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Staying Up to Date with Evolving Postpartum Depression Pathophysiology and Treatment Research
Program Introduction
Early diagnosis of PPD is critical for mother-infant outcomes, and new hypotheses in its pathophysiology has led to novel and emerging therapies that can improve these outcomes.
Learning Objectives
After completing this educational activity, you should be able to:
- Examine the impact of delayed diagnosis on outcomes in PPD and best practices for management
- Explore pathophysiological mechanisms related to the expression of PPD symptoms
- Review clinical trial safety, efficacy, and dosing for current and emerging therapeutics for PPD
Target Audience
Psychiatrists, psychiatric NPs, psychiatric PAs, and primary care mental health specialists
Program Description
One in 7 women are impacted by perinatal depression (PND), and half of postpartum depression (PPD) cases begin during pregnancy but are not diagnosed until postpartum. Delayed diagnosis and treatment of PND lead to poor outcomes for both mother and child, and if untreated can be associated with low birth weight in infants, child neurodevelopmental delays, and behavioral differences. New understandings in the pathophysiology of depression and PND have led to the development of novel and emerging therapeutics that are changing the treatment paradigm for these disorders. In this video Drs Rubiahna L. Vaughn, MD, MPH, and Kristina M. Deligiannidis, MD, discuss the neurosteroid mechanism within these new hypotheses and the therapeutics that focus on this mechanism.
Neuroactive steroids (NAS) are metabolites of progesterone localized throughout the stress neurocircuit that regulate inhibition-excitation balance within neural networks and have important roles in the response to stress conditions. Due to vast fluctuations in progesterone in the peripartum and postpartum periods, large physiological shifts in the NAS progesterone metabolite allopregnanolone (ALLO) and changing GABAA receptors (GABAAR) and/or GABA and glutamate concentrations lead to the GABAergic system being compromised and therefore a dysfunctional affective state. It is hypothesized that ALLO acts on GABAAR to shift the network to a healthy state. Many NAS are GABA positive allosteric modulators and generate both phasic and tonic effects, creating a longer effect. Recently approved and several investigational synthetic ALLO drugs are showing promising results with faster onset and lasting effects and are changing the game with regard to the treatment of PPD and depression.
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Support Statement
Supported by an educational grant from Sage Therapeutics, Inc. and Biogen Inc.
Learning Objective
After completing this educational activity, you should be able to:
- Examine the impact of delayed diagnosis on outcomes in PPD and best practices for management
- Explore pathophysiological mechanisms related to the expression of PPD symptoms
- Review clinical trial safety, efficacy, and dosing for current and emerging therapeutics for PPD
Release and Expiration Dates
This CME activity was published in August 2023 and is eligible for AMA PRA Category 1 Credit™ through August 31, 2024.
Statement of Need and Purpose
Postpartum depression (PPD) is the most common medical complication of childbirth. PPD can be disabling, with potential negative effects on maternal health-related quality-of-life (HRQoL) as well as on children and partners. Postpartum depression has been estimated to affect 12% (95% CI 0.04-0.20) of healthy mothers without a prior history of depression. Major gaps exist in screening for postpartum depression and major depression. According to the Centers for Disease Control and Prevention, up to 1 in 5 women were not asked about depression during a prenatal visit, and more than half of pregnant women with depression were not treated. Diagnostic delay has negative consequences for both infants and mothers. Risks when a mothers’ PPD is untreated include weight problems, alcohol and illicit drug use, social relationship problems, breastfeeding problems, or persistent depression. Risks to children of untreated depressed mothers (compared to mothers without PPD) include problems such as poor cognitive functioning, behavioral inhibition, emotional maladjustment, violent behavior, externalizing disorders, and psychiatric and medical disorders in adolescence. An abundance of neuropathophysiological research has been published to suggest there may be a greater understanding of the pathophysiology of PPD emerging. Additionally, there are multiple existing and/or emerging therapies acting upon non-monoaminergic pathways that have published relevant data related to their potential therapeutic effects in postpartum depression. There is a need for psychiatric healthcare professionals and primary care mental health specialists to be aware of the impact of delayed diagnosis as well as emerging opportunities to improve patient outcomes.
Unlabeled and Investigational Usage
The faculty of this educational activity may include discussions of products or devices that are not currently labeled for use by the FDA. Faculty members have been advised to disclose to the audience any reference to an unlabeled or investigational use.
No endorsement of unapproved products or uses is made or implied by coverage of these products or uses.
Please refer to the official prescribing information for each product for discussion of approved indicators, contraindications and warnings.
Review Process
The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.
The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.
© Copyright 2023 Physicians Postgraduate Press, Inc.
Faculty Affiliation
Rubiahna L. Vaughn, MD, MPH |
Kristina M. Deligiannidis, MD |
Financial Disclosure
The CME Institute adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME). Any individuals in a position to control the content of a continuing education activity, including faculty, content developers, reviewers, staff, and others, are required to disclose to learners the presence or absence of any relevant financial relationships with an ACCME-defined ineligible company within the preceding 24 months of the activity. The ACCME defines an “ineligible company” as one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
The CME Institute has mitigated all relevant conflicts of interest prior to the commencement of the activity. None of the individuals involved in the content have relevant financial relationships with ineligible companies except the following:
Dr Deligiannidis has received consulting fees from Sage Therapeutics, Brii Biosciences, GH Research, Neuroscience Software, Gerbera Therapeutics, and Reunion Neuroscience; has received grant/research support from Sage Therapeutics, Premier Healthcare, and Woebot Health; has received honoraria for speaking/teaching from Platform Q Health Education, PeerView Institute for Medical Education, CME Institute, and PRIME Education; and received other financial support (travel expense) from Biogen.
Dr Vaughn has no financial disclosures.
None of the other planners, reviewers, and CME Institute staff for this educational activity have relevant financial relationships with ineligible companies to disclose. All relevant financial relationships have been mitigated.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation