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Perinatal or Postnatal Depression - Alternative treatment options

Depression, Mental Health, Women's Health, Infant and Children | October 8, 2014 | Author: The Super Pharmacist

depression, infant, mental

Perinatal or Postnatal Depression - Alternative treatment options

Perinatal or postnatal depression may be a familiar term to many. Perinatal depression is a less well-known incidence of depression occurring in the course of pregnancy, while postnatal depression occurs after birth. These conditions have been recognised each as a distinct condition in the latest version of the Diagnostic and Statistical Manual (DSM-5) of psychiatric disorders.

Depression during pregnancy, or perinatal depression, is defined as depression experienced while pregnant or in the first four weeks after birth. Postnatal or Post-partum depression, on the other hand, may be experienced for a number of months following birth. 

Risk Factors for Perinatal or Postnatal depression

There are a number of factors associated with an increased risk of depression during and after pregnancy. These include:

  • History of pre-existing depression or similar psychiatric condition
  • Personal history of prior perinatal or postnatal depression
  • Family history of perinatal or postnatal depression
  • Socioeconomic factors
  • Poor support from family or close social contacts
  • Conflict with a partner
  • Stressful life events

A pre-existing mood disorder may increase the risk of depression during pregnancy. Perinatal depression has been found not to affect the symptoms of these conditions, (for better or worse) however. On the other hand, depression after pregnancy in patients with bipolar disorder has been associated with a lack of prior management of this condition. Early screening and treatment for these types of depression is regarded as important for the health of the pregnant woman. In addition, some researchers conclude that depression during pregnancy is associated with negative consequences for the mother and newborn, including:

  • Pre-eclampsia
  • Premature birth
  • Low birth weight
  • Impaired fetal growth
  • Complications at birth
  • High neonatal cortisol (a biological marker of stress) at birth

Depression after pregnancy is also popularly associated with poor mother/infant bonding and subsequent impaired development of the child in question. Untreated depressive symptoms in the course of pregnancy may be associated with other adverse consequences, such as a reduced uptake of or adherence to obstetric monitoring, or potentially harmful behaviours such as smoking and alcohol intake.

Diagnosis of depression after pregnancy is carried out using procedures such as the Structured Clinical Interview for the DSM, and with depression scoring systems such as the Hamilton Depression Rating Scale or the Edinburgh Postnatal Depression Scale. The Edinburgh scale may also be used to diagnose depression during pregnancy.

Treatments for Perinatal or Postnatal depression

Treatment for these types of depressive disorders may require careful design, planning and consultation between physician and patient. Pregnancy may significantly affect the normal course of treatment for those with pre-existing conditions, particularly if it is pharmacological in nature.

Some classes of medications such as tricyclic antidepressants (TCA's) and some selective serotonin uptake inhibitors or SSRI's (particularly paroxetine) are associated with congential defects (i.e. foetal malformations in utero) and as such should be avoided. Anti-convulsive medications, which are sometimes applied to the treatment of severe depression, are also associated with neural tube defects and other severe foetal abnormalities. Therefore, women may not wish to take these drugs during pregnancy, either as a continuation of normal treatment or for perinatal depression. In addition, medications taken for other conditions (e.g. anxiety, bipolar disorder) are also associated with an increased risk of congenital defects and problems with infant development or function. Patients with these conditions may also wish to discontinue treatment while pregnant, thus potentially increasing the risk of developing perinatal depression. Therefore, alternatives to drug therapy may be more desirable. These include:

Psychotherapy

Interpersonal psychotherapy (IPT) is a long-standing treatment option for depression after pregnancy. This is a short-term form of psychotherapy focusing on improving the mood and psychosocial symptoms of the patient.

PsychotherapyA trial of IPT with 99 patients with postpartum depression demonstrated a significant improvement in Hamilton rating scores, self-reported Social Adjustment Scale scores and Postpartum Adjustment Questionnaire scores, in comparison with untreated controls.

This indicates significant effects on depressive symptoms and social functioning.

A sixteen-week trial of IPT with 38 women with perinatal depression showed significant improvements in mood, and 60% showed recovery (as measured by the Clinical Global Impression Improvement scale). A systematic review of more research into IPT and similar interventions concluded that this form of therapy was also effective in preventing depression after pregnancy.

A promising variation on psychotherapy is the 'home visit', in which a midwife or nurse meets a postpartum patient in her home to provide advice and healthcare monitoring. This may reduce the risk of depression due to a perceived lack of support.

Neuromodulation

Neuromodulation is a technique that moderates signals from certain major cranial nerves that control functions such as mood regulation and pain perception. This is often achieved with electrical stimulation, which may be delivered with specialised equipment through the skull to the nerve in question.

A common target of this form of neuromodulation is the vagus nerve, which is applied to the treatment of severe depression. As this method (known as transcranial vagus nerve stimulation or tVNS) is not invasive or systemic, it may have potential as a treatment for depression during pregnancy. A reported case study involving a patient continuing her tVNS treatment throughout pregnancy resulted in an absence of adverse events and effective management of depressive symptoms. A similar form of neuromodulation employed in severe depression, electroconvulsive therapy, has been reported as safe for use during pregnancy, but there are reports of defects in or harm to the developing foetus or infant as a result.

Alternative or Complementary Therapies

Other non-pharmacological and non-psychotherapeutic treatment options may be used during or after pregnancy. Research on their effects is often inconclusive.

Massage therapy

A trial comparing massage therapy to standard care demonstrated that massage reduced stress and self-reported depression. 

Massage therapy combined with IPT was reported as effective in treating perinatal depression.

Omega-3 fatty acid supplementation is often suggested, however no association between omega-3 intake and post-partum depression was found in a one-year follow-up study of over 54,000 patients.

Some research indicates that acupuncture may be effective in the treatment of perinatal depression. However, a review of the research testing this indicated there was little or no evidence of a significant effect of acupuncture therapy on depression after or during pregnancy.

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