Treatment Advances in Perinatal Depression: Innovations and Promising Approaches.

Several innovative, mostly non-invasive treatments for depression during pregnancy and postpartum are emerging. Integrative approaches such as vitamin D, infant massage, mindfulness-based cognitive therapy, acupuncture, and repetitive transcranial magnetic stimulation show promise for perinatal women without medication side effects, and can be used alongside standard care. Two new medications, brexanolone and esketamine, quickly treat severe depression by targeting GABA and glutamate receptors rather than serotonin or norepinephrine, though their effectiveness diminishes after 30 days and they can be combined with SSRIs. Pregnant and postpartum women now have more options beyond psychotherapy and antidepressants.

Study at a glance

Abstract

Background/Objectives: Psychotherapy and antidepressants are the standard treatment for depression during pregnancy or postpartum. However, several new treatments for depression represent major advances and paradigm changes. This commentary highlights some innovative treatment options that are on the horizon. Most of these modalities are promising, and most are non-invasive. Many of these modalities have been used in the general population, where evidence supports their use. The methods have only recently been used for pregnant and postpartum women. Other modalities are specifically for perinatal women but do not have an established track record. Methods: This commentary describes some promising approaches to treatment, while acknowledging that the literature is preliminary. The goal is to highlight some interesting approaches drawn from a recent comprehensive review of the entire literature on treatment for perinatal mental illness. Results: Integrative treatments include vitamin D, infant massage, mindfulness-based cognitive therapy, acupuncture, and repetitive transcranial magnetic stimulation (rTMS). Many studies in the general population have found that these methods are effective, and they also show promise for perinatal women without side effects associated with medications. Some of these treatments can also be adjuncts to what is considered standard care. Two new medications, brexanolone and esketamine, quickly and effectively treat severe depression and work on GABA and glutamate receptors rather than serotonin or norepinephrine. These medications become less effective after 30 days but can be combined with selective serotonin reuptake inhibitors (SSRIs). Conclusions: Pregnant and postpartum women seeking care for depression and other mental health conditions have many options beyond psychotherapy and SSRI/SNRI antidepressants. These modalities can also be added to their care.