The effect of sertraline add-on to brief dynamic psychotherapy for the treatment of postpartum depression: a randomized, double-blind, placebo-controlled study.

OBJECTIVE: The efficacy of antidepressants in the treatment of mild-to-moderate postpartum depression and the possible advantage of the combination of an antidepressant and psychotherapy have not been adequately studied. We hypothesized that psychotherapy and concurrent antidepressant treatment would be more effective than psychotherapy alone in the treatment of postpartum depression. METHOD: Women diagnosed with mild-to-moderate severity postpartum depression according to DSM-IV-TR criteria were enrolled in an 8-week, randomized, double-blind, placebo-controlled study. Participants received 12 sessions of focused brief dynamic psychotherapy (BDP) concurrently with 8-week sertraline or placebo treatment, followed by a 4-week open phase. Primary outcomes were depression scores measured by the Montgomery-Asberg Depression Rating Scale (MADRS) and remission rates. The study was conducted in a referral center from May 2008 to September 2010. RESULTS: Forty of 42 women randomized into the study entered the intent-to-treat analysis. A significant time effect for the MADRS was observed (F4,35 = 21.3, P < .0001); however, no time-by-group effect was found for any outcome measure. Response rates were 70% and 55% for the drug and placebo groups, respectively, and remission rates were 65% and 50%, respectively, with no significant difference between groups. CONCLUSION: While both treatment groups improved significantly, the results of the present study did not demonstrate a significant benefit for sertraline over placebo as an add-on treatment to focused BDP in mild-to-moderate postpartum depression. Because of the study's small sample, the results cannot be viewed as definitive, and a much larger study is needed to confirm these results. Furthermore, the promising potential of focused BDP as an intervention in this population should be studied under controlled conditions. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01028482.

GnRH-agonist induced depressive and anxiety symptoms during in vitro fertilization-embryo transfer cycles.

To determine whether the use of a GnRH agonist inducing a hypogonadic state during IVF-ET cycles induces negative mood symptoms, we conducted a prospective randomized study in 108 women comparing two different controlled ovarian stimulation protocols. A significant phase effect was observed for depression and anxiety symptoms during IVF-ET cycles reflecting an increase in symptoms between the hypogonadal phase and the peak in gonadotropin stimulation; however, the hypogonadal phase induced by the GnRH agonist was not associated with a significant increase in any of the studied mood parameters.

Gonadal steroids and affective symptoms during in vitro fertilization: implication for reproductive mood disorders.

Gonadal steroids (GSs) have been associated with the onset of a number of reproductive-related mood disorders in women, in which fluctuating or unstable hormonal levels are postulated to act as the trigger for the destabilization of mood. There is, however, rather limited direct clinical evidence that can link rapidly changing GS levels with the induction of mood symptoms. We aimed to study the effect of controlled and rapid GS fluctuations on mood in an in vivo model. Women undergoing in vitro fertilization (n=108) were assessed for depression and anxiety levels on 3 time points: during a low estradiol and progesterone baseline, during a gonadotropin stimulated estradiol-dominant phase, and after embryo transfer, during a progesterone-dominant low estrogen phase. Plasma levels for estrogen and progesterone were drawn on these time points. Symptoms of depression and anxiety significantly increased from baseline to the high estradiol levels but were not correlated with estrogen. The sharp drop from high estradiol levels at the estradiol-dominant phase to low levels at the progesterone-dominant phase was significantly correlated with rising depression scores. The rise in progesterone levels from low levels at the estradiol-dominant phase to high levels at the progesterone-dominant phase was significantly and inversely correlated with depression scores. This study suggests that the mechanism underlying the role of estrogen in reproductive-related mood disorders involves an abrupt and precipitous drop in its plasma level that can precipitate negative mood states. This finding has implications on the treatment of GS-related mood disorders.