Perinatal Depression Part II

CURRENT MEDICAL TREATMENT

According to the clinical care guidelines, pharmacological treatment in Australia includes antidepressants and benzodiazepines. Benzo’s are prescribed first as the antidepressants take effect. Side effects of these drugs may include an increased risk of miscarriage, pre-term birth, postpartum haemorrhage, and an increased risk of respiratory difficulties, seizures and negative neurobehavioral outcomes for newborns and infants. Additionally, these class of drugs are addictive - withdrawal and overdoses may potentially be life threatening.  Furthermore, the heavy sedative action in new mothers may decrease general alertness and cognititive abilites during this critical stage of parenting. The effects of these medications on breastfeeding are also of concern as the infants blood-brain-barrier is not fully developed and infantile kidneys and livers remain immature.

DIET

A healthy diet acts on several pathways in the body that are implicated in mental health. These include oxidative stress, inflammation, gut microbiota and mitochondrial function, which are often disrupted in people with mental disorders. A healthy diet impacts the modulation of the stress response, immune function, neurotransmission, and neurogenesis. Fruits/vegetables, nuts/seeds and wholegrains contain many beneficial vitamins and minerals, fibre and polyphenols that are associated with reduced rates of depression in scientific studies due to their anti-inflammatory, prebiotic, and neuroprotective actions. Additionally, lean meats and fish contain the protein and essential fatty acids needed for optimal brain function and the production of serotonin and dopamine. Therefore, the traditional Mediterranean diet is recommended for mothers in the perinatal stages of motherhood where possible.

EXERCISE

Exercise has been shown in several studies to be beneficial in the treatment of perinatal depression by improving mood, and significantly reducing major depressive symptom scores overall. Exercise increases neurogenesis, reduces stress, and increases feelings of self-confidence and well-being. Exercise improves the stress response by modulating the HPA axis, reducing inflammatory processes involved in depression, and restoring the parasympathetic controls in the brain. Additionally, exercise enhances brain function by regulating the neurotransmitters dopamine, noradrenaline, and serotonin which are the three major monoamines involved in anxiety and depression outcomes. Women in the perinatal phases of motherhood are recommended to engage in aerobic activity four times per week.

HERBAL MEDICINE

Whilst many herbal medicines are generally deemed safe during pregnancy, it is best to avoid them during the first trimester of pregnancy. From the second trimester through to birth however, there are herbs available that support the nervous system via anxiolytic, thymoleptic, nervine, and sedative actions. Additionally, herbal medicine can reduce sympathetic nervous system dominance and regulating the parasympathetic nervous system by increasing the uptake of GABA in the brain. For example, Bacopa regulates mood, reduces anxiety, and increases cognitive function. Chamomile and Lemon balm reduce restlessness, irritability, and anxiety, and help to induce sleep. Magnolia has anti-depressant and anxiolytic actions and is also neuroprotective. Saffron exhibits significant anti-stress and anxiolytic properties, and in therapeutic doses, acts as an antidepressant. Passionflower has sedative and anxiolytic actions and is gentle enough to be consumed daily. It is recommended that these herbs are ingested in the form of herbal teas throughout the second and third trimesters of pregnancy for safety. St John’s Wort is indicated for use in the postpartum stage of motherhood due to its powerful anti-depressant abilities, yet further studies are required for the use during pregnancy using smaller amounts of the compound hypericin, which is currently contraindicated.

Part III - St John’s Wort in Perinatal depression…cont’d on next blog post.

REFERENCES

Australian Institute of Health and Welfare. (2012). Experience of perinatal depression: Data from the 2010 Australian National Infant Feeding Survey. 97(4).  Retrieved from https://www.aihw.gov.au/reports/primary-health-care/perinatal-depression-data-from-the-2010-australia/contents/table-of-contents

Alhusen, J. L., & Alvarez, C. (2016). Perinatal depression: A clinical update. The Nurse Practitioner, 41(5), 50. https://doi.org/10.1097/01.NPR.0000480589.09290.3E

Austin M-P, Highet N, & the Expert Working Group. (2017). Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline. Melbourne: Centre of Perinatal Excellence. Retrieved from https://www.cope.org.au/wp-content/uploads/2018/05/COPE-Perinatal-MH-Guideline_Final-2018.pdf

Buckley, S. J. (2015). Executive Summary of Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. The Journal of Perinatal Education, 24(3), 145–153. https://doi.org/10.1891/1058-1243.24.3.145

Duthie, L., & Reynolds, R. M. (2013). Changes in the Maternal Hypothalamic-Pituitary-Adrenal Axis in Pregnancy and Postpartum: Influences on Maternal and Fetal Outcomes. Neuroendocrinology, 98(2), 106–115. https://doi.org/10.1159/000354702

 Fitelson, E., Kim, S., Baker, A. S., & Leight, K. (2011). Treatment of postpartum depression: Clinical, psychological and pharmacological options. International Journal of Women’s Health, 3(1), 1. https://doi.org/10.2147/IJWH.S6938 

Lam, R. W., Tam, E. M., Grewal, A., & Yatham, L. N. (2001). Effects of Alpha-Methyl-Para-Tyrosine-Induced Catecholamine Depletion in Patients with Seasonal Affective Disorder in Summer Remission. Neuropsychopharmacology 2001 25:1, 25(1), S97–S101. https://doi.org/10.1016/s0893-133x(01)00337- 2 

Meltzer-Brody, S. (2011). New insights into perinatal depression: Pathogenesis and treatment during pregnancy and postpartum. Dialogues in Clinical Neuroscience, 13(1), 89. https://doi.org/10.31887/DCNS.2011.13.1/SMBRODY

Perry, D. F., Nicholson, W., Christensen, A. L., & Riley, A. W. (2011). A Public Health Approach to Addressing Perinatal Depression. International Journal of Mental Health Promotion, 13(3), 5–13. https://doi.org/10.1080/14623730.2011.9715657 

RANZCOG. (2018). Perinatal Anxiety and Depression. Retrieved 11th July, 2021 from https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Perinatal-Anxiety-and-Depression-(C-Obs-48)-Review-March-2015.pdf?ext=.pdf

Seth, S., Lewis, A. J., & Galbally, M. (2016). Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: A systematic literature review. BMC Pregnancy and Childbirth 2016 16:1, 16(1), 1–19. https://doi.org/10.1186/S12884-016-0915-Y