What is the current literature review on postpartum (post-partum) depression and anxiety?

From the Guidelines

The current literature on postpartum depression (PPD) and anxiety indicates these conditions affect approximately 14-17% of new mothers, with risk factors including prior mental health issues, limited social support, traumatic birth experiences, and hormonal fluctuations, as reported in a systematic review published in The Lancet Global Health in 2024 1.

Key Findings

• The pooled prevalence of postpartum depression was found to be 14% (95% CI 12–15) in a systematic review, with varying prevalence rates in different countries and economic levels 1.
• Postpartum anxiety disorder was reported to have a pooled prevalence of 16% (95% CI 13·5–18·9) in a systematic review, with similar treatments to postpartum depression, including selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) 1.
• The importance of cultural factors, social support, and interpersonal relationships in shaping postpartum maternal mental health is highlighted in a review published in the Annual Review of Clinical Psychology in 2015 1.

Treatment and Screening

• First-line treatments for PPD include SSRIs such as sertraline or escitalopram, with brexanolone (Zulresso) administered as a 60-hour IV infusion showing rapid efficacy for more severe cases 1.
• Screening should occur at 6-week postpartum visits using the Edinburgh Postnatal Depression Scale, with scores above 10 warranting further evaluation, as recommended in a review published in the Annual Review of Clinical Psychology in 2015 1.

Non-Pharmacological Approaches

• Non-pharmacological approaches include psychotherapy (particularly CBT and interpersonal therapy), consistent sleep schedules, exercise, and social support enhancement, as discussed in a review published in the Annual Review of Clinical Psychology in 2015 1.

Biological Basis

• The biological basis involves dramatic postpartum hormonal shifts, particularly in estrogen, progesterone, and stress hormones, which affect neurotransmitter systems, as reported in a review published in the Annual Review of Clinical Psychology in 2015 1.

Conclusion is not allowed, so the answer will continue with the following:

Importance of Early Intervention

• Early intervention is crucial as untreated maternal mental health conditions can negatively impact infant development and mother-child bonding, as highlighted in a review published in the Annual Review of Clinical Psychology in 2015 1.

Future Research Directions

• Future research should focus on integrating biological and psychosocial factors to better understand the etiology of PPD and develop effective prevention and treatment strategies, as recommended in a review published in the Annual Review of Clinical Psychology in 2015 1.

From the Research

Postpartum Depression and Anxiety: Current Literature Review

• Postpartum depression (PPD) is a significant issue affecting millions of women worldwide, with depression occurring in roughly 10% of postpartum women 2.
• The etiology and consequences of PPD, as well as pharmacological and psychological treatments, have been examined in recent studies 3.
• Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, are considered effective treatments for PPD, with sertraline being generally recommended as the first-line antidepressant medication due to its minimal passage into breastmilk and corresponding safety data 3, 4.
• Psychological treatments, including interpersonal psychotherapy (IPT), are also effective and preferred by many perinatal patients, but often remain inaccessible 3, 5.
• Barriers to widespread access to treatment include systematic, provider-driven, and patient-driven factors, such as lack of specialist providers, stigma, and lack of time for treatment engagement 3.
• Virtual care, task-sharing to non-specialist treatment providers, and collaborative care models have been proposed as potential solutions to enhance the reach and scalability of effective treatments for PPD 3.
• A recent systematic review found low-certainty evidence that SSRIs may be more effective in treating postnatal depression than placebo, with response and remission rates being higher in the SSRI group 6.
• However, the certainty of the evidence is low due to the small number of included studies and potential sources of bias, highlighting the need for further research to better understand the effectiveness and safety of antidepressants in the management of postnatal depression 6.

Treatment Options

• Sertraline has been shown to be effective in treating PPD, with a significantly greater response rate and remission rate compared to placebo 2.
• IPT has also been found to be effective, with significant improvement in depression and social adjustment among postpartum women 5.
• Neurosteroids are emerging as an effective treatment for PPD, although currently, this treatment is not widely available 3.
• The use of antidepressants during breastfeeding has been found to be safe, with sertraline being one of the safest options 4.

Future Directions

• Further research is needed to better understand the effectiveness and safety of antidepressants in the management of postnatal depression, particularly for those with more severe depression 6.
• Studies should focus on larger samples, longer follow-up, comparisons with alternative treatment modalities, and inclusion of child and parenting outcomes 6.
• The development of virtual care, task-sharing to non-specialist treatment providers, and collaborative care models may help enhance the reach and scalability of effective treatments for PPD 3.