Pregnancy and Postpartum Depression
More research needed on lithium therapy while breastfeeding
Women wondering if they should keep up with their lithium treatments for bipolar disorder while breastfeeding are left without clear answers, according to a new review that calls for more research. Lithium can reduce mania in people with bipolar disorder, which comes with an increased risk of postpartum psychosis. But some groups warn that lithium exposure through breast milk can potentially be harmful for infants. While more recent studies with better designs suggest that the risk of lithium is low, the researchers write that without better data, “recommendations on whether to continue lithium while breastfeeding must be personalized to the individual woman and her infant.”
Full Scientific article: www.tandfonline.com/doi/full/10.1080/09540261.2019.1586657
Women wondering if they should keep up with their lithium treatments for bipolar disorder while breastfeeding are left without clear answers, according to a new review that calls for more research. Lithium can reduce mania in people with bipolar disorder, which comes with an increased risk of postpartum psychosis. But some groups warn that lithium exposure through breast milk can potentially be harmful for infants. While more recent studies with better designs suggest that the risk of lithium is low, the researchers write that without better data, “recommendations on whether to continue lithium while breastfeeding must be personalized to the individual woman and her infant.”
Full Scientific article: www.tandfonline.com/doi/full/10.1080/09540261.2019.1586657
How to Prevent Perinatal Depression
New research provides strong evidence for a low tech, relatively low cost solution—without medication.
Perinatal depression—depression that occurs during pregnancy or after the birth of a child—is surprisingly common, affecting about 1 in 7 women. And, although depression is debilitating at any time, it may carry a particularly heavy public health burden during the transition to parenthood. Women with depression are less likely to obtain medical care for themselves and their babies, and may struggle to bond with their infants. It’s no wonder that the children of depressed mothers experience heightened long-term risk of emotional and behavioral problems.Read the full article from Scientific American, April 2, 2019.
www.scientificamerican.com/article/how-to-prevent-perinatal-depression/
New research provides strong evidence for a low tech, relatively low cost solution—without medication.
Perinatal depression—depression that occurs during pregnancy or after the birth of a child—is surprisingly common, affecting about 1 in 7 women. And, although depression is debilitating at any time, it may carry a particularly heavy public health burden during the transition to parenthood. Women with depression are less likely to obtain medical care for themselves and their babies, and may struggle to bond with their infants. It’s no wonder that the children of depressed mothers experience heightened long-term risk of emotional and behavioral problems.Read the full article from Scientific American, April 2, 2019.
www.scientificamerican.com/article/how-to-prevent-perinatal-depression/
New Drug approved for Postpartum Depression
The U.S. Food and Drug Administration today approved Zulresso (brexanolone) injection for intravenous (IV) use for the treatment of postpartum depression (PPD) in adult women. This is the first drug approved by the FDA specifically for PPD.
The new drug, brexanolone, which is being marketed by the manufacturer Sage Therapeutics as Zulresso, is unlike other antidepressants.
It is a synthetic version of a compound called allopregnanolone, which is naturally synthesized by the body from the hormone progesterone. And it works relatively fast — women who were given the drug in clinical trials started to feel better as early as 48 hours after starting treatment, and the effects lasted for a month.
Link to CBS News story
FDA Press Release
The U.S. Food and Drug Administration today approved Zulresso (brexanolone) injection for intravenous (IV) use for the treatment of postpartum depression (PPD) in adult women. This is the first drug approved by the FDA specifically for PPD.
The new drug, brexanolone, which is being marketed by the manufacturer Sage Therapeutics as Zulresso, is unlike other antidepressants.
It is a synthetic version of a compound called allopregnanolone, which is naturally synthesized by the body from the hormone progesterone. And it works relatively fast — women who were given the drug in clinical trials started to feel better as early as 48 hours after starting treatment, and the effects lasted for a month.
Link to CBS News story
FDA Press Release
Placental Stress and Mental Illness
From STAT JULY 31, 2019
Biologist Jennifer Erwin of the Lieber Institute for Brain Development, however, has no intention of babying her organoids: the world’s first human placentas in a dish that were made from stem cells. Challenging as the half-millimeter-across organoids were to create, she intends to starve them of oxygen and douse them with stress hormones, among other assaults. It’s all for a good cause: to mimic pregnancy complications that raise the risk of brain development going off the rails, resulting in conditions including schizophrenia, autism, attention deficit hyperactivity disorder, and intellectual disability.
The results of the experiments could fill in a huge blank in science’s understanding of brain development. Years of studies show that if a mother experiences stress during pregnancy, it increases the chances that the child will develop schizophrenia or other neurodevelopmental disorders. “In some cases the risk is two to four times greater,” said neuroscientist Dr. Daniel Weinberger, director of the Lieber Institute. By comparison, genetic variants increase the odds of developing schizophrenia by only a fraction.
Read more here: www.statnews.com/2019/07/31/unraveling-psychiatric-disorders-with-placenta-brain-organoids/
From STAT JULY 31, 2019
Biologist Jennifer Erwin of the Lieber Institute for Brain Development, however, has no intention of babying her organoids: the world’s first human placentas in a dish that were made from stem cells. Challenging as the half-millimeter-across organoids were to create, she intends to starve them of oxygen and douse them with stress hormones, among other assaults. It’s all for a good cause: to mimic pregnancy complications that raise the risk of brain development going off the rails, resulting in conditions including schizophrenia, autism, attention deficit hyperactivity disorder, and intellectual disability.
The results of the experiments could fill in a huge blank in science’s understanding of brain development. Years of studies show that if a mother experiences stress during pregnancy, it increases the chances that the child will develop schizophrenia or other neurodevelopmental disorders. “In some cases the risk is two to four times greater,” said neuroscientist Dr. Daniel Weinberger, director of the Lieber Institute. By comparison, genetic variants increase the odds of developing schizophrenia by only a fraction.
Read more here: www.statnews.com/2019/07/31/unraveling-psychiatric-disorders-with-placenta-brain-organoids/
An Entirely New Type of Antidepressant Targets Postpartum Depression
Scientific American
A novel drug is intended to help women who suffer from depression after childbirth
Postpartum depression afflicts 10 to 20 percent of the nearly four million women who give birth in the U.S. every year. The condition can interfere with normal bonding between mothers and infants and jeopardize children’s development through adolescence. There is no specific treatment, but a promising new drug may change that.
Postpartum depression afflicts 10 to 20 percent of the nearly four million women who give birth in the U.S. every year. The condition can interfere with normal bonding between mothers and infants and jeopardize children’s development through adolescence. There is no specific treatment, but a promising new drug may change that.
“There is a real need to identify [depressed] women and treat them—and treat them quickly,” says Samantha Meltzer-Brody, director of the Perinatal Psychiatry Program at the University of North Carolina Center for Women’s Mood Disorders. She conducted recent trials of the drug, which targets hormonal changes in new mothers.
Many women who suffer from postpartum depression receive standard antidepressants, including selective serotonin reuptake inhibitors such as Prozac. It is unclear how well these drugs work, however, because the neurotransmitter serotonin may play only a secondary role in the condition or may not be involved at all. Instead researchers suspect a different biological process may be the culprit.
Pregnancy causes a dramatic rise in the reproductive hormones estrogen and progesterone. It also produces a spike in brain levels of a steroid called allopregnanolone, which normally activates receptors for GABA—a neurochemical that signals brain cells to stop firing. GABA receptors go dormant during pregnancy to avoid overactivation by allopregnanolone; otherwise a pregnant woman would become virtually anesthetized. Immediately following birth, estrogen, progesterone and allopregnanolone drop back to normal levels, after which GABA receptor levels rebound quickly. But in some new mothers, this rebound takes longer, which may result in postpartum depression.
The new drug, developed by Sage Therapeutics, works by elevating allopregnanolone. Doing so activates GABA receptors and keeps the neurochemical at a healthy level. In one of Meltzer-Brody’s studies, a phase II clinical trial of 21 severely depressed postpartum women, 70 percent of those who received the drug went into remission. Most important, the effect occurred immediately after it was administered, and benefits persisted for 30 days. Sage Therapeutics has since conducted two phase III trials with a combined 226 postpartum women, and preliminary reports are promising. The drug, called brexanolone, is now under review by the U.S. Food and Drug Administration.
Not everyone is convinced that a single hormonal pathway is responsible, however. Joseph Lonstein, a professor of psychology at Michigan State University, who was not involved in the research, says, “I very much doubt this is the only system that’s atypical in women [who] might suffer from postpartum depression or anxiety, but I think it’s a completely reasonable one.”
Scientific American
- By Dana G. Smith on August 15, 2018
A novel drug is intended to help women who suffer from depression after childbirth
Postpartum depression afflicts 10 to 20 percent of the nearly four million women who give birth in the U.S. every year. The condition can interfere with normal bonding between mothers and infants and jeopardize children’s development through adolescence. There is no specific treatment, but a promising new drug may change that.
Postpartum depression afflicts 10 to 20 percent of the nearly four million women who give birth in the U.S. every year. The condition can interfere with normal bonding between mothers and infants and jeopardize children’s development through adolescence. There is no specific treatment, but a promising new drug may change that.
“There is a real need to identify [depressed] women and treat them—and treat them quickly,” says Samantha Meltzer-Brody, director of the Perinatal Psychiatry Program at the University of North Carolina Center for Women’s Mood Disorders. She conducted recent trials of the drug, which targets hormonal changes in new mothers.
Many women who suffer from postpartum depression receive standard antidepressants, including selective serotonin reuptake inhibitors such as Prozac. It is unclear how well these drugs work, however, because the neurotransmitter serotonin may play only a secondary role in the condition or may not be involved at all. Instead researchers suspect a different biological process may be the culprit.
Pregnancy causes a dramatic rise in the reproductive hormones estrogen and progesterone. It also produces a spike in brain levels of a steroid called allopregnanolone, which normally activates receptors for GABA—a neurochemical that signals brain cells to stop firing. GABA receptors go dormant during pregnancy to avoid overactivation by allopregnanolone; otherwise a pregnant woman would become virtually anesthetized. Immediately following birth, estrogen, progesterone and allopregnanolone drop back to normal levels, after which GABA receptor levels rebound quickly. But in some new mothers, this rebound takes longer, which may result in postpartum depression.
The new drug, developed by Sage Therapeutics, works by elevating allopregnanolone. Doing so activates GABA receptors and keeps the neurochemical at a healthy level. In one of Meltzer-Brody’s studies, a phase II clinical trial of 21 severely depressed postpartum women, 70 percent of those who received the drug went into remission. Most important, the effect occurred immediately after it was administered, and benefits persisted for 30 days. Sage Therapeutics has since conducted two phase III trials with a combined 226 postpartum women, and preliminary reports are promising. The drug, called brexanolone, is now under review by the U.S. Food and Drug Administration.
Not everyone is convinced that a single hormonal pathway is responsible, however. Joseph Lonstein, a professor of psychology at Michigan State University, who was not involved in the research, says, “I very much doubt this is the only system that’s atypical in women [who] might suffer from postpartum depression or anxiety, but I think it’s a completely reasonable one.”
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10 Silent Signs You Could Have Postpartum Depression
BY JEN BABAKHAN More than just "baby blues," postpartum depression is a serious condition that affects one in nine women, according to the U.S. Centers for Disease Control and Prevention. Here are some ways to tell if you are suffering from postpartum depression symptoms, and what you can do to get the help you need. www.rd.com/advice/parenting/postpartum-depression-symptoms/ Postpartum Depression Affects 1 In 7 Mothers; Bipolar Rate Strikingly High, Study Finds
Author: Bob Carolla - 3/18/2013 The largest study to date of postpartum depression has found that one in seven women experience symptoms of depression after childbirth. Published in JAMA Psychiatry by theAmerican MedicalAssociation, the basic finding is consistent with past prevalence estimates however, the study’s follow-up evaluations of women at risk revealed especially serious symptoms. Approximately 20 percent of the mothers with depressive symptoms were experiencing suicidal thoughts. Among those who were followed for a full year, 22 percent experienced severe depression. In the study, 10,000 mothers who gave birth at a Pittsburgh hospital were contacted by telephone and screened six to eight months later for symptoms of depression. Fourteen percent were identified as being at risk. Approximately 60 percent of the at-risk group received follow-up home visits. Another 11 percent completed diagnostic interviews by telephone Forty percent of the women’ symptoms began postpartum. Thirty-three percent were assessed as having begun during pregnancy and 27 percent beforehand. Follow-up evaluations most often resulted in a diagnosis of depression with a co-occurring anxiety disorder. “A striking 22.6 percent had bipolar disorder,” the study warned. The study calls for all pregnant women and new mothers to be screened for depression, beyond what current medical practice requires. It also emphasizes the need for “strategies to differentiate women with bipolar from unipolar disorders.” In 2010, the American Congress of Obstetricians and Gynecologists (ACOG) held that there was “insufficient evidence to support a firm recommendation” for universal screening for depression. However, its Committee on Obstetric Practice recognized the potential benefits of screening and stressed that women already experiencing depression or having a history of depression particularly warranted “close monitoring and evaluation.” In the study, women who tested positively for symptoms of depression were “more likely to be younger, African American, publicly insured, single and less well educated.” |
Men's Perinatal Mental Health
By Daniel Singley, Ph.D. ABPP The Center for Men's Excellence www.menexcel.com 10% of men experience Perinatal Mood and Anxiety Disorders during the perinatal period. Excerpts of this presentation are included here. men’s_perinatal_mental_health.pptx For the full video,visit https://youtu.be/yNgwk_48ECE. |
