Słowa kluczowe
połóg
laktacja
karmienie piersią
farmakoterapia
leki przeciwdepresyjne
inhibitory wychwytu zwrotnego
brexanolon
terapia żywieniowa
leczenie biologiczne niefarmakologiczne
elektrowstrząsy
fototerapia
przezczaszkowa stymulacja magnetyczna
muzykoterapia
Jak cytować
Abstrakt
Wstęp: Podstawowym problemem matki z depresją poporodową jest ograniczenie zdolności zaspokajania potrzeb ich dziecka. Depresja matki stwarza poważne zagrożenie dla zdrowia i bezpieczeństwa zarówno matki jak i dziecka. Dla obojga ważne jest włączenie metody leczenia o szybkim początku działania i minimalnym wpływie na dziecko.
Cel: Omówienie rekomendacji towarzystw naukowych oraz wyników randomizowanych kontrolowanych badań dotyczących leczenia karmiących matek z depresją z uwzględnieniem obserwacji klinicznych, aspektów praktycznych i przyszłych kierunków badań.
Metody: Omówienie rekomendacji narodowych towarzystw naukowych oraz wyników metaanaliz i przeglądów systematycznych poświęconych leczeniu depresji zidentyfikowanych w bazach Cochrane i Pubmed przy użyciu słów kluczowych "postanatal" lub "postpartum" lub "puerperium" i "depression". Wyboru artykułów dokonano tematycznie w oparciu o praktyczne aspekty leczenia.
Wyniki: Pomimo szerokiego stosowania, bezpieczeństwo i skuteczność inhibitorów wychwytu zwrotnego serotoniny (SSRI) w leczeniu okołoporodowych zaburzeń nastroju nie została dotąd jednoznacznie potwierdzona. Długotrwała obserwacja zachowania i rozwoju dzieci z wczesną ekspozycją na SSRI aż do okresu dorosłości jest niezbędna dla pełnej oceny ryzyka stosowania leków przeciwdepresyjnych u karmiących matek.
Wnioski: Najbardziej dostępną metodą leczenia depresji w okresie poporodowym pozostaje farmakoterapia, jednak wiedza o bezpieczeństwie stosowania leków przeciwdepresyjnych podczas laktacji jest ciągle niewystarczająca. Konieczna jest indywidualizacja leczenia w zależności od stanu pacjentki, jej specyficznych potrzeb, dostępności metod oraz współistniejących chorób psychicznych i fizycznych.
Bibliografia
(1) Samochowiec J, Rybakowski J, Galecki P, et al. Recommendations of the Polish Psychiatric Association for treatment of affective disorders in women of childbearing age. Part I: Treatment of depression. Psychiatr Pol 2019 Apr 30; 53(2):245-262. DOI:10.12740/PP/103385. Epub 2019 Apr 30. English, Polish. PMID:31317956.
(2) Rozporządzenie Ministra Zdrowia z dnia 16 sierpnia 2018 r. w sprawie standardu organizacyjnego opieki okołoporodowej. Dz. U. 2018, poz. 1756.
(3) Jarema M. [red.]: Standardy leczenia farmakologicznego niektórych zaburzeń psychicznych. Wydawnictwo Via Medica; Gdańsk 2015, wydanie drugie.
(4) Weinberg MK, Tronick EZ. The impact of maternal psychiatric illness on infant development. J Clin Psychiatry 1998; 59 Suppl 2:53-61. Review. PMID:9559760.
(5) Kadriu B, Deng ZD, Kraus C, Henter ID, Lisanby SH, Zarate CA. Not So Fast: Recent Successes and Failures in Treating Depression. J Clin Psychiatry. 2020 May 26; 81(4):19ac13138. DOI:10.4088/JCP.19ac13138. PMID:32459405.
(6) Oates M. Suicide: the leading cause of maternal death. Br J Psychiatry 2003 Oct; 183:279-81. PMID:14519602.
(7) d'Orbán PT. Women who kill their children. Br J Psychiatry 1979 Jun; 134:560-71.
(8) Cooper PJ, Murray L. Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic concept. Br J Psychiatry 1995 Feb; 166(2):191-195.
(9) MacQueen GM, Frey BN, Ismail Z, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 6. Special populations: Youth, women, and the elderly. Can J Psychiatry 2016; 61(9):588-603.
(10) Accortt EE, Cheadle AC, Dunkel Schetter C. Prenatal depression and adverse birth outcomes: an updated systematic review. Matern Child Health J 2015 Jun; 19(6):1306-37. DOI:10.1007/s10995-014-1637-2. Review. PMID:25452215.
(11) Suri R, Lin AS, Cohen LS, Altshuler LL. Acute and long-term behavioral outcome of infants and children exposed in utero to either maternal depression or antidepressants: a review of the literature. J Clin Psychiatry 2014 Oct; 75(10):e1142-52. DOI:10.4088/JCP.13r08926. Review. PMID:25373125.
(12) Brummelte S, Galea LA. Postpartum depression: Etiology, treatment and consequences for maternal care. Horm Behav 2016 Jan; 77:153-66. DOI:10.1016/j.yhbeh.2015.08.008. Epub 2015 Aug 28. Review. PMID:26319224.
(13) Pużyński S, Wciórka J. Klasyfikacja zaburzeń psychicznych i zaburzeń zachowania w ICD-10. Opisy kliniczne i wskazówki diagnostyczne. Stanisław Pużyński, Jacek Wciórka 83-85688-25-0 WydawnictwoVesalius; Kraków 2000, wyd.2.
(14) BC Reproductive Mental Health Program. Best Practice Guidelines for Mental Health Disorders in the Perinatal Period. Vancouver, BC, Canada: BC Reproductive Mental Health; 2014.
(15) Nederlandse Vereniging voor Obstetrie en Gynaecologie. Richtlijn: SSRI-gebruik in de zwangerschap en tijdens de lactatie. North Padre Island, TX: Nederlandse Vereniging voor Obstetrie en Gynaecologie; 2012.
(16) National Collaborating Centre for Mental Health. Antenatal and Postnatal Mental Health: The NICE Guideline on Clinical Management and Service Guidance. London: British Psychological Society and Royal College of Psychiatrists; 2014.
(17) Van Weel-Baumgarten EM, Van Gelderen MG, Grundmeijer HGLM, et al. NHG-Standaard Depressie (tweede herziening). Huisarts Wet 2012; 55:252-259.
(18) Weissman AM, Levy BT, Hartz AJ, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk and nursing infants. Am J Psychiatry 2004; 161:1066-107.
(19) Bazire S. Psychotropic Drug Directory 2018: The Professionals' Pocket Handbook and Aide Memoire. Lloyd-Reinhold Publications Limited 2018.
(20) Davanzo R, Copertino M, De Cunto A et al. Antidepressant drugs and breastfeeding: A review of the literature. Breastfeed Med 2011; 6:89-98.
(21) Wisner KL, Perel JM, Blumer J Serum sertraline and N-desmethylsertraline levels in breast-feeding mother-infant pairs Am J Psychiatry 1998; 155:690-692.
(22) Epperson N, Czarkowski KA: Ward-O’Brien D, et al. Maternal sertraline treatment and serotonin transport in breast-feeding mother-infant pairs. Am J Psychiatry 2001; 158:1631-1637.
(23) Women’s Health Research. Food and Drug Administration Web site. List of Pregnancy Exposure Registries. US Department of Health and Human Services. Web site http://www.fda.gov/ScienceResearch/SpecialTopics/WomensHealthResearch/ucm134848.htm.
(24) Pinheiro E, Bogen DL, Hoxha D, et al. Sertraline and breastfeeding: Review and meta-analysis Arch. Womens Ment Health 2015; 18(2):139-146.
(25) Ministry of Health, Social Services and Equality. Clinical Practice Guideline on the Management of Depression in Adults: SNS Clinical Practice Guidelines. Madrid: Ministry of Health, Social Services and Equality 2014.
(26) Marshall AM, Nommsen-Rivers LA, Hernandez LL, et al. Serotonin transport and metabolism in the mammary gland modulates secretory activation and involution. J Clin Endocrinol Metab 2010 Feb; 95(2):837-46. DOI:10.1210/jc.2009-1575. Epub 2009 Dec 4.
(27) Molyneaux E, Howard LM, McGeown HR, et al. Antidepressant treatment for postnatal depression. Cochrane Database Syst Rev 2014; (9):CD002018.
(28) Dansk Psykiatrisk Selskab, Dansk Selskab for Obstetrik og Gynaekologi, Dansk Paediatrisk Selskab, Dansk Selskab for Klinisk Farmakologi. Anvendelse af psykofarmaka ved graviditet og amning – kliniske reningslinjer. Edition 27.10.2014.
(29) Egen-Lappe V, Hasford J. Drug prescription in pregnancy: analysis of a large statutory sickness fund population. Eur J Clin Pharmacol 2004 Nov; 60(9):659-66. Epub 2004 Oct 7.
(30) Mitchell AA, Gilboa SM, Werler MM, et al. National Birth Defects Prevention Study. Medication use during pregnancy, with particular focus on prescription drugs: 1976-2008. Am J Obstet Gynecol 2011 Jul; 205(1):51.e1-8. DOI:10.1016/j.ajog.2011.02.029. Epub 2011 Apr 22. PMID: 21514558.
(31) De Crescenzo F, Perelli F, Armando M, Vicari S. Selective serotonin reuptake inhibitors (SSRIs) for post-partum depression (PPD): a systematic review of randomized clinical trials. J Affect Disord 2014 Jan; 152-154:39-44. DOI:10.1016/j.jad.2013.09.019. Epub 2013 Oct 5.
(32) Hayes RM, et al. Maternal antidepressant use and adverse outcomes: a cohort study of 228,876 pregnancies. American journal of obstetrics and gynecology 2012; 207(1):49 e1-49 e9. PubMed: 22727349.
(33) Oberlander TF, et al. Pain reactivity in 2-month-old infants after prenatal and postnatal serotonin reuptake inhibitor medication exposure. Pediatrics. 2005; 115(2):411-425. PubMed: 15687451.
(34) Pawluski JL, et al. Prenatal SSRI exposure alters neonatal corticosteroid binding globulin, infant cortisol levels, and emerging HPA function. Psychoneuroendocrinology 2012; 37(7):1019-1028. PubMed: 22177580.
(35) Weikum WM, et al. Prenatal serotonin reuptake inhibitor (SRI) antidepressant exposure and serotonin transporter promoter genotype (SLC6A4) influence executive functions at 6 years of age. Front Cell Neurosci 2013; 7:180. PubMed: 24130516.
(36) Meltzer-Brody S, Colquhoun H, Riesenberg R, et al. Brexanolone injection in post-partum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials. Lancet 2018; 392:1058-1070.
(37) Cooper MC, Kilvert HS, Hodgkins P, Roskell NS, Eldar-Lissai A. Using Matching-Adjusted Indirect Comparisons and Network Meta-analyses to Compare Efficacy of Brexanolone Injection with Selective Serotonin Reuptake Inhibitors for Treating Postpartum Depression. CNS Drugs 2019 Oct; 33(10):1039-1052. DOI:10.1007/s40263-019-00672-w. PMID:31642037.
(38) Cooper MC, Kilvert HS, Hodgkins P, et al. Using Matching-Adjusted Indirect Comparisons and Network Meta-analyses to Compare Efficacy of Brexanolone Injection with Selective Serotonin Reuptake Inhibitors for Treating Postpartum Depression. CNS Drugs. 2019 Oct; 33(10):1039-1052. DOI:10.1007/s40263-019-00672-w.
(39) Lin PY, Mischoulon D, Freeman MP, et al. 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; 17:1161-1163.
(40) Bloch MH, Hannestad J Omega-3 fatty acids for the treatment of depression: Systematic review and meta-analysis. Mol Psychiatry 2012; 17:1272-1282.
(41) Grosso G, Galvano F, Marventano S, et al. Omega-3 fatty acids and depression: scientific evidence and biological mechanisms. Oxid Med Cell Longev 2014; 2014:313570. DOI:10.1155/2014/313570. Epub 2014 Mar 18. Review. PMID:24757497.
(42) Sarris J, Logan AC, Akbaraly TN, et al. Nutritional medicine as mainstream in psychiatry. Lancet Psychiatry 2015; 2:271-274.
(43) Sarris J, Logan AC, Akbaraly TN, et al. International Society for Nutritional Psychiatry Research consensus position statement: Nutritional medicine in modern psychiatry. World Psychiatry 2015; 14:370-371.
(44) Vaziri, F, Nasiri, S, Tavana, Z et al A randomized controlled trial of vitamin D supplementation on perinatal depression: In Iranian pregnant mothers. BMC Pregnancy Childbirth 2016; 16, 239.
(45) Terman M, Terman JS Light therapy for seasonal and non-seasonal depression: efficacy, protocol, safety, and side effects. CNS Spectr 2005; 10:647-663.
(46) Golden RN, Gaynes BN, Ekstrom RD, et al. 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.
(47) Tuunainen A, Kripke DF, Endo T, et al. Light therapy for non-seasonal depression. Cochrane Database Syst Rev 2004; 2:CD004050.
(48) Rastad C, Ulfberg J, Lindberg P: Improvement in fatigue, sleepiness, and health-related quality of life with bright light treatment in persons with seasonal affective disorder and subsyndromal SAD. Depress Res Treat 2011; 2011:543906.
(49) Phipps-Nelson J, Redman JR, Dijk DJ, Rajaratnam SM: Daytime exposure to bright light, as compared to dim light, decreases sleepiness and improves psychomotor vigilance performance. Sleep 2006; 26:695-700.
(50) Vandewalle G, Balteau E, Phillips C, et al. Daytime light exposure dynamically enhances brain responses. Curr Biol 2006; 16:1616-1621.
(51) Espiritu RC, Kripke DF, Ancoli-Israel S, et al. Low illumination experienced by San Diego adults: association with atypical depressive symptoms. Biol Psychiatry 1994; 35:403-407.
(52) Wang EJ, Kripke DF, Stein MT, Parry BL: Measurement of illumination exposure in postpartum women. BMC Psychiatry 2003; 3:1-7.
(53) Sylvenm SM, Papadopoulos FC, Olovsson M, et al. Seasonality patterns in postpartum depression. Am J Obstet Gynecol 2011, 204:e1-e6.
(54) Parry BL, Meliska CJ, Sorenson DL, et al. Plasma melatonin circadian rhythm disturbances during pregnancy and postpartum in depressed women and women with personal or family histories of depression. Am J Psychiatry 2008; 165:1551-1558.
(55) Meltzer-Brody S. New insights into perinatal depression: pathogenesis and treatment during pregnancy and postpartum. Dialogues Clin Neurosci 2011; 13:89-100.
(56) Ahokas A, Kaukoranta J, Wahlbeck K, Aito M Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17beta-estradiol: a preliminary study. J Clin Psychiatry 2001; 62:332-336.
(57) Kripke DF, Elliott JA, Youngstedt SD, et al. Weak evidence of bright light effects on human LH and FSH. J Circadian Rhythms 2010; 8:1-9.
(58) Corral M, Kuan A, Kostaras D. Bright light therapy’s effect on postpartum depression. Am J Psychiatry 2000; 157:303-304.
(59) Corral M, Wardrop AA, Zhang H, et al. Morning light therapy for postpartum depression. Arch Womens Ment Health 2007; 10:221-224.
(60) Anderson EL, Reti IM. ECT in pregnancy: a review of the literature from 1941 to 2007. Psychosom Med 2009; 71:235-42.
(61) Coshal S, Jones K, Coverdale J, Livingston R. An Overview of Reviews on the Safety of Electroconvulsive Therapy Administered During Pregnancy. J Psychiatr Pract 2019 Jan; 25(1):2-6. DOI:10.1097/PRA.0000000000000359. PMID:30633726.
(62) Focht A, Kellner CH. Electroconvulsive therapy (ECT) in the treatment of postpartum psychosis. J ECT 2012; 28:31-3.
(63) Sinha P, Goyal P, Andrade C. A Meta-review of the Safety of Electroconvulsive Therapy in Pregnancy. J ECT 2017 Jun; 33(2):81-88. DOI:10.1097/YCT.0000000000000362.
(64) Thyen A, Narang P, Sarai S, et al. Electroconvulsive Therapy During Pregnancy. Prim Care Companion CNS Disord. 2017 Jul 13; 19(4). pii:17br02096. DOI:10.4088/PCC.17br02096.
(65) Goldstein HH, Weinberg J, Sankstone MI. Shock therapy in psychosis complicating pregnancy: a case report. Am J Psychiatry 1941; 98:201-202.
(66) Protheroe C. Puerperal psychoses: a long term study 1927-1961. Br J Psychiatry 1969; 115:9-30.
(67) Forray A, Ostroff RB. The use of electroconvulsive therapy in postpartum affective disorders. J ECT 2007; 23:188-93.
(68) Babu GN, Thippeswamy H, Chandra PS. Use of electroconvulsive therapy (ECT) in postpartum psychosis – a naturalistic prospective study. Arch Womens Ment Health 2013; 16:247-51.
(69) Reed P, Sermin N, Appleby L, Faragher B. A comparison of clinical response to electroconvulsive therapy in puerperal and non-puerperal psychoses. J Affect Disord 1999; 54:255-256.
(70) Gressier F, Rotenberg S, Cazas O, Hardy P. Postpartum electroconvulsive therapy: a systematic review and case report. Gen Hosp Psychiatry 2015 Jul-Aug; 3(4):310-4. DOI:10.1016/j.genhosppsych.2015.04.009. Epub 2015 Apr 16.
(71) McClintock SM, Choi J, Deng ZD, et al. Multifactorial determinants of the neurocognitive effects of electroconvulsive therapy. J ECT 2014; 30:165-76.
(72) Impastato DJ, Gabriel AR Electroshock therapy during the puerperium. J Am Med Assoc 1957 Mar 23; 163(12):1017-22.
(73) Nitsun M, Szokol JW, Saleh HJ, et al. Pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk. Clin Pharmacol Ther 2006; 79:549-557.
(74) Rabheru K. The use of electroconvulsive therapy in special patient populations. Can J Psychiatry 2001; 46:710-719.
(75) Nobler MS, Sackeim HA, Moeller JR, et al. Quantifying the speed of symptomatic improvement with electroconvulsive therapy: comparison of alternative statistical methods. Convuls Ther 1997; 13:208-21.
(76) Bourgon LN, Kellner CH. Relapse of depression after ECT: a review. J ECT 2000; 16:19-31.
(77) Baker AA. Admitting schizophrenic mothers with their babies. Lancet 1961; 2:557-558.
(78) Cazas O, Glangeaud-Freudenthal NM. The history of Mother-Baby Units (MBUs) in France and Belgium and of the French version of the Marce checklist. ArchWomens Ment Health 2004; 7:53-58.
(79) Liston C, Chen AC, Zebley BD, et al. Default mode network mechanisms of transcranial magnetic stimulation in depression. Biol Psychiatry 2004; 76, 517-526. https://doi.org/10.1016/j.biopsych.2014.01.023.
(80) Berlim MT, Van Den Eynde F, Daskalakis Z. Clinically meaningful efficacy and acceptability of low-frequency repetitive transcranial magnetic stimulation (rTMS) for treating primary major depression: a meta-analysis of randomized, double-blind and sham-controlled trials. Neuropsychopharmacology 2013; 38, 543-551. https://doi.org/10.1038/npp.2012.237.
(81) Berlim, MT, Van Den Eynde F, Tovar-Perdomo S, Daskalakis ZJ. Response, remission and drop-out rates following high-frequency repetitive transcranial magnetic stimulation (rTMS ) for treating major depression: a systematic review and meta-analysis of randomized , double-blind and sham-controlled trials. Psychol Med.2014; 44, 225-239. https://doi.org/10.1017/S003329171300051.
(82) Brunoni AR, Chaimani A, Moffa AH, et al. Repetitive transcranial magnetic stimulation for the acute treatment of major depressive episodes: a systematic review with network metaanalysis. JAMA Psychiatr 2017; 74,143-153. https://doi.org/10.1001/jamapsychiatry2016.3644.
(83) Cole J, Bright K, Gagnon L, McGirr A. A systematic review of the safety and effectiveness of repetitive transcranial magnetic stimulation in the treatment of peripartum depression. J Psychiatr Res 2019 Aug; 115:142-150. DOI:10.1016/j.jpsychires.2019.05.015. Epub 2019 May 16. Review. PMID:31129438.
(84) Vicario CM, Ali M, Felmingham K, et al. A systematic review on the therapeutic effectiveness of non-invasive brain stimulation for the treatment of anxiety disorders. Neurosci. Biobehav Rev 2019; 96:219-231. https://doi.org/10.1016/j.neubiorev.2018.12.012.
(85) Leach LS, Poyser C, Cooklin AR, Giallo R. Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: A systematic review. J Affect Disord 2016 Jan 15; 190:675-686. DOI:10.1016/j.jad.2015.09.063. Epub 2015 Oct 24. Review. PMID:26590515.
(86) Raglio A, Attardo L, Gontero G, Effects of music and music therapy on mood in neurological patients. World J Psychiatry 2015; 5(1):68-78. https://doi.org/10.5498/wjp.v5.i1.68.
(87) Stegemoller EL Exploring a neuroplasticity model of music therapy. J Music Ther 2014; 51(3):211-227. https://doi.org/10.1093/jmt/thu023.
(88) Salomonsson B. The music of containment: Addressing the participants in mother-infant psychoanalytic treatment. Infant Ment Health J 2011; 32(6):599-612. DOI:10.1002/imhj.20319. Epub 2011 Nov 3. PMID: 28520149.
(89) Guétin S, Portet F, Picot MC, et al. Effect of music therapy on anxiety and depression in patients with Alzheimer's type dementia: randomised, controlled study. Dement Geriatr Cogn Disord 2009; 28(1):36-46. DOI:10.1159/000229024. Epub 2009 Jul 23. PMID:19628939.
(90) Shiranibidabadi S, Mehryar A. Music therapy as an adjunct to standard treatment for obsessive compulsive disorder and co-morbid anxiety and depression: A randomized clinical trial. J Affect Disord 2015 Sep 15; 184:13-7. DOI:10.1016/j.jad.2015.04.011. Epub 2015 Apr 11. Erratum In: J Affect Disord. 2017 Nov; 222:40. PMID: 26066780.
(91) Broder-Fingert S, Feinberg E, Silverstein M. Music therapy for children with autism spectrum disorder. J Am Med Assoc 2017; 318(6):523-524, https://doi.org/10.1001/jama.2017.9477.
(92) Boyde C, Linden U, Boehm K, Ostermann T. The use of music therapy during the treatment of cancer patients: a collection of evidence. Global Advances in Health and Medicine 2012; 1(5): 24-29. https://doi.org/10.7453/gahmj.2012.1.5.009. Epub 2012 Nov 1.
(93) Gutgsell KJ, Schluchter M, Margevicius S, et al. Music therapy reduces pain in palliative care patients: a randomized controlled trial. J Pain Symptom Manage 2013; 45(5):822-31. DOI:10.1016/j.jpainsymman.2012.05.008. Epub 2012 Sep 24. Erratum In: J Pain Symptom Manage 2014 Dec; 48(6):1279. PMID:23017609.
(94) Yang WJ, Bai YM, Qin L, et al. The effectiveness of music therapy for postpartum depression: A systematic review and meta-analysis. Complement Ther Clin Pract 2019; 37:93-101. DOI:10.1016/j.ctcp.2019.09.002. Epub 2019 Sep 16. Review. PMID:31541788.
(95) Scope A, Leaviss J, Kaltenthaler E, Parry G, Sutcliffe P, Bradburn M, Cantrell A. Is group cognitive behaviour therapy for postnatal depression evidence-based practice? A systematic review. BMC Psychiatry 2013 Nov 28; 13:321. DOI:10.1186/1471-244X-13-321.
(96) Grigoriadis S, Ravitz P. An approach to interpersonal psychotherapy for postpartum depression: focusing on interpersonal changes. Can Fam Physician 2007 Sep; 53(9):1469-75. PMID: 17872875.
(97) Curry SJ Krist AH Owens DK, et al. Interventions to prevent perinatal depression: US preventive services task force recommendation statement. JAMA 2019; 321:580-587.
(98) Cluxton-Keller F, Bruce ML. Clinical effectiveness of family therapeutic interventions in the prevention and treatment of perinatal depression: A systematic review and meta-analysis. PLoS One 2018 Jun 14; 13(6):e0198730. DOI:10.1371/journal.pone.0198730. eCollection 2018. PMID:29902211.
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