EC Gynaecology

Postpartum depression (PPD) or baby blue refers to conditions in new mothers who experience depression, mood swings, and desperation. Affecting as many as 85% of mothers post-delivery, PPD is a serious health concern, especially in some vulnerable populations, precipitating postpartum psychosis leading to confusion, cognitive impairment, delusion, and disorganized behaviour. Left untreated, these may lead to suicidal episodes in some extreme situations. The first FDA-approved drug for PPD was brexanolone in 2019, which is infused over three days under medical supervision. A recent clinical trial using a single low dose of esketamine (0.2 mg/kg body weight), infused 40 minutes postdelivery, seems to significantly reduce symptoms in the treated groups. Affecting a large number of females, PPD is a major health concern that needs to be addressed promptly by healthcare professionals.

 Keywords: Postpartum Depression; Mood Swings; Baby Blue; Hormones; Drugs; Serotonin Receptors

1. Upadhyay Ravi Prakash., et al. “Postpartum depression in India: a systematic review and meta-analysis”. Bulletin of the World Health Organization10 (2017): 706C-717C.
2. Tebeka Sarah., et al. “Prevalence and incidence of postpartum depression and environmental factors: The IGEDEPP cohort”. Journal of Psychiatric Research 138 (2021): 366-374.
3. Lanjewar Shraddha., et al. “Depressed motherhood: prevalence and covariates of maternal postpartum depression among urban mothers in India”. Asian Journal of Psychiatry 57 (2021): 102567.
4. Lancaster Eva E., et al. “Understanding the genetics of peripartum depression: Research challenges, strategies, and opportunities”. Frontiers in Genetics 13 (2022): 1022188.
5. Payne Jennifer L and Jamie Maguire. “Pathophysiological mechanisms implicated in postpartum depression”. Frontiers in Neuroendocrinology 52 (2019): 165-180.
6. Rupanagunta Gnana Prasoona., et al. “Postpartum depression: aetiology, pathogenesis and the role of nutrients and dietary supplements in prevention and management”. Saudi Pharmaceutical Journal7 (2023): 1274-1293.
7. Li Jianming., et al. “5HTTLPR polymorphism and postpartum depression risk: A meta-analysis”. Medicine 39 (2020): e22319.
8. Binder Elisabeth B., et al. “A serotonin transporter gene polymorphism predicts peripartum depressive symptoms in an at-risk psychiatric cohort”. Journal of Psychiatric Research10 (2010): 640-646.
9. Mehta Divya., et al. “The 5-HTTLPR polymorphism modulates the influence on environmental stressors on peripartum depression symptoms”. Journal of Affective Disorders3 (2012): 1192-1197.
10. Schiller Crystal Edler., et al. “The role of reproductive hormones in postpartum depression”. CNS Spectrums1 (2015): 48-59.
11. Worthen Ryan J and Eleonore Beurel. “Inflammatory and neurodegenerative pathophysiology implicated in postpartum depression”. Neurobiology of Disease 165 (2022): 105646.
12. Dennis Cindy-Lee., et al. “Oestrogens and progestins for preventing and treating postpartum depression”. The Cochrane Database of Systematic Reviews 4 (2008): CD001690.
13. Watkins Stephanie., et al. “Early breastfeeding experiences and postpartum depression”. Obstetrics and Gynecology 2Pt1 (2011): 214-221.
14. Li Yan., et al. “Estrogen-induced uterine vasodilation in pregnancy and preeclampsia”. Maternal-fetal Medicine (Wolters Kluwer Health, Inc.)1 (2021): 52-60.
15. Kim Sohye., et al. “Maternal oxytocin response predicts mother-to-infant gaze”. Brain Research 1580 (2014): 133-142.
16. Pope Carley J and Dwight Mazmanian. “Breastfeeding and postpartum depression: an overview and methodological recommendations for future research”. Depression Research and Treatment (2016): 4765310.
17. Pearlstein Teri., et al. “Postpartum depression”. American Journal of Obstetrics and Gynecology4 (2009): 357-364.
18. Hazelgrove Katie. “The role of the immune system in postpartum psychosis”. Brain, Behavior, & Immunity. Health 18 (2021): 100359.
19. Zhu Jialei., et al. “Inflammatory pathophysiological mechanisms implicated in postpartum depression”. Frontiers in Pharmacology 13 (2022): 955672.
20. Cervenka Igor., et al. “Kynurenines: Tryptophan's metabolites in exercise, inflammation, and mental health”. Science (New York, N.Y.)6349 (2017): eaaf9794.
21. Guille Constance., et al. “Management of postpartum depression”. Journal of Midwifery and Women's Health6 (2013): 643-653.
22. Ram Daya and S Gandotra. “Antidepressants, anxiolytics, and hypnotics in pregnancy and lactation”. Indian Journal of Psychiatry2 (2015): S354-S371.
23. Buttner Melissa M., et al. “Efficacy of yoga for depressed postpartum women: A randomized controlled trial”. Complementary Therapies in Clinical Practice2 (2015): 94-100.
24. Hamdan Aisha and Hani Tamim. “The relationship between postpartum depression and breastfeeding”. International Journal of Psychiatry in Medicine3 (2012): 243-259.
25. Fitelson Elizabeth., et al. “Treatment of postpartum depression: clinical, psychological and pharmacological options”. International Journal of Women's Health 3 (2010): 1-14.
26. Figueroa Caroline A., et al. “Differences in objectively measured daily physical activity patterns related to depressive symptoms in community dwelling women - mPED trial”. Preventive Medicine Reports 22 (2021): 101325.
27. Poyatos-León Raquel., et al. “Effects of exercise-based interventions on postpartum depression: A meta-analysis of randomized controlled trials”. Birth (Berkeley, Calif.)3 (2017): 200-208.
28. Eustis Elizabeth H., et al. “Innovations in the treatment of perinatal depression: the role of yoga and physical activity interventions during pregnancy and postpartum”. Current Psychiatry Reports12 (2019): 133.
29. Tucker Zachary and Chasity O'Malley. “Mental health benefits of breastfeeding: a literature review”. Cureus 9 (2022): e29199.
30. Figueiredo Bárbara., et al. “Breastfeeding and postpartum depression: state of the art review”. Jornal de Pediatria4 (2013): 332-338.