Breastfeeding, Antidepressants, and Depression in the Mercy Pregnancy and Emotional Well-Being Study.

BACKGROUND:: Depression is consistently shown to predict lower rates of breastfeeding. In a handful of studies, breastfeeding has predicted lower depression symptoms. However, studies demonstrating the latter are limited in their measurement of both depression and breastfeeding and have not followed participants from pregnancy across the postpartum period. RESEARCH AIM:: The primary aim of this study was to describe breastfeeding intentions and behaviors for the first 12 months postpartum among nonmedicated depressed, antidepressant-exposed, and control participants. The secondary aim was to examine group differences in the association between depressive symptoms and breastfeeding duration up to 12 months postpartum. METHODS:: First-trimester women ( N = 212) were recruited into a prospective longitudinal study. Depressive disorders at baseline were diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders, and depressive symptoms were measured at the first and second trimesters and 6 and 12 months postpartum using the Edinburgh Postnatal Depression Scale. Breastfeeding duration, support from family and employers, and perceptions of participants' experience were measured. RESULTS:: Depressed women and antidepressant-exposed women reported a trend toward lower rates of intention, initiation, and duration, but this did not reach statistical significance. There was a statistically significant difference on depressive symptoms for women taking antidepressants during pregnancy, compared with controls, when they continued to breastfeed for 12 months postpartum. CONCLUSIONS:: This study did not find a strong association between depression or antidepressant use and intention to breastfeed, partner breastfeeding support, or initiation or duration of breastfeeding. However, for women who took antidepressants, there was evidence that breastfeeding for 12 months was associated with lower depressive symptoms.

Maternal depression, antidepressant use and placental oxytocin receptor DNA methylation: Findings from the MPEWS study.

The aim of this study was to investigate placental DNA methylation of the oxytocin receptor gene (OXTR) in women with depression in pregnancy. We also explored the role of antidepressant medication in pregnancy on placental OXTR methylation. Data were obtained from 239 women in the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a selected pregnancy cohort. Current depressive disorders were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-IV). Depressive symptoms were measured during the third trimester in pregnancy using the Edinburgh Postnatal Depression Scale (EPDS). Plasma levels of antidepressant drugs were measured in maternal and cord blood obtained at delivery. OXTR DNA methylation was measured in placenta samples. Depressive symptoms in pregnancy were not associated with significant changes in DNA methylation of OXTR in the placenta. Cord plasma antidepressant levels were more strongly associated than maternal antidepressant dose or circulating blood antidepressant levels with increased DNA methylation of a specific unit within the promotor region of OXTR. This study provides preliminary data to suggest that antidepressant use during pregnancy can alter OXTR methylation in placental tissue. Our findings also indicate that the way exposures are measured in pregnancy can influence the direction and strength of findings. Future studies should investigate whether altered OXTR methylation might mediate the impacts of maternal antidepressant treatment on pregnancy and offspring outcomes.

Impact of irritability: a 2-year observational study of outpatients with bipolar I or schizoaffective disorder.

OBJECTIVES: Many people experience irritability when manic, hypomanic, or depressed, yet its impact on illness severity and quality of life in bipolar and schizoaffective disorders is poorly understood. This study aimed to examine the relationship between irritability and symptom burden, functioning, quality of life, social support, suicidality, and overall illness severity in a naturalistic cohort of people with bipolar I or schizoaffective disorder. METHODS: We used data from 239 adult outpatients with bipolar I or schizoaffective disorder in the Bipolar Comprehensive Outcomes Study (BCOS) - a non-interventional observational study with a 2-year follow-up period. Baseline demographic and clinical characteristics of participants with and without irritability were compared. A mixed-model repeated measures analysis was conducted to examine the longitudinal effect of irritability on clinical and quality-of-life variables over follow-up using significant baseline variables. RESULTS: At baseline, 54% of participants were irritable. Baseline irritability was associated with illness severity, mania, depression, psychotic symptoms, suicidality, poor functioning, and quality of life, but not diagnosis (schizoaffective/bipolar disorder). Participants with irritability were less likely to have a partner and perceived less adequate social support. On average, over follow-up, those with irritability reported more symptoms, functional impairment, and suicidality. Furthermore, the effects of irritability could not be fully explained by illness severity. CONCLUSIONS: Irritability was associated with more negative symptomatic, functional, and quality-of-life outcomes and suicidality. The identification, monitoring, and targeted treatment of irritability may be worth considering, to enhance health and wellbeing outcomes for adults with bipolar and schizoaffective disorders.

Offspring of Parents with Schizophrenia: A Systematic Review of Developmental Features Across Childhood.

A significant body of longitudinal research has followed the offspring of parents with schizophrenia. This article presents a systematic review of 46 separate papers presenting the results of 18 longitudinal studies that have followed children who are at familial high risk of developing psychotic disorders. The studies suggest that these children do show distinct developmental patterns characterized by higher rates of obstetric complication, neurodevelopmental features such as motor and cognitive deficits, and distinctive social behavior. This review summarizes those findings according to child developmental stages. Twelve of the studies followed offspring into adulthood and examined psychiatric diagnoses. From 15% to 40% of children at familial high risk developed psychotic disorders in adulthood. Many also received other psychiatric diagnoses such as mood or anxiety disorders. This combination of results suggests that offspring of parents with schizophrenia are at high risk not just for schizophrenia but, more broadly, for poor developmental and general mental health outcomes. The clinical implications of the findings are discussed, as are new prognostic strategies and potential programs for selective prevention.

Maternal Prenatal Mental Health and Placental 11ß-HSD2 Gene Expression: Initial Findings from the Mercy Pregnancy and Emotional Wellbeing Study.

High intrauterine cortisol exposure can inhibit fetal growth and have programming effects for the child's subsequent stress reactivity. Placental 11beta-hydroxysteroid dehydrogenase (11ß-HSD2) limits the amount of maternal cortisol transferred to the fetus. However, the relationship between maternal psychopathology and 11ß-HSD2 remains poorly defined. This study examined the effect of maternal depressive disorder, antidepressant use and symptoms of depression and anxiety in pregnancy on placental 11ß-HSD2 gene (HSD11B2) expression. Drawing on data from the Mercy Pregnancy and Emotional Wellbeing Study, placental HSD11B2 expression was compared among 33 pregnant women, who were selected based on membership of three groups; depressed (untreated), taking antidepressants and controls. Furthermore, associations between placental HSD11B2 and scores on the State-Trait Anxiety Inventory (STAI) and Edinburgh Postnatal Depression Scale (EPDS) during 12-18 and 28-34 weeks gestation were examined. Findings revealed negative correlations between HSD11B2 and both the EPDS and STAI (r = -0.11 to -0.28), with associations being particularly prominent during late gestation. Depressed and antidepressant exposed groups also displayed markedly lower placental HSD11B2 expression levels than controls. These findings suggest that maternal depression and anxiety may impact on fetal programming by down-regulating HSD11B2, and antidepressant treatment alone is unlikely to protect against this effect.

The Janus face of schizotypy: enhanced spiritual connection or existential despair?

It has been asserted that schizotypy has a negative relationship with subjective well-being. By employing a multidimensional measure of spiritual well being with 400 British College students we report a more complex relationship. The Multidimensional Inventory for Religious/Spiritual Well-Being and Schizotypal Personality Questionnaire-Brief Version were used and analysis made use of Canonical Correlational Analysis. Results suggested that two distinct relationships emerged between schizotypy and spirituality. First, a positive association between cognitive/perceptual features of schizotypy and spiritual connectedness emerged. Second a more global negative relationship between feelings of spiritual isolation and despair was found for all aspects of schizotypy. These findings challenge the previous literature based on one-dimensional subjective well being measures which have found only a negative relationship. However, the positive association between connectedness and cognitive-perceptual aspects of schizotypy raises import questions about the possible benefit of certain types of schizotypal experience.

Early life programming as a target for prevention of child and adolescent mental disorders.

This paper concerns future policy development and programs of research for the prevention of mental disorders based on research emerging from fetal and early life programming. The current review offers an overview of findings on pregnancy exposures such as maternal mental health, lifestyle factors, and potential teratogenic and neurotoxic exposures on child outcomes. Outcomes of interest are common child and adolescent mental disorders including hyperactive, behavioral and emotional disorders. This literature suggests that the preconception and perinatal periods offer important opportunities for the prevention of deleterious fetal exposures. As such, the perinatal period is a critical period where future mental health prevention efforts should be focused and prevention models developed. Interventions grounded in evidence-based recommendations for the perinatal period could take the form of public health, universal and more targeted interventions. If successful, such interventions are likely to have lifelong effects on (mental) health.

The role of oxytocin in mother-infant relations: a systematic review of human studies.

BACKGROUND: Oxytocin is associated with the establishment and quality of maternal behavior in animal models. Parallel investigations in humans are now under way. This article reviews the current research examining the role of oxytocin in mother-infant relations, attachment, and bonding in humans. METHODS: A systematic search was made of three electronic databases and other bibliographic sources for published research studies that examined oxytocin and mother-infant relations in humans, including attachment, maternal behavior, parenting, and mother-infant relations. RESULTS: Eight studies were identified, all of which were unique in their methodologies, populations studied, and measures used. Seven studies found significant and strong associations between levels or patterns of oxytocin and aspects of mother-infant relations or attachment. CONCLUSIONS: Oxytocin appears to be of crucial importance for understanding mother-infant relationships. The findings of this review suggest that the pioneering, but preliminary, research undertaken to date is promising and that replication with larger samples is needed. Research that draws on more robust measures of attachment and bonding, as well as improved measures of oxytocin that include both central and peripheral levels, will elucidate the role of oxytocin in human mother-infant relationships. As the production of oxytocin is by no means restricted to mothers, the extension of the oxytocin studies to fathering, as well as to alloparental caregiving, would be an intriguing next step.