Postpartum Depression: A Clinical Review of Impact and Current Treatment Solutions.

IF 13 1区 医学 Q1 PHARMACOLOGY & PHARMACY
Drugs Pub Date : 2024-06-01 Epub Date: 2024-05-30 DOI:10.1007/s40265-024-02038-z
Cindy-Lee Dennis, Daisy R Singla, Hilary K Brown, Katarina Savel, Crystal T Clark, Sophie Grigoriadis, Simone N Vigod
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Abstract

Depression during the first year postpartum (postpartum depression) impacts millions of women and their families worldwide. In this narrative review, we provide a summary of postpartum depression, examining the etiology and consequences, pharmacological and psychological treatments, and potential mechanisms of change and current barriers to care. Psychological treatments are effective and preferred by many perinatal patients over medications, but they often remain inaccessible. Key potential mechanisms underlying their effectiveness include treatment variables (e.g., dosage and therapeutic alliance) and patient behaviors (e.g., activation and avoidance and emotional regulation). Among pharmacological treatments, the selective serotonin reuptake inhibitor (SSRI) sertraline is generally the first-line antidepressant medication recommended to women in the postpartum period due to its minimal passage into breastmilk and the corresponding decades of safety data. Importantly, most antidepressant drugs are considered compatible with breastfeeding. Neurosteroids are emerging as an effective treatment for postpartum depression, although currently this treatment is not widely available. Barriers to widespread access to treatment include those that are systematic (e.g., lack of specialist providers), provider-driven (e.g., lack of flexibility in treatment delivery), and patient-driven (e.g., stigma and lack of time for treatment engagement). We propose virtual care, task-sharing to non-specialist treatment providers, and collaborative care models as potential solutions to enhance the reach and scalability of effective treatments to address the growing burden of postpartum depression worldwide and its negative impact on families and society.

Abstract Image

产后抑郁症:影响和当前治疗方案的临床回顾。
产后第一年的抑郁(产后抑郁症)影响着全球数百万妇女及其家庭。在这篇叙述性综述中,我们总结了产后抑郁症的病因和后果、药物和心理治疗方法、潜在的变化机制以及目前的护理障碍。心理治疗是有效的,许多围产期患者更愿意选择心理治疗而非药物治疗,但心理治疗往往难以获得。其有效的关键潜在机制包括治疗变量(如剂量和治疗联盟)和患者行为(如激活和回避以及情绪调节)。在药物治疗中,选择性血清素再摄取抑制剂(SSRI)舍曲林通常是推荐给产后妇女的一线抗抑郁药物,因为它进入母乳的几率很小,而且几十年来也有相应的安全数据。重要的是,大多数抗抑郁药物都被认为与母乳喂养相容。神经类固醇正在成为治疗产后抑郁症的一种有效方法,尽管目前这种治疗方法尚未普及。阻碍广泛获得治疗的因素包括系统性障碍(如缺乏专业的医疗服务提供者)、医疗服务提供者驱动的障碍(如缺乏提供治疗的灵活性)和患者驱动的障碍(如耻辱感和缺乏参与治疗的时间)。我们建议将虚拟护理、非专业治疗提供者的任务分担以及协作护理模式作为潜在的解决方案,以提高有效治疗的覆盖面和可扩展性,从而解决全球产后抑郁症日益增长的负担及其对家庭和社会的负面影响。
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来源期刊
Drugs
Drugs 医学-毒理学
CiteScore
22.70
自引率
0.90%
发文量
134
审稿时长
3-8 weeks
期刊介绍: Drugs is a journal that aims to enhance pharmacotherapy by publishing review and original research articles on key aspects of clinical pharmacology and therapeutics. The journal includes: Leading/current opinion articles providing an overview of contentious or emerging issues. Definitive reviews of drugs and drug classes, and their place in disease management. Therapy in Practice articles including recommendations for specific clinical situations. High-quality, well designed, original clinical research. Adis Drug Evaluations reviewing the properties and place in therapy of both newer and established drugs. AdisInsight Reports summarising development at first global approval. Moreover, the journal offers additional digital features such as animated abstracts, video abstracts, instructional videos, and podcasts to increase visibility and educational value. Plain language summaries accompany articles to assist readers with some knowledge of the field in understanding important medical advances.
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