Assisted reproductive technologies could be associated with higher risk of parenting difficulties in women with postpartum major depression.

No increased risk of postpartum major depression (PPMD) was reported in women conceiving through assisted reproductive technologies (ART). However, ART may be associated with a higher risk of parenting difficulties in women with PPMD. In 359 women with a PPMD admitted to a Mother-Baby Unit (MBU), ART-women (4.2%) showed a 5-fold higher rate of parenting difficulties than those with spontaneous pregnancy (73.33% vs. 35.17%, multivariate ORa = 5.09 [1.48-17.48] p = 0.01). Specific support for mother-child relationship should be implemented in ART-women with PPMD.

French Society for Biological Psychiatry and Neuropsychopharmacology and French-speaking Marcé Society guidelines for the management of mood disorders in women before, during, and after pregnancy.

PURPOSE: The French Society for Biological Psychiatry and Neuropsychopharmacology and the French-speaking Marcé Society have joined forces to establish expert recommendations on the prescription of psychotropic drugs before, during, and after pregnancy in women with major depressive disorder (MDD) and bipolar disorder (BD). METHODS: To elaborate recommendations, we used the RAND/UCLA Appropriateness Method, which combines scientific evidence and expert clinicians' opinions. A written survey was completed by 48 psychiatrists, who have expertise in the management of mood disorders and/or in perinatal psychiatry. Key recommendations are provided by the scientific committee based on data analysis and interpretation of the results of the survey. RESULTS: The recommendations address the following three areas that are deemed essential in women with mood disorders, with an emphasis on screening, treatment options, and monitoring: (i) management of mood disorders in women of childbearing age, (ii) management during pregnancy, (iii) management during the post-partum period. As first-line strategies, experts recommend treating mood symptoms during pregnancy and maintaining a pharmacological treatment, even in euthymic or stabilized patients. First-line options include only medications with no teratogenic risk, and during breastfeeding, only medications without evidence of adverse effects in nursing infants. CONCLUSION: The expert consensus guidelines will help facilitate treatment decisions for clinicians in the daily assessment and management of mood disorders in women of childbearing age, during pregnancy, and in the post-partum period.

Habenular volume changes after venlafaxine treatment in patients with major depression.

BACKGROUND: Habenula, a hub brain region controlling monoaminergic brain center, has been implicated in major depressive disorder (MDD) and as a possible target of antidepressant response. Nevertheless, the effect of antidepressant drug treatment on habenular volumes remains unknown. The objective of the present research was to study habenular volume change after antidepressant treatment in patients with MDD, and assess whether it is associated with clinical improvement. METHODS: Fifty patients with a current major depressive episode (MDE) in the context of MDD, and antidepressant-free for at least 1 month, were assessed for habenula volume (3T MRI with manual segmentation) before and after a 3 months sequence of venlafaxine antidepressant treatment. RESULTS: A 2.3% significant increase in total habenular volume (absolute volume: P = 0.0013; relative volume: P = 0.0055) and a 3.3% significant increase in left habenular volume (absolute volume: P = 0.00080; relative volume: P = 0.0028) were observed. A significant greater variation was observed in male patients (4.8%) compared to female patients. No association was observed between habenular volume changes and response and remission. Some habenula volume changes were associated with improvement of olfactory pleasantness. CONCLUSION: Habenular volumes increased after 3 months of venlafaxine treatment in depressed patients. Further studies should assess whether cell proliferation and density or dendritic structure variations are implied in these volume changes.

Social determinants in prenatal antidepressant use and continuation: Systematic review and meta-analysis.

INTRODUCTION: Depression is one of the most common co-morbidities during pregnancy; with severe symptoms, antidepressants are sometimes recommended. Social determinants are often linked with antidepressant use in the general population, and it is not known if this is the case for pregnant populations. Our objective was to determine if social determinants are associated with prenatal antidepressant intake via a systematic review and meta-analysis. METHODS: A systematic search of five databases was conducted to identify publications from inception to October 2022 that reported associations with prenatal antidepressant intake (use/continuation) and one or more social determinants: education, race, immigration status, relationship, income, or employment. Eligible studies were included in random effects meta-analyses. RESULTS: A total of 23 articles describing 22 studies were included. Education was significantly and positively associated with prenatal antidepressant continuation and heterogeneity was moderate. (Odds ratio = 0.83; 95% CI, 0.78 to 0.89; p < 0.00001; I2 = 53%). Meta-analyses of antidepressant use and education, race, and relationship status, and antidepressant continuation and income were not significant with high levels of heterogeneity. DISCUSSION: While most social determinants in this review were not linked with prenatal antidepressant intake, lower maternal education level does seem to be associated with lower rates of prenatal antidepressant continuation. CONCLUSIONS: Education appears to be linked with prenatal antidepressant intake. The low number of included studies precludes conclusive evidence for other social determinants.

The role of parents' and friends' support in preventing suicide attempts among French sexual minority adolescents.

OBJECTIVES: French sexual minority adolescents are at higher risk for suicide attempts than their heterosexual peers. However, little is known about the role of parents' and friends' support among French lesbian, gay and bisexual (LGB) youth. This study aimed to research the role of their support in preventing suicide attempts among LGB adolescents in France. MATERIALS AND METHODS: Data were drawn from a French cross-sectional study entitled "Portraits d'adolescents". Parental support was defined by satisfactory relations between participants and their parents. Friends' support was defined by satisfactory relations between participants and their friends. Chi-square and multiple logistic regression analyses were used to estimate and identify associated factors of suicide attempts in LGB as opposed to heterosexual youth. RESULTS: Data from a sample of 14,265 French adolescents aged 13 to 20 were analyzed. Among them, 637 (4.47%) identified as LGB. Attempted suicide was independently associated with sexual orientation (30.7% vs 10.6%; OR = 2.59 [2.11-3.18]; p < 0.0001). Both parents' and friends' support appeared to be protective factors in suicide attempts among heterosexuals (adjusted ORs = 0.40 [0.35-0.46] and 0.61 [0.51-0.75], respectively), whereas in the LGB group, only parental support was significant (adjusted OR = 0.42 [0.27-0.65]), independently of other variables. DISCUSSION: Prevention efforts might be carried out by identifying within-group differences among French adolescents with different sexual orientations. The supportive role of family members should be strengthened. Positive resources and salutary support systems may effectively prevent suicide attempts. CONCLUSIONS: French LGB adolescents have a higher risk for suicide attempts than their heterosexual peers. Parental support was reconfirmed as a major protective factor against suicide attempts in sexual minority adolescents.

Bipolar disorder in the postpartum period: the impact of a prenatal mood episode on maternal improvement at postpartum discharge after joint inpatient hospitalization.

Bipolar disorder (BD) is linked to a high risk of relapse in the year postpartum. The aim of this study was to search for an association of a mood episode during pregnancy with a lack of maternal improvement after a post-partum episode requiring joint hospitalization. In an observational, naturalist, and multicentric study, 261 women suffering from a BD and jointly hospitalized with their child in a Mother-Baby Unit (MBU) were assessed for risk factors associated with a lack of maternal improvement at discharge. A directed acyclic graph (DAG)-based approach was used to identify confounders to be included in a multiple regression model. In bivariate analyses, a lack of improvement (16.9%) was associated with pregnancy specificities (decompensation, psychotropic treatment, antipsychotics, and benzodiazepines intake), as well as maternal smoking during pregnancy and baby's neonatal hospitalization. In a multivariate analysis based on DAG, a lack of improvement was linked to psychiatric decompensation during pregnancy (OR = 3.31, 95%CI [1.55-7.35], p = 0.002), independently from maternal age, mother's maltreatment during childhood, low level of education, single status, low familial social support, and diagnosis of personality disorder. This study shows the critical importance of mental health during pregnancy in women with BD. Clinical screening and evaluation of the benefit/risk balance of psychotropics during pregnancy are essential.

The olfactory deficits of depressed patients are restored after remission with venlafaxine treatment.

BACKGROUND: It is unclear whether olfactory deficits improve after remission in depressed patients. Therefore, we aimed to assess in drug-free patients the olfactory performance of patients with major depressive episodes (MDE) and its change after antidepressant treatment. METHODS: In the DEP-ARREST-CLIN study, 69 drug-free patients with a current MDE in the context of major depressive disorder (MDD) were assessed for their olfactory performances and depression severity, before and after 1 (M1) and 3 (M3) months of venlafaxine antidepressant treatment. They were compared to 32 age- and sex-matched healthy controls (HCs). Olfaction was assessed with a psychophysical test, the Sniffin' Sticks test (Threshold: T score; Discrimination: D score; Identification: I score; total score: T + D + I = TDI score) and Pleasantness (pleasantness score: p score; neutral score: N score; unpleasantness score: U score). RESULTS: As compared to HCs, depressed patients had lower TDI olfactory scores [mean (s.d.) 30.0(4.5) v. 33.3(4.2), p < 0.001], T scores [5.6(2.6) v. 7.4(2.6), p < 0.01], p scores [7.5(3.0) v. 9.8(2.8), p < 0.001)] and higher N scores [3.5(2.6) v. 2.1(1.8), p < 0.01]. T, p and N scores at baseline were independent from depression and anhedonia severity. After venlafaxine treatment, significant increases of T scores [M1: 7.0(2.6) and M3: 6.8(3.1), p < 0.01] and p scores [M1: 8.1(3.0) and M3: 8.4(3.3), p < 0.05] were evidenced, in remitters only (T: p < 0.01; P: p < 0.01). Olfaction improvement was mediated by depression improvement. CONCLUSIONS: The olfactory signature of MDE is restored after venlafaxine treatment. This olfaction improvement is mediated by depression improvement.

Lower plasma vascular endothelial growth factor A in major depressive disorder not normalized after antidepressant treatment: A case control study.

OBJECTIVE: Vascular endothelial growth factor A is a growth factor with pro-angiogenic and neurotrophic properties. Anti-vascular endothelial growth factor A treatments, used to treat cancers and opthalmic diseases, are known to induce depressive symptoms. Thus, we hypothesized that vascular endothelial growth factor A plasma levels are low in patients experiencing a major depressive episode in the context of major depressive disorder, which consequently increase after antidepressant treatment. The aim of this study was to compare plasma vascular endothelial growth factor A levels in patients with major depressive episode-major depressive disorder before and after antidepressant treatment. METHODS: Vascular endothelial growth factor A fasting plasma levels of 469 major depressive episode-major depressive disorder patients were compared with healthy controls. Depressed patients were assessed for remission after 3 and 6 months of antidepressant treatment. Bivariate and multivariate analyses adjusted for sex, age, body mass index and tobacco use were performed. RESULTS: As compared to healthy controls, major depressive episode patients had lower vascular endothelial growth factor A, 66.0 (38.3) pg/mL (standard deviation) vs 83.2 (49.2) pg/mL, p < 0.0001. Plasma vascular endothelial growth factor A levels did not change after antidepressant treatment, even in remitters, and remained lower than those of healthy controls, 64.9 (39.3) pg/mL vs 83.2 (49.2) pg/mL, p < 0.0001. CONCLUSION: Depressed patients with major depressive disorder have lower plasma vascular endothelial growth factor A levels than healthy controls during their major depressive episode and after remission following antidepressant treatment. New strategies targeting enhancement of plasma vascular endothelial growth factor A could be promising for the prevention and treatment of major depressive disorder.

Negative impact of maternal antenatal depressive symptoms on neonate's behavioral characteristics.

Prenatal maternal depression is associated with developmental disorders in offspring. However, the specific effects of the intensity of prenatal depressive symptoms on infant behavior remain poorly explored. The aim of this work is to explore the links between early neonatal behavior and maternal prenatal depressive symptoms, independently from maternal pre- and postnatal anxiety and early postnatal maternal depressive symptoms. Five hundred and ninety-eight women and their newborns from the MATQUID cohort were prospectively evaluated during the 8th month of pregnancy (T1) and at day 3 postpartum (T2). We analyzed the independent associations between neonates' behavior (Neonatal Behavioral Assessment Scale-NBAS) at T2 and the intensity of maternal prenatal depressive symptoms (CES-D), taking into account confounding factors including depressive symptoms at T2 and anxiety (T1 and T2). The presence of a major depressive episode (MDE) based on MINI at T1 was also studied, independently. Our results show a significant negative correlation between prenatal CES-D scores and NBAS scores on "habituation" (p = 0.0001), "orientation" (p = 0.015), "motor system" (p < 0.0001), "autonomic stability" (p < 0.0001) dimensions, independently of other variables, including pre/postnatal anxiety and postnatal depressive symptoms. A prenatal MDE was independently associated with lower scores on the "orientation" dimension (p = 0.005). This study reports a specific effect of prenatal depressive symptoms on newborn's behavior. These results highlight the crucial necessity for antenatal screening and adjusted treatments of maternal depressive symptoms and not only of MDE. Particular attention must be paid to infants of mothers presenting prenatal depressive symptoms to provide them with early developmental care when necessary.

[Inflammatory Biomarkers and Postpartum Depression: A Systematic Review of Literature]. / Biomarqueurs de L'inflammation et Dépression du Post-Partum: Une Revue Systématique De la Littérature.

OBJECTIVE: Postpartum Depression (PPD) affects over 15% new mothers. Its etiology is multifactorial and still partly unknown. Some hypotheses suggest a link with inflammation. This review aims to explore the existence of inflammatory biomarkers associated with PPD. The possibility of potential adjunct treatments, linked with these biomarkers, will be discussed. METHOD: The systematic review of literature was performed using in PubMed, PsycInfo and Embase, and 25 articles were included. Various biomarkers were identified. The most often studied are C-reactive protein (CRP), interleukins 6 and 10, tumor necrosis factor-alpha and interferon-gamma. RESULTS: Although few results appear as significant during the various testing times, the dosage of some inflammation biomarkers, including CRP, at the very end of pregnancy or immediately after delivery could predict PPD. Interactions between inflammation and the corticotropic axis could explain PPD onset. Epigenetic mechanisms could lead to pro-inflammatory state. Several therapeutics provide interest due to their anti-inflammatory property. CONCLUSIONS: Further studies are needed to assess these biomarkers value as predictive factors of PPD and to consider adjunct treatments to antidepressants. If this value is confirmed, the inflammatory marker dosage, in particular CRP, could help to provide early screening of women at risk of PPD, parallel of the clinical evaluation. A zinc supplementation could then be offered.

OBJECTIF: La Dépression du Post-Partum (DPP) affecte plus de 15% des nouvelles mères. Son étiologie est plurifactorielle et encore partiellement méconnue. Certaines hypothèses posent l'idée d'un lien avec l'inflammation. L'objectif de cette revue est d'explorer l'existence de biomarqueurs de l'inflammation associés à la DPP. Puis sera discutée la possibilité de compléments thérapeutiques éventuels, en lien avec ces biomarqueurs. MÉTHODE: La revue systématique de la littérature a été réalisée à partir de PubMed, PsycInfo et Embase. Vingt-cinq articles ont été inclus. Différents biomarqueurs ont été identifiés. Les plus étudiés sont la C-Réactive Protéine (CRP), les Interleukines 6 et 10, le Tumor Necrosis Factor-alpha et l'Interferon Gamma. RÉSULTATS: Alors que peu de résultats apparaissent comme significatifs aux différents temps, le dosage de certains biomarqueurs de l'inflammation, notamment la CRP, en toute fin de grossesse ou juste après l'accouchement pourrait être une piste de recherche intéressante avec une orientation prédictive de la DPP. Les interactions entre inflammation et axe corticotrope peuvent expliquer la survenue de la DPP. Des phénomènes épigénétiques pourraient conduire à un état pro-inflammatoire. Plusieurs thérapeutiques offrent des pistes intéressantes grâce à leur propriété anti-inflammatoire. CONCLUSIONS: Davantage d'études sont nécessaires afin d'évaluer l'intérêt de ces biomarqueurs comme facteur prédictif de la DPP et d'envisager des traitements complémentaires à l'antidépresseur. Si cet intérêt était confirmé, le dosage de marqueur de l'inflammation, notamment la CRP, pourrait aider au dépistage précoce des femmes à risque de DPP, parallèlement à la clinique. Une supplémentation en Zinc pourrait alors être proposée.

Impact of a prenatal episode and diagnosis in women with serious mental illnesses on neonatal complications (prematurity, low birth weight, and hospitalization in neonatal intensive care units).

Pregnancy in women with mental disorders is increasingly common. The aim of this study was to determine, in women with severe mental illnesses, whether a prenatal episode was related to neonatal complications and if a specific disorder was associated with a higher risk. A population of infants and their mothers (n = 1439) jointly admitted to psychiatric Mother-Baby Units in France and Belgium (2001-2010) was assessed respectively for prematurity, low birth weight (LBW), hospitalization in neonatal intensive care units (NICUs), and maternal mental health during pregnancy. Logistic regression was used to explore the association between neonatal complications and a prenatal episode of mental illness and if the presence of a specific disorder was related to a higher risk, taking into account maternal socio-demographic characteristics, pregnancy data, and antenatal exposure to psychotropic drugs. Among the children, 145 (10.2%) were premature, 226 (15.8%) had a LBW, and 348 (24.3%) have been hospitalized in neonatology. The presence of an episode of mental illness during pregnancy was linked to LBW (OR = 2.21 [1.44-3.38]; p = 0.003) and NICU hospitalizations (OR = 1.53 [1.06-2.19], p = 0.002). Among diagnoses, the presence of a severe substance use disorder in these women was related to LBW (OR = 2.96 [1.49-5.85]; p = 0.002) and NICU (OR = 2.88 [1.56-5.29]; p = 0.04). Our results underline the importance of systematic and early detection of psychiatric symptoms and substance use disorders during pregnancy in preventing neonatal complications in women with serious mental illness.

Pregnancy in women with psychotic disorders: risk factors associated with mother-baby separation.

Pregnancy in women suffering from psychotic disorders is becoming more common. However, this psychiatric disorder is linked to the highest risk of early mother and child separation. The aim of this study was to evaluate risk factors associated with these separations. In an observational, naturalist, and multicentric study, 320 women suffering from a psychotic disorder and jointly hospitalized with their child in one of the sixteen mother-baby units (MBUs) in France and Belgium between 2001 and 2010 were assessed for risk factors associated with mother-child separation. Eighty-seven (27.2%) mothers were separated from their infant at discharge from MBUs. Early separation was linked to the placement of the mother herself in an institution in childhood (OR 4.44; CI 95% 1.12-18.69), to the mother being single (OR 3.84; CI 95% 1.38-11.44), to early hospitalization of the baby in neonatology (OR 2.88; CI 95% 1.27-6.59), and to maternal psychiatric decompensation during pregnancy (OR 2.60; CI 95% 1.15-6.20), independently from maternal neglectful behaviors. Low family/social support showed a trend towards association with separation (OR 2.17; CI 95% 0.91-5.42). This study shows that separation is mostly linked to mothers' environmental and interactive past and current history, to the child's health, and to maternal mental health decompensation. The identification of these factors is essential to implement antenatal prevention and social programs for these women. Further studies should focus on the long-term development of children of schizophrenic mothers, whether or not they have been placed, in order to help clarifying the impact of the risk factors.

[Assistance with parenthood for new mothers with mental health problems]. / Aide à la parentalité pour les nouvelles mères présentant un trouble psychiatrique.

Women with mental health problems during the perinatal period need support with parenthood. Guidance from professionals providing the paediatric nursing care must favour the baby's development, but also help the mother assume her role and support the establishment of the mother-baby bond. Mediation when providing paediatric nursing care is a means of supporting parenthood.

[Post-partum psychosis]. / Psychose du post-partum.

Postpartum psychosis occurs in 1-2/1000 childbearing women. It is commonly admitted that it belongs to bipolar disorder with psychotic features. A strong link between puerperal psychosis and bipolar disorder has been established. Symptoms include rapid mood fluctuations, confusion, delusions, hallucinations and bizarre behaviour. It can lead to devastating consequences. It is a psychiatric emergency that requires an urgent evaluation to exclude any organic cause. Therefore, early identification and appropriate treatment are critical. A quick and effective relief is necessary for maternal and child health and mother-infant relationship. Perinatal health professionals have to be accurate screening postpartum psychosis symptoms and have to educate patients and their family.

Menopausal status could modulate the association between 5-HTTLPR and antidepressant efficacy in depressed women: a pilot study.

The aim of this study was to evaluate the association between the functional polymorphic region of the serotonin transporter gene (5-HTTLPR) and antidepressant efficacy in menopausal and non-menopausal women. Since serotonergic system has been shown to be linked to estrogens, menopausal status of women may explain previous contradictory results on antidepressant efficacy in major depressive episode related to 5-HTTLPR in women. Seventy-four women (43 non-menopausal and 31 menopausal) and 29 men with a major depressive episode were genotyped for the 5-HTTLPR and assessed prospectively for antidepressant efficacy after 4 weeks of treatment. Non-menopausal women with at least one copy of the long allele had better antidepressant efficacy than those who were homozygous for the short allele, whereas no difference was found in menopausal women. Furthermore, antidepressant response was correlated with an interaction between the 5-HTTLPR polymorphism and age in women, but not in men. This finding suggested that the differences in antidepressant response were not linked to age but, rather, to menopausal status of women. Further research on a bigger sample is needed with steroids measurements to determine how menopausal status and 5-HTTLPR polymorphism influence antidepressant response.