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Oestrogens and progestins for preventing and treating postpartum depression

Additional research needed to evaluate the effect of oestrogens for the prevention and treatment of postpartum depression but synthetic progesterones should not be administered.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Psychosocial and psychological interventions for postpartum depression

Postpartum depression affects approximately 13% of all new mothers. Many women desire to try treatment options other than medication. Results from nine trials involving 956 women found that both psychosocial (e.g., peer support, non‐directive counselling) and psychological (e.g., cognitive behavioural therapy and interpersonal psychotherapy) interventions appear to be effective in reducing symptoms of postpartum depression. The long‐term benefits are unknown. Larger trials evaluating psychosocial and psychological treatments for postpartum depression are needed to provide clear conclusions about specific intervention benefits.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Psychosocial and psychological interventions for preventing postpartum depression

Postpartum depression is a serious condition of significant public health importance. The purpose of this review was to examine the effect of psychosocial and psychological interventions to reduce the risk of postpartum depression compared with usual care. This review includes data from 28 randomised controlled trials involving almost 17,000 women. The preventative interventions evaluated in the included trials were diverse and the end‐points differed widely but the methodological quality was good to excellent. A clear beneficial effect in the prevention of postpartum depression was found from a range of psychosocial and psychological interventions. Promising interventions included professionally‐based postpartum home visits, lay‐ or peer‐based postpartum telephone support, and interpersonal psychotherapy. Interventions provided by various health professionals and lay individuals were similarly beneficial. Interventions that were individually‐based were beneficial as were those that involved multiple contacts. There is also evidence that interventions initiated postnatally assisted in preventing postpartum depression as were those specifically targeting 'at‐risk' mothers. Many questions remain unanswered and additional research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Hypnosis during pregnancy, childbirth, and the postnatal period for preventing postnatal depression

Mental illness during pregnancy and the postnatal period can consist of a short period of mood swings, crying spells, irritability (baby blues), depression and postnatal psychosis. Postnatal depression (PND) falls along this spectrum. The morbidity caused by PND is enormous. Possible symptoms can include depressive mood, loss of interest or pleasure in daily activities, anxiety, irritability, insomnia, feelings of guilt, and thoughts of suicide in the first three months after giving birth. These can negatively impact on infant feeding, maternal‐infant interaction and the mother's perceptions of infant behaviour. Several psychological or psychosocial interventions appear to be effective for treating the disorder, such as cognitive‐behavioural therapy, counselling with or without antidepressants, health visitor‐led counselling, peer support, and interpersonal psychotherapy. In regard to prevention however, psychosocial or psychological interventions have not shown a clear benefit in preventing the development of PND. Although hypnosis has been used for a long time to reduce pain during labour and birth, the effectiveness of hypnosis for preventing PND has not yet been evaluated. Hypnosis can be described as a heightened state of focal concentration and receptivity to the suggestions of another person. This person brings about the hypnotic state by focusing the person's attention on a monotonous routine. This review included one study (involving 63 women) but it did not contribute any data to this review. There is insufficient evidence from randomised controlled trials to determine whether hypnosis is effective for preventing PND when compared with usual antenatal, birthing, or postnatal care procedures. Two trials are currently underway however, which may provide further information in the future.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antidepressant prevention of postnatal depression

Postnatal depression is a common and important disorder with negative implications for the mother, the infant and the wider family. Women who are not depressed, but at high risk of postnatal depression, such as those with a previous history of a postpartum mood disorder, may wish to consider antidepressant prevention during pregnancy or early postpartum. This review addresses the effectiveness of such treatment. Only two small trials met the criteria for inclusion. Both trials used medication immediately postpartum. The drugs were nortriptyline, a tricylic antidepressant (TCA) and sertraline, a selective serotonin reuptake inhibitor (SSRI). Both drugs were compared only to placebo. Nortripyline was not shown to have any benefit over placebo; there was some evidence that sertraline was effective both in reducing the incidence of recurrent postpartum depression and in increasing the time to recurrence. However, both trials involved only very small numbers of women and did not use intention to treat analyses. There is, therefore, no clear evidence for the use of these antidepressants in the prevention of postnatal depression.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Antidepressants for postnatal depression

Postnatal depression is a common disorder that can have short‐ and long‐term adverse effects on the mother, the new infant and the family as a whole. Antidepressants are commonly used as the first treatment option for adults with moderate to severe depression, but there is little evidence on whether antidepressants are an effective and safe choice for the treatment of this disorder in the postnatal period. This review was undertaken to evaluate the effectiveness of different antidepressants and to compare their effectiveness with other forms of treatment (e.g. psychosocial interventions such as peer support, psychological interventions such as cognitive behavioural therapy), placebo or treatment as usual.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Pregnancy and birth: Depression after childbirth – What can help?

Pregnant women usually expect the days and weeks following the birth of their child to be a happy time. But many have also heard of the “baby blues”: sadness and severe mood swings that often start a few days after giving birth. If the sadness does not go away, it might be the start of depression.Depression after childbirth is called postnatal (or postpartum) depression. It is very similar to the kind of depression that can affect people in any phase of life. Except for one major difference: Mothers often feel very guilty and worry about not being able to care properly for their baby. Many mothers feel too ashamed to speak with others about how they are feeling. They are afraid of not living up to the idea of a “good mother” and might become more and more withdrawn. Some women say that they no longer recognize themselves.Taking care of a newborn baby is a real challenge. Some women do not get the emotional and practical help that they need. It is not always easy to deal with all of the changes that need to be made to care full-time for a new baby. Coping with the everyday stress and getting used to your new life can be very difficult – and sometimes it may even be depressing.But these phases usually do not last long and go away by themselves once things have settled down a bit. If it turns into a lasting depression, though, it can greatly affect the mother’s relationship with her child. So it is important to take deep unhappiness and mood swings after childbirth seriously, and get more support.The first step towards doing that is to accept that there is a problem. Sometimes people who are depressed do not realize that they need help. One of the features of depression is that it can be hard to recognize that you are depressed, and that your mood swings are no longer “normal.”Or you might feel so bad that you aren’t able to reach out for the help you need. So it might be a doctor, midwife, partner, friend or family member who realizes what is happening, and helps get more support.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 21, 2016

Types of depression

There are different types of depression, with different levels of severity. Some only arise under certain circumstances, for example after giving birth.Doctors differentiate between the following types of depression based on the symptoms and possible causes:

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 12, 2017

Pregnancy and birth: Depression after childbirth: Can psychosocial and psychological treatment approaches help?

In some women, the “baby blues” they have after childbirth develops into clinical depression. Non-directive counselling, cognitive behavioral therapy and interpersonal psychotherapy can help relieve postnatal depression in many women.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 21, 2016

Psychosocial and psychological interventions for treating antenatal depression

Not enough evidence to say if non‐drug interventions are effective in treating antenatal depression.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Dietary supplements for preventing postnatal depression

Postnatal depression is a common condition that affects women and may impact on their babies. Common symptoms of postnatal depression include fluctuations in mood, mood changes, suicidal ideation and preoccupation with infant well‐being ranging from over‐concern to frank delusions. There is currently not much evidence regarding interventions that might prevent or treat postnatal depression. A diet lacking in certain vitamins, minerals or other nutrients may cause postnatal depression in some women. Correcting this deficiency with dietary supplements might therefore prevent postnatal depression. Examples of possible dietary supplements aimed at preventing postnatal depression include omega‐3 fatty acids, iron, folate, s‐adenosyl‐L‐methionine, vitamin B12 (cobalamin), B6 (pyridoxine), B2 (riboflavin), vitamin D and calcium.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression

There is not enough evidence available to determine if acupuncture, maternal massage, bright light therapy, or omega‐3 fatty acids are effective interventions in treating antenatal depression.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Antenatal psychosocial assessment for reducing perinatal mental health morbidity

Women can develop mental health problems during pregnancy or at childbirth and over the following year. These problems range from depression (both minor and major), anxiety disorders, post‐traumatic stress disorder to bipolar disorder, schizophrenia and psychosis (puerperal psychosis). Life stresses such as bereavement, separation, unemployment, illness, moving house, migration, lack of social support networks, a past history of psychological or psychiatric disorders, history of physical, emotional or sexual abuse, drug or alcohol abuse, dysfunctional personality or coping styles and parenting behaviours can contribute to their onset. Obstetric factors such as timing and type of delivery and infant temperament can also play a role. Disorders may become chronic and carry over to future pregnancies. The mother’s mood during pregnancy and mental illness can impact on the development of the baby both during pregnancy and after birth. Assessing women for psychosocial risk factors and symptoms of distress during regular pregnancy checks gives the opportunity to link women with appropriate services.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Home visits during pregnancy and after birth for women with an alcohol or drug problem

Not enough information on home visiting in pregnancy and after the birth for women with an alcohol or drug problem.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Mother and baby units for schizophrenia

Post‐partum psychosis is a consistent source of new episodes of severe mental illness and its worldwide prevalence has remained unchanged at 1 in 1000 live births over the past 150 years. For some women, admission to hospital is necessary. In the UK special mother and baby units (MBUs) are available in some areas to allow mothers to remain with their babies during treatment. This can help avoid the potential detrimental effects of separation from the mother on the baby and the effect this separation would have on the mother's confidence and capability as a future carer.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Early postnatal discharge from hospital for healthy mothers and term infants

The length of time women spend in hospital after childbirth has fallen dramatically in many countries over the past 30 years. This review of trials compared the policy of early discharge after childbirth with standard length of stay and care at the time.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Parent‐infant psychotherapy for improving parent and infant well‐being

Parent‐infant psychotherapy (PIP) is intended to address problems in the parent‐infant relationship, and problems such as excessive crying and sleeping/eating difficulties. A parent‐infant psychotherapist works directly with the parent and infant in the home or clinic, to identify unconscious patterns of relating and behaving, and influences from the past that are impeding the parent‐infant relationship. Parents may be referred to this service (e.g. by a general practitioner in the UK) or may self refer to privately run services. The intervention is delivered to individual dyads but can also be delivered to small groups of parents and infants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Aspirin (single dose) for relief of perineal pain after childbirth

Many women experience pain in the perineum (the area between the vagina and anus) following childbirth. The perineum may be bruised or torn during childbirth, or a cut made for the baby to be born (an episiotomy). After childbirth, perineal pain can interfere with women's ability to care for their newborns and establish breastfeeding. If perineal pain is not relieved effectively, longer‐term problems for women may include painful sexual intercourse, pelvic floor problems resulting in incontinence, prolapse or chronic perineal pain. Aspirin may be given to women who have perineal pain after childbirth, but its effectiveness and safety had not been assessed in a systematic review. This is part of a series of reviews looking at drugs to help relieve perineal pain in first few weeks after childbirth.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Anti‐inflammatory drugs for relief of perineal pain after childbirth

Following childbirth, many women experience pain in the perineum, an area between the anus and the vagina. This Cochrane review asked if this pain can be reduced by one dose of a non‐steroidal anti‐inflammatory drug (NSAIDs), such as aspirin or ibuprofen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Individual or group antenatal education for childbirth or parenthood, or both

Benefits of antenatal education for childbirth, and the best educational approaches to use, remain unclear.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

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