Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-03T03:56:50.083Z Has data issue: false hasContentIssue false
  • English
  • Français

The management of mood disorders in pregnancy: alternatives to antidepressants

Published online by Cambridge University Press:  10 April 2013

Erica M. Richards  and
Jennifer L. Payne
Erica M. Richards
Affiliation:
Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland, USA
Jennifer L. Payne*
Affiliation:
Department of Psychiatry and Women's Mood Disorders Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
*
*Address for correspondence: Jennifer L. Payne, MD, Associate Professor of Psychiatry, Johns Hopkins School of Medicine, Department of Psychiatry, 550 N. Broadway, Suite 305, Baltimore, MD 21205, USA. (Email [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

The management of mood disorders during pregnancy is complex due to risks associated with medication use and risks associated with untreated depression. Antidepressant use during pregnancy is an exposure for the unborn child, and it currently remains unclear what long-term repercussions there might be from this exposure, though available data are reassuring. On the other hand, there are risks for both the mother and child of untreated depression during pregnancy. There is a real need for research into nonpharmacological strategies for the prevention of relapse of mood disorders in pregnant women who are off medications. We have reviewed a number of potential candidate interventions including psychotherapies, exercise, light box therapy (LBT), repetitive transcranial magnetic stimulation (rTMS), electroconvulsive therapy (ECT), holistic strategies, and nutritional and herbal supplements. Currently there is a lack of evidence supporting the use of such strategies in the prevention of depressive relapse during pregnancy, though most of these strategies have at least some support for their use in the treatment of a major depressive episode. Carefully conducted research using one or more of these strategies in women who want to discontinue antidepressants for pregnancy is sorely needed.

Keywords

Peripartumdepressionmood disorderpersistent pulmonary hypertensionholisticpoor neonatal adaptation
Type
Review Articles
Information
CNS Spectrums , Volume 18 , Issue 5 , October 2013 , pp. 261 - 271
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Payne, JL, Meltzer-Brody, A. Antidepressant use during pregnancy: current controversies and treatment strategies. Clin Obstet Gynecol. 2009; 52(3): 469–482.CrossRefGoogle ScholarPubMed
2.O'Hara, MW, Swain, AM. Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry. 1996; 8(1): 37–54.CrossRefGoogle Scholar
3.Gaynes, BN, Gavin, N, Meltzer-Brody, S, etal. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ). 2005; (119): 1–8.Google ScholarPubMed
4.Dietz, PM, Williams, SB, Callaghan, WM, etal. Clinically identified maternal depression before, during, and after pregnancies ending in live births. Am J Psychiatry. 2007; 164(10): 1515–1520.CrossRefGoogle ScholarPubMed
5.Yonkers, KA, Ramin, SM, Rush, AJ, etal. Onset and persistence of postpartum depression in an inner-city maternal health clinic system. Am J Psychiatry. 2001; 158(11): 1856–1863.CrossRefGoogle Scholar
6.Payne, JL, Roy, PS, Murphy-Eberenz, K, etal. Reproductive cycle-associated mood symptoms in women with major depression and bipolar I disorder. J Affect Disord. 2007; 99: 221–229.CrossRefGoogle Scholar
7.Mills, JL. Depressing observations on the use of selective serotonin-reuptake inhibitors during pregnancy. New Engl J Med. 2006; 354(6): 636–638.CrossRefGoogle ScholarPubMed
8.Cooper, WO, Willy, ME, Pont, SJ, Ray, WA. Increasing use of antidepressants in pregnancy. Am J Obstet Gynecol. 2007; 196(6): 544–545.CrossRefGoogle ScholarPubMed
9.Andrade, SE, Raebel, MA, Brown, J, etal. Use of antidepressant medications during pregnancy: a multisite study. Am J Obstet Gynecol. 2008; 198(2): 194.e1–194.e5.CrossRefGoogle ScholarPubMed
10.Mitchell, AA, Gilboa, SM, Werler, MM, etal. Medication use during pregnancy, with particular focus on prescription drugs: 1976–2008. Am J Obstet Gynecol. 2011; 205(1): 51.e1–51.e8.CrossRefGoogle ScholarPubMed
11.Yonkers, KA, Wisner, KL, Steward, DE, etal. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet Gynecol. 2009; 114(3): 703–713.Google ScholarPubMed
12.Hemels, M, Einarson, A, Koren, G, Lanctot, K, Einarson, T. Antidepressant use during pregnancy and the rates of spontaneous abortions: a meta-analysis. Ann Pharmacother. 2005; 39: 803–809.CrossRefGoogle ScholarPubMed
13.Källén, BAJ, Otterblad Olausson, P. Maternal use of selective serotonin re-uptake inhibitors in early pregnancy and infant congenital malformations. Birth Defects Res A Clin Mol Teratol. 2007; 79: 301–308.CrossRefGoogle ScholarPubMed
14.Källén, B, Otterblad Olausson, P. Antidepressant drugs during pregnancy and infant congenital heart defect. Reprod Toxicol. 2006; 21: 221–222.CrossRefGoogle ScholarPubMed
15.Cole, JA, Modell, JG, Haight, BR, etal. Buproprion in pregnancy and the prevalence of congenital malformations. Pharmacoepidemiol Drug Saf. 2007; 16: 474–484.CrossRefGoogle Scholar
16.Louik, C, Lin, A, Werler, M, Hernandez-Diaz, S, Mitchell, A. First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects. New Engl J Med. 2007; 356: 2675–2683.CrossRefGoogle ScholarPubMed
17.Alwan, S, Reefhuis, J, Rasmussen, SA, Olney, RS, Friedman, JM. National Birth Defects Prevention Study. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. New Engl J Med. 2007; 356: 2684–2692.CrossRefGoogle ScholarPubMed
18.Chambers, CD, Hernandez-Diaz, S, Van Marter, LJ, etal. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. New Engl J Med. 2006; 354(6): 579–587.CrossRefGoogle ScholarPubMed
19.Källén, B, Olausson, PO. Maternal use of selective serotonin re-uptake inhibitors and persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf. 2008 Aug; 17(8): 801–806.CrossRefGoogle ScholarPubMed
20.Kieler, H, Artama, M, Engeland, A, etal. Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from the five Nordic countries. BMJ. 2012; 344: d8012.CrossRefGoogle ScholarPubMed
21.Andrade, SE, McPhillips, H, Loren, D, etal. Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf. 2009; 18(3): 246–252.CrossRefGoogle ScholarPubMed
22.Wichman, CL, Moore, KM, Lang, TR, etal. Congenital heart disease associated with selective serotonin reuptake inhibitor use during pregnancy. Mayo Clin Proc. 2009; 84(1): 23–27.CrossRefGoogle ScholarPubMed
23.Wilson, KL, Zelig, CM, Harvey, JP, etal. Persistent pulmonary hypertension of the newborn is associated with mode of delivery and not with maternal use of selective serotonin reuptake inhibitors. Am J Perinatol. 2011; 28(1): 19–24.CrossRefGoogle Scholar
24.Oberlander, TF, Misri, S, Fitzgerald, CE, etal. Pharmacological factors associated with transient neonatal symptoms following prenatal psychotropic medication exposure. J Clin Psychiatry. 2004; 65(2): 230–237.CrossRefGoogle ScholarPubMed
25.Levinson-Castiel, R, Merlob, P, Linder, N, Sirota, L, Klinger, G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediat Adolesc Med. 2006; 160: 173–176.CrossRefGoogle ScholarPubMed
26.Chambers, CD, Johnson, KA, Dick, LM, Felix, RJ, Jones, KL. Birth outcomes in pregnant women taking fluoxetine. New Engl J Med. 1996; 335: 1010–1015.CrossRefGoogle ScholarPubMed
27.Ter Horst, PG, Jansman, FG, van Lingen, RA, etal. Pharmacological aspects of neonatal antidepressant withdrawal. Obstet Gynecol Surv. 2008; 63(4): 267–279.CrossRefGoogle ScholarPubMed
28.Koch, S, Jäger-Roman, E, Lösche, G, etal. Antiepileptic drug treatment in pregnancy: drug side effects in the neonate and neurological outcome. Acta Paediatr. 1996; 85(6): 739–746.CrossRefGoogle ScholarPubMed
29.Cohen, LS, Altshuler, LL, Harlow, BL, etal. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006; 295(5): 499–507.CrossRefGoogle ScholarPubMed
30.Cohen, LS, Nonacs, RM, Bailey, JW, etal. Relapse of depression during pregnancy following antidepressant discontinuation: a preliminary prospective study. Arch Womens Ment Health. 2004; 7(4): 217–221.CrossRefGoogle ScholarPubMed
31.Murray, L, Sinclair, D, Cooper, P, etal. The socioemotional development of 5-year-old children of postnatally depressed mothers. J Child Psychol Psychiatry. 1999; 40(8): 1259–1271.CrossRefGoogle ScholarPubMed
32.Marmorstein, NR, Malone, SM, Lacono, WG. Psychiatric disorders among offspring of depressed mothers: associations with paternal psychopathology. Am J Psychiatry. 2004; 161(9): 1588–1594.CrossRefGoogle ScholarPubMed
33.Li, D, Liu, L, Odouli, R. Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod. 2009; 24(1): 146–153.CrossRefGoogle ScholarPubMed
34.Zuckerman, B, Amaro, H, Bauchner, H, Cabral, H. Depressive symptoms during pregnancy: relationship to poor health behaviors. Am J Obstet Gynecol. 1989; 160(5 pt 1): 1107–1111.CrossRefGoogle ScholarPubMed
35.Orr, ST, Blazer, DG, James, SA, Reiter, JP. Depressive symptoms and indicators of maternal health status during pregnancy. J Womens Health (Larchmt). 2007; 16(4): 535–542.CrossRefGoogle ScholarPubMed
36.Ashman, SB, Dawson, G, Panagiotides, H, Yamada, E, Wilkinson, CW. Stress hormone levels of children of depressed mothers. Devel Psychopathol. 2002; 14(2): 333–349.CrossRefGoogle ScholarPubMed
37.Diego, MA, Field, T, Hernandez-Reif, M, etal. Prepartum, postpartum, and chronic depression effects on newborns. Psychiatry. 2004; 67(1): 63–80.CrossRefGoogle ScholarPubMed
38.Essex, MJ, Klein, MH, Cho, E, Kalin, NH. Maternal stress beginning in infancy may sensitize children to later stress exposure: effects on cortisol and behavior. Biol Psychiatry. 2002; 52(8): 776–784.CrossRefGoogle ScholarPubMed
39.Halligan, SL, Herbert, J, Goodyer, IM, Murray, L. Exposure to postnatal depression predicts elevated cortisol in adolescent offspring. Biol Psychiatry. 2004; 55(4): 376–381.CrossRefGoogle ScholarPubMed
40.Brennan, PA, Pargas, R, Walker, EF, etal. Maternal depression and infant cortisol: influences of timing, comorbidity and treatment. J Child Psychol Psychiatry. 2008; 49(10): 1099–1107.CrossRefGoogle ScholarPubMed
41.O'Connor, TG, Ben-Shlomo, Y, Heron, J, etal. Prenatal anxiety predicts individual differences in cortisol in pre-adolescent child. Biol Psychiatry. 2005; 58(3): 211–217.CrossRefGoogle Scholar
42.Lindahl, V, Pearson, JL, Colpe, L. Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health. 2005; 8(2): 77–87.CrossRefGoogle ScholarPubMed
43.Akman, I, Kuscu, K, Ozdemir, N, etal. Mothers’ postpartum psychological adjustment and infantile colic. Arch Dis Child. 2006; 91(5): 417–419.CrossRefGoogle ScholarPubMed
44.Flynn, HA, Davis, M, Marcus, SM, Cunningham, R, Blow, FC. Rates of maternal depression in pediatric emergency department and relationship to child service utilization. Gen Hosp Psychiatry. 2004; 26(4): 316–322.CrossRefGoogle ScholarPubMed
45.McLearn, KT, Minkovitz, CS, Strobino, DM, Marks, E, Hou, W. The timing of maternal depressive symptoms and mothers’ parenting practices with young children: implications for pediatric practice. Pediatrics. 2006; 118(1): e174–e182.CrossRefGoogle ScholarPubMed
46.Grace, SL, Evindar, A, Stewart, DE. The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Arch Womens Ment Health. 2003; 6(4): 263–274.CrossRefGoogle ScholarPubMed
47.Kim, DR, Sockol, L, Barber, JP, etal. A survey of patient acceptability of repetitive transcranial magnetic stimulation (TMS) during pregnancy. J Affect Disord. 2011; 129(1–3): 385–390.CrossRefGoogle ScholarPubMed
48.Dennis, CE. Treatment of postpartum depression, part 2: a critical review of nonbiological interventions. J Clin Psychiatry. 2004; 65: 1252–1265.CrossRefGoogle ScholarPubMed
49.Dennis, CL, Ross, LE, Grigoriadis, S. Psychosocial and psychological interventions for treating antenatal depression. Cochrane Database Syst Rev. 2007; 18(3): CD006309.Google Scholar
50.Dimidjian, S, Goodman, S. Nonpharmacologic intervention and prevention strategies for depression during pregnancy and the postpartum. Clin Obstet Gynecol. 2009; 52: 498–515.CrossRefGoogle ScholarPubMed
51.O'Hara, MW, Stuart, S, Gorman, LL, etal. Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gen Psychiatry. 2000; 57: 1039–1045.CrossRefGoogle ScholarPubMed
52.Brandon, AR, Ceccotti, N, Hynan, LS, etal. Proof of concept: partner-assisted interpersonal psychotherapy for perinatal depression. Arch Womens Ment Health. 2012; 15(6): 469–480.CrossRefGoogle ScholarPubMed
53.Zlotnick, C, Miller, IW, Pearlstein, T, etal. A preventive intervention for pregnant women on public assistance at risk for postpartum depression. Am J Psychiatry. 2006; 163: 1443–1445.CrossRefGoogle ScholarPubMed
54.Teasdale, JD, Segal, Z, Williams, JMG, etal. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. 2000; 68: 615–623.CrossRefGoogle ScholarPubMed
55.Ma, SH, Teasdale, JD. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol. 2004; 72: 31–40.CrossRefGoogle ScholarPubMed
56.U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington, DC: Department of Health and Human Services; 2008.Google Scholar
57.Blumenthal, JA, Babyak, MA, Moore, KA, etal. Effects of exercise training on older patients with major depression. Arch Intern Med. 1999; 159(19): 2349–2356.CrossRefGoogle ScholarPubMed
58.Babyak, M, Blumenthal, JA, Herman, S, etal. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000; 62(5): 633–638.CrossRefGoogle Scholar
59.Blumenthal, JA, Babyak, MA, Doraiswamy, PM, etal. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med. 2007; 69(7): 587–596.CrossRefGoogle ScholarPubMed
60.Robledo-Colonia, AF, Sandoval-Restrepo, N, Mosquera-Valderrama, YF, Escobar-Hurtado, C, Ramírez-Vélez, R. Aerobic exercise training during pregnancy reduces depressive symptoms in nulliparous women: a randomised trial. J Physiother. 2012; 58(1): 9–15.CrossRefGoogle ScholarPubMed
61.Lam, RW, Levitt, AJ. Canadian Consensus Guidelines for the Treatment of Seasonal Affective Disorder. Vancouver: Clinical and Academic Publishing; 1999.Google Scholar
62.American Psychiatric Association. Practice Guidelines for the Treatment of Psychiatric Disorders, Compendium 2000. Washington, DC: American Psychiatric Association; 2000.Google Scholar
63.Lewy, AJ, Wehr, TA, Goodwin, FK, Newsome, DA, Markey, SP. Light suppresses melatonin secretion in humans. Science. 1980; 210: 1267–1269.CrossRefGoogle ScholarPubMed
64.Wirz-Justice, A, Terman, M, Oren, DA, etal. Brightening depression. Science. 2004; 303: 467–469.CrossRefGoogle ScholarPubMed
65.Levitt, AJ, Joffe, RT, Moul, DE, etal. Side effects of light therapy in seasonal affective disorder. Am J Psychiatry. 1993; 150: 650–652.Google ScholarPubMed
66.Terman, M, Terman, JS. Bright light therapy: side effects and benefits across the symptom spectrum. J Clin Psychiatry. 1999; 60: 799–808.CrossRefGoogle ScholarPubMed
67.Gallin, PF, Terman, M, Reme, CE, etal. Ophthalmologic examination of patients with seasonal affective disorder, before and after bright light therapy. Am J Ophthalmol. 1995; 119: 202–210.CrossRefGoogle ScholarPubMed
68.Kripke, DF, Mullaney, DJ, Klauber, MR, Risch, SC, Gillin, JC. Controlled trial of bright light for nonseasonal major depressive disorders. Biol Psychiatry. 1992; 31: 119–134.CrossRefGoogle ScholarPubMed
69.Kripke, DF. Light treatment for nonseasonal depression: speed, efficacy, and combined treatment. J Affect Disord. 1998; 49: 109–117.CrossRefGoogle ScholarPubMed
70.Yamada, N, Martin-Iverson, MT, Daimon, K, Tsujimoto, T, Takahashi, S. Clinical and chronobiological effects of light therapy on nonseasonal affective disorders. Biol Psychiatry. 1995; 37: 866–873.CrossRefGoogle ScholarPubMed
71.Golden, RN, Gaynes, BN, Ekstrom, RD, etal. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry. 2005; 162: 656–662.CrossRefGoogle ScholarPubMed
72.Even, C, Schroder, CM, Friedman, S, Rouillon, F. Efficacy of light therapy in nonseasonal depression: a systematic review. J Affect Disord. 2008; 108: 11–23.CrossRefGoogle ScholarPubMed
73.Oren, DA, Wisner, KL, Spinelli, M, etal. An open trial of morning light therapy for treatment of antepartum depression. Am J Psychiatry. 2002; 159: 666–669.CrossRefGoogle Scholar
74.Epperson, CN, Terman, M, Terman, JS, etal. Randomized clinical trial of bright light therapy for antepartum depression: preliminary findings. J Clin Psychiatry. 2004; 65: 421–425.CrossRefGoogle ScholarPubMed
75.Wirz-Justice, A, Bader, A, Frisch, U, etal. A randomized, double-blind, placebo-controlled study of light therapy for antepartum depression. J Clin Psychiatry. 2011; 72(7): 986–993.CrossRefGoogle ScholarPubMed
76.Gershon, AA, Dannon, PN, Grunhaus, L. Transcranial magnetic stimulation in the treatment of depression. Am J Psychiatry. 2003; 160(5): 835–845.CrossRefGoogle ScholarPubMed
77.Nahas, Z, Bohning, DE, Molloy, MA, etal. Safety and feasibility of repetitive transcranial magnetic stimulation in the treatment of anxious depression in pregnancy: a case report. J Clin Psychiatry. 1999; 60(1): 50–52.CrossRefGoogle ScholarPubMed
78.Klirova, M, Novak, T, Kopecek, M, Mohr, P, Strunzova, V. Repetitive transcranial magnetic stimulation (rTMS) in major depressive episode during pregnancy. Neuro Endocrinol Lett. 2008; 29(1): 69–70.Google ScholarPubMed
79.Zhang, D, Hu, Z. rTMS may be a good choice for pregnant women with depression. Arch Womens Ment Health. 2009; 12(3): 189–190.CrossRefGoogle ScholarPubMed
80.Zhang, X, Liu, K, Sun, J, Zheng, Z. Safety and feasibility of repetitive transcranial magnetic stimulation (rTMS) as a treatment for major depression during pregnancy. Arch Womens Ment Health. 2010; 13(4): 369–370.CrossRefGoogle ScholarPubMed
81.Kim, DR, Epperson, N, Paré, E, etal. An open label pilot study of transcranial magnetic stimulation for pregnant women with major depressive disorder. J Womens Health (Larchmt). 2011; 20(2): 255–261.CrossRefGoogle ScholarPubMed
82.Janicak, PG, O'Reardon, JP, Sampson, SM, etal. Transcranial magnetic stimulation in the treatment of major depressive disorder: a comprehensive summary of safety experience from acute exposure, extended exposure, and during reintroduction treatment. J Clin Psychiatry. 2008; 69(2): 222–232.CrossRefGoogle ScholarPubMed
83.Kennedy, SH, Milev, R, Giacobbe, P, etal. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. IV. neurostimulation therapies. J Affect Disord. 2009; 117(suppl 1): S44–S53.CrossRefGoogle Scholar
84.UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003; 361: 799–808.CrossRefGoogle Scholar
85.Heijnen, WT, Birkenhager, TK, Wierdsma, AI, etal. Antidepressant pharmacotherapy failure and response to subsequent electroconvulsive therapy: a meta-analysis. J Clin Psychopharmacol. 2010; 30: 616–619.CrossRefGoogle ScholarPubMed
86.Rabheru, K, Persad, E. A review of continuation and maintenance electroconvulsive therapy. Can J Psychiatry. 1997; 42: 476–484.CrossRefGoogle ScholarPubMed
87.Rabheru, K. Maintenance electroconvulsive therapy after acute response. J ECT. 2012; 28: 39–47.CrossRefGoogle ScholarPubMed
88.O'Reardon, JP, Cristancho, MA, von Andreae, CV, etal. Acute and maintenance electroconvulsive therapy for treatment of severe major depression during the second and third trimesters of pregnancy with infant follow-up to 18 months: case report and review of the literature. J ECT. 2011; 27: e23–e26.CrossRefGoogle ScholarPubMed
89.Dennis, CL, Allen, K. Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression. Cochrane Database Syst Rev. 2008; 8(4): CD006795.Google Scholar
90.Sado, M, Ota, E, Stickley, A, Mori, R. Hypnosis during pregnancy, childbirth and the postnatal period for preventing postnatal depression. Cochrane Database Syst Rev. 2012; 6(4): CD009062.Google Scholar
91.Manber, R, Schnyer, RN, Lyell, D, etal. Acupuncture for depression during pregnancy: a randomized controlled trial. Obstet Gynecol. 2010; 115(3): 511–520.CrossRefGoogle ScholarPubMed
92.Chung, KF, Yeung, WF, Zhang, ZJ, etal. Randomized non-invasive sham-controlled pilot trial of electroacupuncture for postpartum depression. J Affect Disord. 2012; 142(1–3): 115–121.CrossRefGoogle ScholarPubMed
93.Freeman, MP. Complementary and alternative medicine for perinatal depression. J Affect Disord. 2009; 112(1–3): 1–10.CrossRefGoogle ScholarPubMed
94.Parker, G, Gibson, NA, Brotchie, H, etal. Omega-3 fatty acids and mood disorders. Am J Psychiatry. 2006; 163(6): 969–978.CrossRefGoogle ScholarPubMed
95.Lin, PY, Mischoulon, D, Freeman, MP, etal. Are omega-3 fatty acids antidepressants or just mood-improving agents? The effect depends upon diagnosis, supplement preparation, and severity of depression. Mol Psychiatry. 2012; 17(12): 1161–1163.CrossRefGoogle ScholarPubMed
96.Su, KP, Huang, SY, Chiu, TH, etal. Omega-3 fatty acids for major depressive disorder during pregnancy: results from a randomized, double-blind, placebo-controlled trial. J. Clin Psychiatry.. 2008; 69(4): 644–651.CrossRefGoogle ScholarPubMed
97.Hösli, I, Zanetti-Daellenbach, R, Holzgreve, W, Lapaire, O. Role of omega 3-fatty acids and multivitamins in gestation. J Perinat Med. 2007; 35(suppl 1): S19–S24.CrossRefGoogle ScholarPubMed
98.Cerutti, R, Sichel, MP, Perin, M, Grussu, P, Zulian, O. Psychological distress during puerperium: a novel therapeutic approach using S-adenosylmethionine. Current Therapeutic Research. 1993; 53(6): 707–716.CrossRefGoogle Scholar
99.Lansdowne, AT, Provost, SC. Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology. 1998; 135: 319–323.CrossRefGoogle ScholarPubMed
100.Jorde, R, Sneve, M, Figenschau, Y, Svartberg, J, Waterloo, K. Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. J Intern Med. 2008; 264: 599–609.CrossRefGoogle ScholarPubMed
101.Kjærgaard, M, Waterloo, K, Wang, CE, etal. Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case–control study and randomised clinical trial. Br J Psychiatry. 2012; 201: 360–368.CrossRefGoogle ScholarPubMed
102.Sanders, KM, Stuart, AL, Williamson, EJ, etal. Annual high-dose vitamin D3 and mental well-being: randomised controlled trial. Br J Psychiatry. 2011; 198: 357–364.CrossRefGoogle ScholarPubMed
103.Cassidy-Bushrow, AE, Peters, RM, Johnson, DA, Li, J, Rao, DS. Vitamin D nutritional status and antenatal depressive symptoms in African American women. J Womens Health (Larchmt). 2012; 21(11): 1189–1195.CrossRefGoogle ScholarPubMed
104.Coppen, A, Baily, J. Enhancement of the antidepressant action of fluoxetine by folic acid: a randomised, placebo controlled trial. J Affect Disord. 2000; 60(2): 121–130.CrossRefGoogle ScholarPubMed
105.Lewis, SJ, Araya, R, Leary, S, Smith, GD, Ness, A. Folic acid supplementation during pregnancy may protect against depression 21 months after pregnancy, an effect modified by MTHFR C677T genotype. Eur J Clin Nutr. 2012; 66(1): 97–103.CrossRefGoogle ScholarPubMed
106.Hypericum Depression Trial Study Group. Effect of Hypericum perforatum (St John's wort) in major depressive disorder: a randomized controlled trial. JAMA. 2002; 287: 1807–1814.CrossRefGoogle Scholar
107.Lecrubier, Y, Clerc, G, Didi, R, Kieser, M. Efficacy of St. John's wort extract WS 5570 in major depression: a double-blind, placebo-controlled trial. Am J Psychiatry. 2002; 159(8): 1361–1366.CrossRefGoogle ScholarPubMed
108.Howland, RH. Update on St. John's Wort. J Psychosoc Nurs Ment Health Serv. 2010; 48(11): 20–24.CrossRefGoogle ScholarPubMed