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Diagnosis and Treatment of Postpartum Depression: A Review

Year 2020, Volume: 11 Issue: 39, 31 - 37, 19.05.2020
https://doi.org/10.17944/mkutfd.584854

Abstract

Pregnancy is a period in which physiological, psychological and social changes are experienced in female life. These changes can cause various mental illnesses during and after pregnancy. Postpartum depression is commonly seen in the perinatal period. Postpartum depression is an important cause of morbidity and mortality for mother and baby. A major depressive episode with peripartum onset is defined as postpartum depression when it occurs during pregnancy or up to 4 weeks of postpartum. The frequency of the disease is extremely high. Biological, psychological and sociocultural factors have been reported to be effective in the etiology. It presents with major depression symptoms such as depression, anhedonia, thoughts of guilt, irritability, concentration disorder, psychomotor agitation, psychomotor retardation, sleep disorder, appetite and weight changes. There are many different options in the treatment. Most of these options have been adapted from the treatment of major depression. Serotonin reuptake inhibitors (SSRI), serotonin noradrenaline reuptake inhibitors (SNRIs), tricyclic antidepressants, estradiol, progesterone, psychotherapies, electronvulsive therapy and brexanolone may be used in the treatment. Brexanolone is a promising new drug in the treatment of postpartum depression. It is the only treatment in postpartum depression that has received special indication. This review aims to investigate the recent developments in the etiology, diagnosis and treatment of postpartum depression in the light of current data.

References

  • Okanlı A, Tortumluoğlu G, Kırpınar İ. Gebe kadınların ailelerinden algıladıkları sosyal destek ile problem çözme becerileri arasındaki ilişki. Anadolu Psikiyatri Dergisi 2013; 4:98-105.
  • Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and health predictors of national postpartum depression prevalence: a systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Front Psychiatry 2017; 8:248.
  • Stewart DE, Robertson E, Dennis CL, Grace SL, Wallington T. Postpartum depression: Literature review of risk factors and interventions. University Health Network Women’s Health Program for Toronto Public Health. 2003.
  • Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health 2005; 8(2):77–87.
  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Arlington (VA): American Psychiatric Publishing; 2013.
  • Dünya Sağlık Örgütü. ICD-10 Ruhsal ve Davranışsal Bozukluklar Sınıflandırılması. MO Öztürk, B Uluğ (Çeviri Ed), Ankara: Türkiye Sinir ve Ruh Sağlığı Derneği Yayını, 1993.
  • O’Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol 2013; 9:379–407.
  • Gavin NI, Gaynes, BN, Lohr KN, Meltzer‐Brody S, Gartlehner G, Swinson, T. Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology 2005; 106:1071–1083.
  • Ayvaz S, Hocaoğlu Ç, Tiryaki A, Ak İ. Trabzon il merkezinde doğum sonrası depresyon sıklığı ve gebelikteki ilişkili demografik risk etmenleri. Türk Psikiyatri Dergisi 2006; 17(4):243-251.
  • Sunter AT, Guz H, Ordulu F. Samsun il merkezinde doğum sonrası depresyonu prevalansı ve risk faktorleri. VIII. Ulusal halk sağlığı kongresi kitabı 2002; 855-858.
  • Danacı AE, Dinç G, Deveci A, Sen FS, Içelli I. Postnatal depression in Turkey: Epidemiological and cultural aspects. Soc Psychatr Epidemiol 2002; 37:125-129.
  • Aydin N, Inandi T, Karabulut N. Depression and associated factors among women within their first postnatal year in Erzurum province in eastern Turkey. Women Health 2005; 41:1-12.
  • Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16(9):606–613.
  • Wang SY, Jiang XY, Jan WC, Chen CH. Acomparative study of postnatal depression and its predictors in Taiwan and Mainland China. Am J Obstet Gynecol 2003; 189:1407-1412
  • Viinamaki H, Niskanen L, Pesonen P, Saarikoski S. Evolution of postpartum mental health. J Psychosom Obstet Gynecol 1997; 18:213-219.
  • Işık MT, Akçınar M, Kadıoğlu S. Mersin ilinde gebelik, doğum ve loğusalık dönemlerinde anneye ve yenidoğana yönelik geleneksel uygulamalar. Uluslararası İnsan Bilimleri Dergisi 2010; 7(1):71-84.
  • Clark A, Skouteris H, Wertheim EH, Paxton SJ, Milgrom J. The relationship between depression and body dissatisfaction across pregnancy and the postpartum: A prospective study. J Health Psychol 2009; 14:27-35.
  • Brett M, Baxendale S. Motherhood and memory: a review. Psychoneuroendocrinology 2001; 26:339–362.
  • Frokjaer VG, Pinborg A, Holst KK, Overgaard A, Henningsson S, Heede M, Stenbæk D. Role of serotonin transporter changes in depressive responses to sex-steroid hormone manipulation: a positron emission tomography study. Biological psychiatry 2015; 78:534-543.
  • Pařízek A, Mikešová M, Jirák, R, Hill, M, Koucký M, Pašková A, Dušková M. Steroid hormones in the development of postpartum depression. Physiol Res 2014; 63 (Suppl 2):277–282.
  • Guintivano J, Arad M, Gould TD, Payne JL, Kmisnky ZA. Antenatal prediction of postpartum depression with blood DNA methylation biomarkers. Mol. Psychiatry 2014;19:560–567.
  • Roes M, Galea LA. The maternal brain: short-and long-term effects of reproductive experience on hippocampus structure and function in adulthood. Sex Differences in the Central Nervous System. Academic Press, 2016;197-220.
  • Bowen A, Muhajarine N. Antenatal depression. Canadian Nurse Journal 2006; 102:26-30.
  • Kalken G, Yılmazer M, Coşar E, Şahin FK, Çevrioğlu S, Geçiçi Ö. Nausea and vomiting in early pregnancy: Relationship with anxiety and depression. J Psychosom Obstet Gynaecol 2008; 29:91-95.
  • Brenda M, Leung Y, Bonnie ND, Kaplan J. Perinatal depression: prevelance, risks, and the nutrition link-a review of the literature. J Am Diet Assoc 2009; 109:1566-1577.
  • Bernstein IH, Rush AJ, Yonkers K, Carmody TJ, Woo A, McConnell K, et al. Symptom features of postpartum depression: are they distinct?. Depress Anxiety 2008; 25(1):20–26.
  • Dindo L, Elmore A, O’Hara M, Stuart S. The comorbidity of Axis I disorders in depressed pregnant women. Arch Womens Ment Health 2017; 20(6):757–764.
  • Erdem Ö, Bucaktepe PG. Postpartum depresyon görülme sıklığı ve tarama yöntemleri. Dicle Tıp Dergisi 2012;39 (3):446-458.
  • Morrell CJ, Slade P, Warner R, Paley G, Dixon S, Walters SJ, et al. Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: Pragmatic cluster randomised trial in primary care. British Medical Journal 2009; 338: 1–14.
  • Frieder A, Fersh M, Hainline M, Deligiannidis KM. Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development. CNS Drugs 2019; 33:265–282.
  • Stowe ZN, Casarella J, Landry J, Nemeroff CB. Sertraline in the treatment of women with postpartum major depression. Depression 1995; 3(1–2):49–55.
  • Wisner KL, Hanusa BH, Perel JM, Peindl KS, Piontek CM, Sit DK, et al. Postpartum depression: a randomized trial of sertraline versus nortriptyline. J Clin Psychopharmacol. 2006; 26(4):353– 360.
  • Dennis CL, Ross LE, Herxheimer A. Oestrogens and progestins for preventing and treating postpartum depression. Cochrane Database Syst Rev. 2008; 4.
  • Ward HB, Fromson JA, Cooper JJ, De Oliveira G, Almeida M. Recommendations for the use of ECT in pregnancy: literature review and proposed clinical protocol. Arch Womens Ment Health 2018; 21(6):715–722.
  • US FDA. FDA approves first treatment for post-partum depression. 2019. http://www.fda.gov/. Accessed 22 Mar 2019.
  • Marcus SM. Depression during pregnancy: rates, risks and consequences. Journal of Population Therapeutics and Clinical Pharmacology 2009; 16(1).
  • Misri SR, Reebye P, Corral M, Mills L. The use of paroxetine and cognitivebehavioral therapy in postpartum depression and anxiety: A randomized controlled trial. Journal of Clinical Psychiatry 2004; 65:1236–1241.
  • De Crescenzo, F, Perelli F, Armando M, Vicari S. Selective serotonin reuptake inhibitors (SSRIs) for post-partum depression (PPD): a systematic review of randomized clinical trials. Journal of Affective Disorders 2014; 152:39-44.
  • Suri R, Burt VK, Altshuler LL. Nefazodone for the treatment of postpartum depression. Arch Womens Ment Health. 2005;8(1):55–56.
  • Gregoire AJ, Kumar R, Everitt B, Henderson AF, Studd JW. Transdermal oestrogen for treatment of severe postnatal depression. Lancet. 1996; 347(9006):930–933.
  • Vigod S, Dennis CL, Daskalakis Z, Murphy K, Ray J, Oberlander T, et al. Transcranial direct current stimulation (tDCS) for treatment of major depression during pregnancy: study protocol for a pilot randomized controlled trial. Trials 2014; 15:366.
  • Deligiannidis KM, Sikoglu EM, Shaffer SA, Frederick B, Svenson AE, Kopoyan A, Moore CM. GABAergic neuroactive steroids and resting-state functional connectivity in postpartum depression: a preliminary study. Journal of psychiatric research 2013; 47(6):816-828.
  • Melón LC, Hooper A, Yang X, Moss SJ, Maguire J. Inability to suppress the stress-induced activation of the HPA axis during the peripartum period engenders deficits in postpartum behaviors in mice. Psychoneuroendocrinology 2017; 90:182–193.
  • Kanes S, Colquhoun H, Gunduz-Bruce H, et al. Brexanolone (SAGE-547 injection) in post-partum depression: a randomised controlled trial. Lancet 2017; 390: 480–489.
  • Zorumski CF, Paul SM, Izumi Y, et al. Neurosteroids, stress and depression: potential therapeutic targets. Neurosci Biobehav Rev 2013; 37(1):109–122.
  • Hoffmann E, Wald J, Colquhoun H. Evaluation of breast milk concentrations following brexanolone iv administration to healthy lactating women. Am J Obstet Gynecol 2019; 220( suppl 1):554.
  • Meltzer-Brody S, Colquhoun H, Riesenberg R, et al. Brexanolone injection in post-partum depression: two multicentre, double blind, randomised, placebo-controlled, phase 3 trials. Lancet 2018; 392(10152):1058–1070.
  • Kanes SJ, Colquhoun IH, Doherty J, Raines S, Hoffmann E, Rubinow DR, Meltzer‐Brody S. Open-label proof-ofconcept study of brexanolone in the treatment of severe postpartum depression. Hum Psychopharmacol 2017; 32(2):2576.

Doğum Sonrası Depresyonun Tanı ve Tedavisi: Bir Gözden Geçirme

Year 2020, Volume: 11 Issue: 39, 31 - 37, 19.05.2020
https://doi.org/10.17944/mkutfd.584854

Abstract

Gebelik dönemi kadın yaşamında fizyolojik,  ruhsal ve sosyal değişimlerin yaşandığı bir
dönemdir. Gebelik dönemi ve sonrasındaki bu değişimler çeşitli ruhsal hastalıklara
sebep olabilmektedir. Bu hastalıklardan doğum sonrası depresyon perinatal
dönemde sık görülmektedir. Doğum sonrası depresyon anne ve bebek için önemli bir
morbidite ve mortalite sebebidir. Peripartum başlangıçlı bir major depresif
epizod hamilelikte ve ya doğum sonrası 4 haftaya kadar ortaya çıktığında doğum
sonrası depresyon olarak tanımlanmaktadır. Sıklığı son derece yüksektir. Etyolojisinde
biyolojik, psikolojik ve sosyokültürel faktörlerin etkili olduğu
bildirilmektedir. Çökkünlük, anhedoni, suçluluk düşünceleri, sinirlilik,
konsantrasyon bozukluğu, psikomotor ajitasyon, psikomotor retardasyon, uyku
düzensizliği, iştah ve kilo değişiklikleri gibi major depresyon semptomları ile
prezante olur. Tedavisinde ise bir çok farklı seçenek bulunmaktadır. Bu
seçeneklerin çoğu major depresyon tedavisinden uyarlanmıştır. Tedavide
serotonin geri alım inhibitörleri (SSRI), serotonin noradrenalin geri alım inhibitörleri
(SNRI), trisiklik antidepresanlar, östradiol, progesteron, psikoterapiler,
elektronvulsiv terapi ve brexanolone kullanılabilmektedir. Brexanolone doğum
sonrası depresyon tedavisinde umut vaat eden
 
yeni bir ilaçtır. Doğum sonrası depresyona özel endikasyon almış tek
tedavidir. Bu derleme çalışması, güncel veriler ışığında doğum sonrası
depresyonun etyoloji,
  tanı ve
tedavisindeki yeni gelişmeleri incelemeyi amaçlamaktadır.

References

  • Okanlı A, Tortumluoğlu G, Kırpınar İ. Gebe kadınların ailelerinden algıladıkları sosyal destek ile problem çözme becerileri arasındaki ilişki. Anadolu Psikiyatri Dergisi 2013; 4:98-105.
  • Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and health predictors of national postpartum depression prevalence: a systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Front Psychiatry 2017; 8:248.
  • Stewart DE, Robertson E, Dennis CL, Grace SL, Wallington T. Postpartum depression: Literature review of risk factors and interventions. University Health Network Women’s Health Program for Toronto Public Health. 2003.
  • Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health 2005; 8(2):77–87.
  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Arlington (VA): American Psychiatric Publishing; 2013.
  • Dünya Sağlık Örgütü. ICD-10 Ruhsal ve Davranışsal Bozukluklar Sınıflandırılması. MO Öztürk, B Uluğ (Çeviri Ed), Ankara: Türkiye Sinir ve Ruh Sağlığı Derneği Yayını, 1993.
  • O’Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol 2013; 9:379–407.
  • Gavin NI, Gaynes, BN, Lohr KN, Meltzer‐Brody S, Gartlehner G, Swinson, T. Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology 2005; 106:1071–1083.
  • Ayvaz S, Hocaoğlu Ç, Tiryaki A, Ak İ. Trabzon il merkezinde doğum sonrası depresyon sıklığı ve gebelikteki ilişkili demografik risk etmenleri. Türk Psikiyatri Dergisi 2006; 17(4):243-251.
  • Sunter AT, Guz H, Ordulu F. Samsun il merkezinde doğum sonrası depresyonu prevalansı ve risk faktorleri. VIII. Ulusal halk sağlığı kongresi kitabı 2002; 855-858.
  • Danacı AE, Dinç G, Deveci A, Sen FS, Içelli I. Postnatal depression in Turkey: Epidemiological and cultural aspects. Soc Psychatr Epidemiol 2002; 37:125-129.
  • Aydin N, Inandi T, Karabulut N. Depression and associated factors among women within their first postnatal year in Erzurum province in eastern Turkey. Women Health 2005; 41:1-12.
  • Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16(9):606–613.
  • Wang SY, Jiang XY, Jan WC, Chen CH. Acomparative study of postnatal depression and its predictors in Taiwan and Mainland China. Am J Obstet Gynecol 2003; 189:1407-1412
  • Viinamaki H, Niskanen L, Pesonen P, Saarikoski S. Evolution of postpartum mental health. J Psychosom Obstet Gynecol 1997; 18:213-219.
  • Işık MT, Akçınar M, Kadıoğlu S. Mersin ilinde gebelik, doğum ve loğusalık dönemlerinde anneye ve yenidoğana yönelik geleneksel uygulamalar. Uluslararası İnsan Bilimleri Dergisi 2010; 7(1):71-84.
  • Clark A, Skouteris H, Wertheim EH, Paxton SJ, Milgrom J. The relationship between depression and body dissatisfaction across pregnancy and the postpartum: A prospective study. J Health Psychol 2009; 14:27-35.
  • Brett M, Baxendale S. Motherhood and memory: a review. Psychoneuroendocrinology 2001; 26:339–362.
  • Frokjaer VG, Pinborg A, Holst KK, Overgaard A, Henningsson S, Heede M, Stenbæk D. Role of serotonin transporter changes in depressive responses to sex-steroid hormone manipulation: a positron emission tomography study. Biological psychiatry 2015; 78:534-543.
  • Pařízek A, Mikešová M, Jirák, R, Hill, M, Koucký M, Pašková A, Dušková M. Steroid hormones in the development of postpartum depression. Physiol Res 2014; 63 (Suppl 2):277–282.
  • Guintivano J, Arad M, Gould TD, Payne JL, Kmisnky ZA. Antenatal prediction of postpartum depression with blood DNA methylation biomarkers. Mol. Psychiatry 2014;19:560–567.
  • Roes M, Galea LA. The maternal brain: short-and long-term effects of reproductive experience on hippocampus structure and function in adulthood. Sex Differences in the Central Nervous System. Academic Press, 2016;197-220.
  • Bowen A, Muhajarine N. Antenatal depression. Canadian Nurse Journal 2006; 102:26-30.
  • Kalken G, Yılmazer M, Coşar E, Şahin FK, Çevrioğlu S, Geçiçi Ö. Nausea and vomiting in early pregnancy: Relationship with anxiety and depression. J Psychosom Obstet Gynaecol 2008; 29:91-95.
  • Brenda M, Leung Y, Bonnie ND, Kaplan J. Perinatal depression: prevelance, risks, and the nutrition link-a review of the literature. J Am Diet Assoc 2009; 109:1566-1577.
  • Bernstein IH, Rush AJ, Yonkers K, Carmody TJ, Woo A, McConnell K, et al. Symptom features of postpartum depression: are they distinct?. Depress Anxiety 2008; 25(1):20–26.
  • Dindo L, Elmore A, O’Hara M, Stuart S. The comorbidity of Axis I disorders in depressed pregnant women. Arch Womens Ment Health 2017; 20(6):757–764.
  • Erdem Ö, Bucaktepe PG. Postpartum depresyon görülme sıklığı ve tarama yöntemleri. Dicle Tıp Dergisi 2012;39 (3):446-458.
  • Morrell CJ, Slade P, Warner R, Paley G, Dixon S, Walters SJ, et al. Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: Pragmatic cluster randomised trial in primary care. British Medical Journal 2009; 338: 1–14.
  • Frieder A, Fersh M, Hainline M, Deligiannidis KM. Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development. CNS Drugs 2019; 33:265–282.
  • Stowe ZN, Casarella J, Landry J, Nemeroff CB. Sertraline in the treatment of women with postpartum major depression. Depression 1995; 3(1–2):49–55.
  • Wisner KL, Hanusa BH, Perel JM, Peindl KS, Piontek CM, Sit DK, et al. Postpartum depression: a randomized trial of sertraline versus nortriptyline. J Clin Psychopharmacol. 2006; 26(4):353– 360.
  • Dennis CL, Ross LE, Herxheimer A. Oestrogens and progestins for preventing and treating postpartum depression. Cochrane Database Syst Rev. 2008; 4.
  • Ward HB, Fromson JA, Cooper JJ, De Oliveira G, Almeida M. Recommendations for the use of ECT in pregnancy: literature review and proposed clinical protocol. Arch Womens Ment Health 2018; 21(6):715–722.
  • US FDA. FDA approves first treatment for post-partum depression. 2019. http://www.fda.gov/. Accessed 22 Mar 2019.
  • Marcus SM. Depression during pregnancy: rates, risks and consequences. Journal of Population Therapeutics and Clinical Pharmacology 2009; 16(1).
  • Misri SR, Reebye P, Corral M, Mills L. The use of paroxetine and cognitivebehavioral therapy in postpartum depression and anxiety: A randomized controlled trial. Journal of Clinical Psychiatry 2004; 65:1236–1241.
  • De Crescenzo, F, Perelli F, Armando M, Vicari S. Selective serotonin reuptake inhibitors (SSRIs) for post-partum depression (PPD): a systematic review of randomized clinical trials. Journal of Affective Disorders 2014; 152:39-44.
  • Suri R, Burt VK, Altshuler LL. Nefazodone for the treatment of postpartum depression. Arch Womens Ment Health. 2005;8(1):55–56.
  • Gregoire AJ, Kumar R, Everitt B, Henderson AF, Studd JW. Transdermal oestrogen for treatment of severe postnatal depression. Lancet. 1996; 347(9006):930–933.
  • Vigod S, Dennis CL, Daskalakis Z, Murphy K, Ray J, Oberlander T, et al. Transcranial direct current stimulation (tDCS) for treatment of major depression during pregnancy: study protocol for a pilot randomized controlled trial. Trials 2014; 15:366.
  • Deligiannidis KM, Sikoglu EM, Shaffer SA, Frederick B, Svenson AE, Kopoyan A, Moore CM. GABAergic neuroactive steroids and resting-state functional connectivity in postpartum depression: a preliminary study. Journal of psychiatric research 2013; 47(6):816-828.
  • Melón LC, Hooper A, Yang X, Moss SJ, Maguire J. Inability to suppress the stress-induced activation of the HPA axis during the peripartum period engenders deficits in postpartum behaviors in mice. Psychoneuroendocrinology 2017; 90:182–193.
  • Kanes S, Colquhoun H, Gunduz-Bruce H, et al. Brexanolone (SAGE-547 injection) in post-partum depression: a randomised controlled trial. Lancet 2017; 390: 480–489.
  • Zorumski CF, Paul SM, Izumi Y, et al. Neurosteroids, stress and depression: potential therapeutic targets. Neurosci Biobehav Rev 2013; 37(1):109–122.
  • Hoffmann E, Wald J, Colquhoun H. Evaluation of breast milk concentrations following brexanolone iv administration to healthy lactating women. Am J Obstet Gynecol 2019; 220( suppl 1):554.
  • Meltzer-Brody S, Colquhoun H, Riesenberg R, et al. Brexanolone injection in post-partum depression: two multicentre, double blind, randomised, placebo-controlled, phase 3 trials. Lancet 2018; 392(10152):1058–1070.
  • Kanes SJ, Colquhoun IH, Doherty J, Raines S, Hoffmann E, Rubinow DR, Meltzer‐Brody S. Open-label proof-ofconcept study of brexanolone in the treatment of severe postpartum depression. Hum Psychopharmacol 2017; 32(2):2576.
There are 48 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Review
Authors

Ali Erdoğan 0000-0003-0329-6778

Çiçek Hocaoğlu 0000-0001-6613-4317

Publication Date May 19, 2020
Submission Date July 1, 2019
Acceptance Date September 25, 2019
Published in Issue Year 2020 Volume: 11 Issue: 39

Cite

Vancouver Erdoğan A, Hocaoğlu Ç. Doğum Sonrası Depresyonun Tanı ve Tedavisi: Bir Gözden Geçirme. mkutfd. 2020;11(39):31-7.