Preventing recurrence of postpartum depression by regulating sleep

ABSTRACT

Introduction

Women are at a high risk of recurrence of depression in the postpartum period. Given the circumscribed duration of the risk period and knowledge of its triggers, postpartum depression should be easily preventable. However, prophylactic drug studies have reported contradictory findings partly due to the heterogeneity of the disorder. Currently, there are no studies on the efficacy of psychotherapy in the prevention of postpartum depression in women with major depressive or bipolar disorder.

Areas Covered

This review evaluates the results of controlled medication and psychotherapeutic studies in the prevention of depression in women with major depressive disorder or bipolar disorder; it further suggests that the management of sleep loss/insomnia may be an effective strategy in the prevention of postpartum depression.

Expert opinion

A thorough understanding of the clinical course of the antecedent mood disorder and historical treatment response is necessary before the implementation of strategies for the prevention of postpartum depression. Targeting disturbed and/or insufficient sleep – a common and early transdiagnostic symptom of peripartum psychiatric disorders – may be a more effective intervention for the prevention of postpartum depression and psychiatric comorbidities in some individuals than the traditional approach of antidepressant use.

KEYWORDS:

• Antidepressants
• depression
• insomnia
• mood stabilizers
• postpartum
• prevention
• sleep

Article highlights

• Challenges and barriers to the uptake of sleep intervention should be acknowledged.

• Sleep and circadian dysregulation are well-documented features as well as risk factors of postpartum depression.

• Targeting insomnia/sleep loss may be effective in the prevention of postpartum depression in some women.

• Emphasizing sleep dysregulation in diagnosis and treatment may reduce stigma-related barriers to care.

• There is a paucity of pharmacological and psychotherapeutic studies on the prevention of postpartum depression in women with major depressive disorder or bipolar disorder.

• It is essential to examine the reasons for discordant research findings and explore clinical opportunities for the effective prevention of postpartum depression and its common psychiatric comorbidities.

• Personalized risk assessment and treatment history could guide the choice of preventative strategies.

Acknowledgments

The authors would like to thank Dr. Katelyn Wood for her assistance in the manuscript preparation.

Declaration of interest

V Sharma reports participation with AMOSO (Academic Medical Organization of Southwestern Ontario). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

KM Sharkey receives funding through grant R01MH118269 from the National Institute of Mental Health.