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Recommendations are often vague, contradictory, according to investigators.
A study on best practices in the identification and management of perinatal depression raised more questions than answers.
The study aimed to examine the guidelines for managing perinatal depression in obstetric and pediatric settings, as well as the evidence supporting these guidelines. To do this, the investigators conducted a search for best practices in the Guideline International Network using the term depression; conducted additional searches on Google and other websites; and had discussions with experts in perinatal depression. To be included, guidelines had to describe the management of perinatal depression in obstetric or pediatric care settings; be written in English; and have been published between 1990 and 2021. The investigators found 25 guidelines published by 17 organizations—with 6 organizations publishing more than 1 guideline—that met the aforementioned criteria for inclusion. They then examined the research supporting these guidelines through searches in PubMed and Google Scholar, and conducted a literature review.
The investigators found that most guidelines (n =18, 72%) made recommendations for screening for perinatal depression, and 16 (89%) made several recommendations, including for screening timeframe, setting, and instrumentation. Just over one-third of the guidelines (n = 9, 36%) recommended assessment by severity and instrumentation to confirm depression after screening, and 3 (33%) made several recommendations. Suicide assessment was also analyzed, with 13 guidelines (52%) addressing suicide assessment, 6 (46%) of which recommended immediate evaluation. 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.
The majority of guidelines (n = 21, 84%) made recommendations for treatment, with most (n = 20, 95%) offering several 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 and norepinephrine reuptake inhibitors (SNRIs); 40% recommended psychoeducation throughout the perinatal period; and 19% recommended alternative treatments like bright light therapy and electronic mental health support (ie, self-guided applications). The investigators also noted that literature on reassessment, remission, and care management was limited, and that they identified no literature discussing treatment adjustments for perinatal depression that was unresponsive to psychotherapy or pharmacology.
Overall, the investigators noted that evidence was inadequate or contradictory across all areas, and that of the limited number of studies available, most include small sample sizes or are not of sufficient quality to meaningfully inform clinical practice.
They concluded: “Clinicians may 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 managing perinatal depression.”
1. Falek I, Acri M, Dominguez J, et al. Management of depression during the perinatal period: state of the evidence. Int J Ment Health Syst. 2022;16:21.