga to perinatal health education for antenatal depression. Arch Womens Ment Health. 2016;19(3):543–7.  https://doi.org/10.1007/s00737-015-0571-7 Although limited by small sample size, this pilot study was one of the first RCTs to examine prenatal yoga to an active comparison condition for women with antenatal depression. This intervention is currently being tested in a full-scale RCT ( ClinicalTrials.gov Identifier: NCT02738216). CrossRefPubMedGoogle Scholar
60. 60.
    Field T, Diego M, Delgado J, Medina L. Yoga and social support reduce prenatal depression, anxiety and cortisol. J Bodyw Mov Ther. 2013;17(4):397–403.  https://doi.org/10.1016/j.jbmt.2013.03.010.CrossRefPubMedGoogle Scholar
61. 61.
    Field T, Diego M, Delgado J, Medina L. Tai chi/yoga reduces prenatal depression, anxiety and sleep disturbances. Complement Ther Clin Pract. 2013;19(1):6–10.  https://doi.org/10.1016/j.ctcp.2012.10.001.CrossRefPubMedGoogle Scholar
62. 62.
    Field T, Diego M, Hernandez-Reif M, Medina L, Delgado J, Hernandez A. Yoga and massage therapy reduce prenatal depression and prematurity. J Bodyw Mov Ther. 2012;16(2):204–9.  https://doi.org/10.1016/j.jbmt.2011.08.002.CrossRefPubMedGoogle Scholar
63. 63.
    Mitchell J, Field T, Diego M, Bendell D, Newton R, Pelaez M. Yoga reduces prenatal depression symptoms. Psychology. 2012;3:782–6.CrossRefGoogle Scholar
64. 64.
    Davis K, Goodman SH, Leiferman J, Taylor M, Dimidjian S. A randomized controlled trial of yoga for pregnant women with symptoms of depression and anxiety. Complement Ther Clin Pract. 2015;21(3):166–72.  https://doi.org/10.1016/j.ctcp.2015.06.005.CrossRefPubMedGoogle Scholar
65. 65.
    Muzik M, Hamilton SE, Lisa Rosenblum K, Waxler E, Hadi Z. Mindfulness yoga during pregnancy for psychiatrically at-risk women: preliminary results from a pilot feasibility study. Complement Ther Clin Pract. 2012;18(4):235–40.  https://doi.org/10.1016/j.ctcp.2012.06.006.CrossRefPubMedPubMedCentralGoogle Scholar
66. 66.
    • Buttner MM, Brock RL, O'Hara MW, Stuart S. Efficacy of yoga for depressed postpartum women: a randomized controlled trial. Complementary therapies in clinical practice. 2015;21(2):94–100.  https://doi.org/10.1016/j.ctcp.2015.03.003 This is one of the first RCTs to examine a yoga intervention for postpartum depression. CrossRefPubMedGoogle Scholar
67. 67.
    Sheffield KM, Woods-Giscombé CL. Efficacy, feasibility, and acceptability of perinatal yoga on women’s mental health and well being: a systematic literature review. J Holist Nurs. 2015;34(1):64–79.CrossRefGoogle Scholar
68. 68.
    Babbar S, Shyken J. Yoga in pregnancy. Clin Obstetr Gynecol. 2016;59(3):6–612.CrossRefGoogle Scholar
69. 69.
    de Manincor M, Bensoussan A, Smith C, Fahey P, Bourchier S. Establishing key components of yoga interventions for reducing depression and anxiety, and improving well-being: a Delphi method study. BMC Complement Altern Med. 2015;15:85.  https://doi.org/10.1186/s12906-015-0614-7.CrossRefPubMedPubMedCentralGoogle Scholar
70. 70.
    Streeter CC, Gerbarg PL, Whitfield TH, Owen L, Johnston J, Silveri MM, et al. Treatment of major depressive disorder with Iyengar yoga and coherent breathing: a randomized controlled dosing study. J Altern Complement Med. 2017;23:201–7.  https://doi.org/10.1089/acm.2016.0140.CrossRefPubMedPubMedCentralGoogle Scholar