Study examines best practices for managing perinatal depression

The recommendations are often vague, contradictory, according to the investigators.

A study of best practices in the identification and management of perinatal depression has raised more questions than answers.

The study aimed to review guidelines for the management of perinatal depression in obstetric and pediatric settings, and the evidence supporting these guidelines. To do this, the investigators searched the Guideline International Network for best practices using the term depression; conducted additional searches on Google and other sites; and had discussions with experts in perinatal depression. To be included, guidelines had to describe the management of perinatal depression in obstetrical or pediatric care settings; be written in English; and were published between 1990 and 2021. Investigators found 25 guidelines published by 17 organizations – with 6 organizations publishing more than one guideline – that met the above inclusion criteria. They then examined the research supporting these guidelines through searches of PubMed and Google Scholar, and conducted a literature review.1

Investigators found that most guidelines (n = 18, 72%) made recommendations for screening for perinatal depression, and 16 (89%) made multiple recommendations, including for screening time, setting, and treatment. ‘instrumentation. Just over a third of the guidelines (n = 9, 36%) recommended assessment by severity and instrumentation to confirm depression after screening, and 3 (33%) made multiple recommendations. Suicide assessment was also analyzed, with 13 guidelines (52%) addressing suicide assessment, of which 6 (46%) recommended immediate assessment. More than 50% of the guidelines (n=7, 54%) recommended referring the patient to a psychiatrist or other mental health clinician to monitor the patient’s well-being.1

The majority of guidelines (n = 21.84%) made treatment recommendations, with most (n = 20.95%) offering multiple recommendations and 14 (67%) making recommendations by severity. Most (90%) recommended psychosocial interventions such as cognitive behavioral therapy or psychodynamic therapy; 60% recommended pharmacological treatment such as selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs); 40% recommend psychoeducation throughout the perinatal period; and 19% recommended alternative treatments like light therapy and electronic mental health support (i.e. self-guided apps). The investigators also noted that the literature on reassessment, remission, and care management was limited, and they did not identify any literature addressing treatment adjustments for perinatal depression that were unresponsive to psychotherapy or therapy. pharmacology.1

Overall, the researchers noted that the evidence was insufficient or conflicting in all areas, and that of the limited number of studies available, most included small sample sizes or were not of sufficient quality to shed light on significantly to clinical practice.1 They concluded:

“Clinicians can use these recommendations to guide their practice, but they should be aware of the limitations of the evidence supporting these guidelines and remain alert to new evidence. There is a clear need for researchers and policymakers to prioritize this area in order to develop evidence-based guidelines for the management of perinatal depression.

Reference

1. Falek I, Acri M, Dominguez J, et al. Management of depression in the perinatal period: state of the evidence. Int J Ment Health System. 2022;16:21.

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