Katherine Genty

Background:  Postpartum depression affects 15% of mothers. It is defined as at least 5 depressive symptoms lasting at least 2 weeks with peripartum onset. Symptoms begin 4-6 weeks postpartum and persist for as long as 2 years in 12.5% of cases. There is an obvious negative impact on the mother with postpartum depression, however, it also poses risk for impaired physical, behavioral, emotional, and cognitive development for the infant. Existing literature indicates the pathophysiology of postpartum depression is linked with HPA axis dysfunction, neuroinflammation, hormone and neurotransmitter imbalance, genetics, psychiatric history, adverse life events, obstetrical outcomes, and other demographic information. Thus, the exact mechanism of postpartum depression is unknown. This review aims to compare therapeutics and evaluate the effectiveness of lifestyle changes and pharmacological treatments. There are several existing therapies for depression that vary in effectiveness depending on the person and severity of disease. However, since postpartum depression differs from depression in the general population, alternative, more targeted interventions must be explored.

Research Objectives:  The objective of this literature review is to evaluate existing treatments for postpartum depression.

Methods:  This review was performed using a PubMed search through the Texas A&M Library database. Specifically, the MeSH database within PubMed was used. Key search terms included “postpartum depression” “depression, postpartum/drug therapy”, “depression, postpartum/epidemiology”, “depression, postpartum/pathophysiology”, and “depression, postpartum/psychology”. Search results were confined within the last 5 years.

Results:  The impact of lifestyle changes on postpartum depression is difficult to measure. One study investigating the impact of exercise, the Mediterranean diet, and a combination on postpartum depression found that only high adherence to a Mediterranean diet during pregnancy is correlated with a lower risk of postpartum depression. Another group hypothesized that adjusting the circadian rhythm of mothers would improve sleep quality and found promising results. However, this study raises questions about realistic applicability of the treatment because newborn babies must be fed throughout the night. Pharmacologics such as esketamine and bexanolone show promise. The effects of these therapeutics onset more rapidly than traditional SSRIs and have been successful in recent clinical trials to treat postpartum depression.

Conclusion:  Although more research is needed to fully explore the impact of lifestyle changes on postpartum depression, emerging pharmacological therapies offer promise for the treatment and management of this condition. Establishing a consistently effective treatment protocol will improve care for patients with postpartum depression. This will have a positive impaction society as mothers will be better equipped to care for and raise their children. It will be interesting to track the progress of future research on both lifestyle and pharmacological treatment methods for postpartum depression.

Works Cited:

1. Mughal S, Azhar Y, Siddiqui W. Postpartum depression. National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/30085612/. Published October 7, 2022. Accessed April 20, 2023.
2. Zhu J, Jin J, Tang J. Inflammatory pathophysiological mechanisms implicated in postpartum depression. Frontiers in Pharmacology. 2022;13. doi:10.3389/fphar.2022.955672.
3. Flor-Alemany M, Migueles JH, Alemany-Arrebola I, Aparicio VA, Baena-García L. Exercise, Mediterranean diet adherence or both during pregnancy to prevent postpartum depression—GESTAFIT trial secondary analyses. International Journal of Environmental Research and Public Health. 2022;19(21):14450. doi:10.3390/ijerph192114450
4. Monks DT, Palanisamy A, Jaffer D, Singh PM, Carter E, Lenze S. A randomized feasibility pilot-study of intravenous and subcutaneous administration of ketamine to prevent postpartum depression after planned cesarean delivery under neuraxial anesthesia. BMC Pregnancy and Childbirth. 2022;22(1). doi:10.1186/s12884-022-05118-8
5. Guevara JP, Morales K, Mandell D, et al. Social Media-based parenting program for women with postpartum depressive symptoms: An RCT. Pediatrics. 2023;151(3). doi:10.1542/peds.2022-058719
6. Avraham Y, Hants Y, Vorobeiv L, et al. Brain neurotransmitters in an animal model with postpartum depressive-like behavior. Behavioural Brain Research. 2017;326:307-321. doi:10.1016/j.bbr.2017.01.013.
7. Parry BL, Meliska CJ, Sorenson DL, et al. Critically-timed sleep+light interventions differentially improve mood in pregnancy vs. postpartum depression by shifting melatonin rhythms. Journal of Affective Disorders. 2023;324:250-258. doi:10.1016/j.jad.2022.12.079
8. Han Y, Li P, Miao M, Tao Y, Kang X, Zhang J. S-ketamine as an adjuvant in patient-controlled intravenous analgesia for preventing postpartum depression: A randomized controlled trial. BMC Anesthesiology. 2022;22(1). doi:10.1186/s12871-022-01588-7.
9. Zheng W, Cai D-B, Zheng W, et al. Brexanolone for postpartum depression: A meta-analysis of randomized controlled studies. Psychiatry Research. 2019;279:83-89. doi:10.1016/j.psychres.2019.07.006.