Postpartum Depression: Identification and Treatment in the Clinic Setting

Perinatal mood and anxiety disorders (PMADs) represent the most prevalent pregnancy-related comorbidity and a leading cause of maternal mortality. Effective treatments exist, but remain underutilized. We sought to identify factors associated with receipt of prenatal and postpartum mental health treatment.

This observational, cross-sectional analysis used self-reported survey data from the Michigan Pregnancy Risk Assessment Monitoring System linked to Michigan Medicaid administrative claims for births from 2012 to 2015. We used survey-weighted multinomial logistic regression to predict prescription medication and psychotherapy utilization among respondents with PMADs.

Only 28.0% of respondents with prenatal PMAD and 17.9% of respondents with postpartum PMAD received both prescription medication and psychotherapy. During pregnancy, Black respondents were 0.33 (95%CI: 0.13–0.85, p = 0.022) times less likely to receive both treatments while more comorbidities were associated with receipt of both treatments (adjRR = 1.31, 95%CI: 1.02–1.70, p = 0.036). In the first three months postpartum, respondents with four or more stressors were 6.52 times more likely to receive both treatments (95%CI: 1.62–26.24, p = 0.008) and those satisfied with prenatal care were 16.25 times more likely to receive both treatments (95%CI: 3.35–78.85, p = 0.001).

Race, comorbidities, and stress are critical factors in PMAD treatment. Satisfaction with perinatal healthcare may facilitate access to care.

Estradiol decline can result in depressive disorders in females; nevertheless, the causes of this decline are unclear. In this study, we isolated estradiol-degrading Klebsiella aerogenes from the feces of premenopausal females with depression. In mice, gavaging with this strain led to estradiol decline and depression-like behaviors. The gene encoding the estradiol-degrading enzyme in K. aerogenes was identified as 3β-hydroxysteroid dehydrogenase (3β-HSD). Heterologously expressing 3β-HSD resulted in Escherichia coli obtaining the ability to degrade estradiol. Gavaging mice with 3β-HSD-expressing E. coli decreased their serum estradiol levels, causing depression-like behaviors. The prevalence of K. aerogene and 3β-HSD was higher in premenopausal women with depression than in those without depression. These results suggest that the estradiol-degrading bacteria and 3β-HSD enzymes are potential intervention targets for depression treatment in premenopausal women.

Postpartum depression (PPD) occurs frequently among postpartum women. Stressful life events (SLE) have gradually been recognized as risk factors for PPD. However, research on this topic has produced equivocal results. The purpose of this study was to explore whether women who experienced prenatal SLE had a higher prevalence of PPD. Electronic databases were systematically searched until October 2021. Only prospective cohort studies were included. Pooled prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using random effects models. This meta-analysis included 17 studies involving 9822 individuals. Women who experienced prenatal SLE had a higher prevalence for PPD (PR = 1.82, 95%CI = 1.52–2.17). In subgroup analyses, a 112% and 78% higher prevalence of depressive disorders (PR = 2.12, 95%CI = 1.34–3.38) and depressive symptoms (PR = 1.78, 95%CI = 1.47–2.17) were detected in women who experienced prenatal SLE. The effect of SLE on PPD at postpartum different time points differed: PR = 3.25 (95%CI = 2.01–5.25) for ≤6 weeks, PR = 2.01 (95%CI = 1.53–2.65) for 7–12 weeks, PR = 1.17 (95%CI = 0.49–2.31) for >12 weeks. No obvious publication bias was detected. The findings support that prenatal SLE increase the prevalence of PPD. The effect of SLE on PPD tends to slightly decrease during the postpartum period. Furthermore, these findings highlight the importance of screening for PPD as early as possible, particularly among postpartum women who have experienced SLE.

As an increasing number of people with disabilities become pregnant and give birth, understanding their vulnerabilities for poor mental health and life stress can help to improve their health and well-being. We examined whether people with disabilities are more likely to experience stressful life events 12 months before childbirth, postpartum depressive symptoms (PDS), and lack of postpartum partner and social support, and compared these associations by race/ethnicity.

Using the Massachusetts Pregnancy Risk Assessment Monitoring System 2016–2020 data (n = 6,483), we used univariate and multivariable logistic regression models to estimate the associations of disability with stressful life events, PDS, and postpartum partner and social support, and calculated risk ratio (RR), adjusted RR, and 95% confidence interval (CI). We also conducted stratified analyses by race/ethnicity.

The prevalence of disability was 10.7% overall, and 8.8% among White non-Hispanic people, 14.3% among Black non-Hispanic people, 15.5% among Hispanic people, and 8.3% among Asian non-Hispanic people. Compared with people without disabilities, those with disabilities were more likely to report emotional stress (RR, 1.54; 95% CI, 1.36–1.74), partner-related stress (RR, 2.55; 95% CI, 2.23–2.91), financial stress (RR, 1.55; 95% CI, 1.44–1.68), traumatic stress (RR, 2.27; 95% CI, 1.85–2.79), and PDS (RR, 3.77; 95% CI, 3.13–4.53). People with disabilities were also more likely to lack a partner's emotional support (RR, 2.57; 95% CI, 2.21–2.97), financial support from the newborn's father (RR, 2.89; 95% CI, 2.39–3.51), and social support while feeling tired or frustrated (RR, 2.05; 95% CI, 1.68–2.52). These associations remained statistically significant after adjustment for maternal factors and newborn's birth year. Strong associations of disability with stressful life events (including emotional stress and partner-related stress), PDS, lacking partner's emotional support, and social support existed across racial/ethnic groups.

Pregnant people with disabilities may benefit from additional screening for stressful life events and depression during pregnancy and postpartum. Multidisciplinary efforts that combine mental health screening and treatment, peer support groups, increased health care provider training about caring for people with disabilities during pregnancy, and better access to care for pregnant people with disabilities are needed to improve their health and support their desire to become parents.

The purpose of this meta-analysis is to evaluate the beneficial effects and ascertain the optimal stimulation protocol of repetitive transcranial magnetic stimulation (rTMS) on patients with postpartum depression (PPD). We performed a comprehensive literature search for randomized clinical trials through September 2022. On the basis of the inclusion criteria, 23 studies were selected for the analysis. The results of our meta-analysis showed that rTMS produced significant effects. Among the studies included in the meta-analysis, the scales used to measure PPD in the participants included the Hamilton Depression Scale (standardized mean differences [SMD] = −0.90; P < 0.05), Edinburgh Postnatal Depression Scale (SMD = −1.05; P < 0.05), Mini-Mental State Examination (SMD = 2.88; P < 0.05), and quality-of-life scores (SMD = 1.81; P < 0.05). Furthermore, rTMS was found to exert a beneficial effect on depression and cognitive performance in PPD patients with distinct optimal stimulation parameters.