Depression Drug Treatment Outcomes in Pregnancy and the Postpartum Period

McDonagh, Marian; Matthews, Annette M.; Phillipi, Carrie A.; Romm, Jillian; Peterson, Kim; Thakurta, Sujata; Guise, Jeanne Marie

doi:10.1097/aog.0000000000000410

Cited by 60 publications

(20 citation statements)

References 64 publications

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“…However, such a task remains exceedingly difficult, given the paucity of randomized controlled trials of antidepressant use in pregnancy as highlighted by a recent metanalysis on this issue. 41 However, one key aspect of these policy statements is that the recommendations include pharmacotherapy “for depression.” Our analysis suggests that women without depression are also receiving antidepressants. It is possible that women were well-controlled on their medications and thus the providers did not consider them “depressed” and omitted a code for depression.…”

Section: Discussionmentioning

confidence: 99%

Disparities in antidepressant use in pregnancy

Yamamoto

McCormick

Burris³

2014

J Perinatol

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BackgroundThe American College of Obstetricians and Gynecologists and the American Psychiatric Association both recommend pharmacotherapy for perinatal depression when the benefits outweigh the risks. While minority adults are less likely to use antidepressant medications compared to Non-Hispanic Whites, whether this pattern occurs among pregnant women is unclear.ObjectiveWe sought to determine the frequency of antidepressant medication use reported during ambulatory care visits for pregnant women and whether these rates varied by race.MethodsWe combined the 2006–2010 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to obtain nationally representative estimates of outpatient preventive care visits for pregnant women. We then obtained estimates of the prevalence of reported depression and antidepressant use during outpatient visits for pregnant women. To determine whether these estimates varied by race, we used multivariable logistic regression analyses accounting for survey design using SAS 9.2 (PROC SURVEYLOGISTIC) to estimate odds ratios of reported antidepressant use after adjustment for age, insurance status and region of the country.ResultsAntidepressant use was reported during 2.2% of all outpatient visits for pregnant women. Providers indicated a depression diagnosis in 4.5% of visits. Among visits for depressed pregnant women, providers reported antidepressant use 25.4% of the time for all visits. Antidepressant use during pregnancy varied significantly by race/ethnicity. Among visits for Non-Hispanic White women, 3.1% included a code for antidepressant use vs. just 1.0% for Non-White women (P<0.0001). After adjustment for age, insurance status, and region of the country, this association persisted with Non-Hispanic White (vs. Non-White) pregnant women having higher odds of antidepressant use (adjusted OR 3.3, 95% CI 2.1, 5.3).ConclusionNon-Hispanic White women were more likely than Non-White women to be using antidepressants during pregnancy. Whether differences in antidepressant use by race/ethnicity indicates over-treatment of non-Hispanic White women or under-treatment of minorities remains unclear. This disparity warrants investigation with the goal of optimizing maternal mental health while minimizing potential adverse sequelae of antidepressants on developing fetuses.

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Section: Discussionmentioning

confidence: 99%

Disparities in antidepressant use in pregnancy

Yamamoto

McCormick

Burris³

2014

J Perinatol

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“…Although several systematic reviews have been completed that report that antidepressants are associated with significant reductions in depressive symptoms in women with unipolar depression postpartum 56, 57 , there is only one published study to date of the acute treatment of acute bipolar postpartum depression 58 . In a chart review of 18 bipolar women who were treated with quietapine alone (or with sedative hypnotic), Sharma et al 58 reported that 83% were much improved or improved on retrospective Clinical Global Impression Scale scores.…”

Section: Part Iv: Recent Advances In Acute Pharmacologic and Psychothmentioning

confidence: 99%

Recent advances in understanding maternal perinatal mood disorders

2017

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The study of perinatal mental health (mental health during pregnancy and postpartum) is a complex field of study that is of major importance both for the mental and physical health of new mothers and for the neurobehavioral development and long-term functioning of the children they bear. In this review, we cover the most recent additions to this rapidly evolving field. Notable advances include further illumination of the epidemiological patterns and clinical manifestations of perinatal mood disruption; new efficacy data on treatment and prevention; clarifications of the respective contributions of maternal mental illness and psychotropic medication to outcomes of pregnancy, birth, and child development; and updated expert guidelines for screening.

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“…Placebo-controlled, randomized trials of antidepressant substances in this population are lacking, and the methodological flaws of available studies limit the generalizability of the findings. A large meta-analysis recently concluded that evidence over benefits/harms of available compounds cannot adequately support informed decisions about the treatment of PND [14]. Furthermore, teratogenicity concerns commonly influence women’s acceptance of potentially effective treatments.…”

Section: Introductionmentioning

confidence: 99%

Chronobiology, sleep-related risk factors and light therapy in perinatal depression: the “Life-ON” project

Baiardi¹,

Cirignotta²,

Cicolin³

et al. 2016

BMC Psychiatry

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BackgroundPerinatal depression (PND) has an overall estimated prevalence of roughly 12 %. Untreated PND has significant negative consequences not only on the health of the mothers, but also on the physical, emotional and cognitive development of their children. No certain risk factors are known to predict PND and no completely safe drug treatments are available during pregnancy and breastfeeding. Sleep and depression are strongly related to each other because of a solid reciprocal causal relationship. Bright light therapy (BLT) is a well-tested and safe treatment, effective in both depression and circadian/sleep disorders.MethodsIn a 3-year longitudinal, observational, multicentre study, about 500 women will be recruited and followed-up from early pregnancy (10–15 gestational week) until 12 months after delivery. The primary aim of the present study is to systematically explore and characterize risk factors for PND by prospective sleep assessment (using wrist actigraphy, polysomnography and various sleep questionnaires) and bloodbased analysis of potential markers during the perinatal period (Life-ON study). Secondary aims are to explore the relationship between specific genetic polymorphisms and PND (substudy Life-ON1), to investigate the effectiveness of BLT in treating PND (substudy Life-ON2) and to test whether a short term trial of BLT during pregnancy can prevent PND (substudy Life-ON3).DiscussionThe characterization of specific predictive and risk factors for PND may substantially contribute to improve preventive medical and social strategies for the affected women. The study results are expected to promote a better understanding of the relationship between sleep disorders and the development of PND and to confirm, in a large sample of women, the safety and efficacy of BLT both in prevention and treatment of PND.Trial registrationClinicalTrials.gov NCT02664467. Registered 13 January 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1086-0) contains supplementary material, which is available to authorized users.

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Depression Drug Treatment Outcomes in Pregnancy and the Postpartum Period

Abstract: Evidence about the comparative benefits and harms of pharmacologic treatment of depression in pregnant and postpartum women was largely inadequate to allow informed decisions about treatment. Considering the prevalence of depression, filling this gap is essential.

Cited by 60 publications

References 64 publications

Disparities in antidepressant use in pregnancy

Disparities in antidepressant use in pregnancy

Recent advances in understanding maternal perinatal mood disorders

Chronobiology, sleep-related risk factors and light therapy in perinatal depression: the “Life-ON” project

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