The association of serum C-reactive protein with the occurrence and course of postpartum depression.

CRP has been positively correlated with depressive symptomatology but this has received less study in postpartum depression (PPD). In this secondary analysis of a trial of PPD treatment, depressive symptoms (Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Symptoms (SIGH-ADS29)) and serum CRP levels were assessed and associations between CRP and SIGH-ADS29 scores evaluated. The associations between baseline log CRP and depression response and remission were also assessed. Of the 35 women included, neither baseline log CRP nor exit log CRP was significantly associated with SIGH-ADS29 score. Baseline CRP was not associated with response or remission. In this sample of women with PPD, CRP was not associated with depressive symptoms nor response to treatment.

Twice the negativity bias and half the positivity offset: Evaluative responses to emotional information in depression.

BACKGROUND AND OBJECTIVES: Humans have the dual capacity to assign a slightly pleasant valence to neutral stimuli (the positivity offset) to encourage approach behaviors, as well as to assign a higher negative valence to unpleasant images relative to the positive valence to equally arousing and extreme pleasant images (the negativity bias) to facilitate defensive strategies. We conducted an experimental psychopathology study to examine the extent to which the negativity bias and the positivity offset differ in participants with and without major depression.. METHOD: Forty-one depressed and thirty-six healthy participants were evaluated using a structured clinical interview for DSM-IV Axis I disorders, questionnaires, and a computerized task designed to measure implicit affective responses to unpleasant, neutral, and pleasant stimuli. RESULTS: The negativity bias was significantly higher and the positivity offset was significantly lower in depressed relative to healthy participants.. LIMITATIONS: Entry criteria enrolling medication-free participants with minimal DSM-IV comorbidity may limit generalizability of the findings. CONCLUSIONS: This study advances our understanding of the positive and negative valence systems in depression, highlighting the irregularities in the positive valence system..

The negativity bias predicts response rate to Behavioral Activation for depression.

BACKGROUND AND OBJECTIVES: This treatment study investigated the extent to which asymmetric dimensions of affective responding, specifically the positivity offset and the negativity bias, at pretreatment altered the rate of response to Behavioral Activation treatment for depression. METHOD: Forty-one depressed participants were enrolled into 16 weekly sessions of BA. An additional 36 lifetime healthy participants were evaluated prospectively for 16 weeks to compare affective responding between healthy and remitted patients at post-treatment. All participants were assessed at Weeks 0, 8 and 16 using repeated measures, involving a structured clinical interview for DSM-IV Axis I disorders, questionnaires, and a computerized task designed to measure affective responses to unpleasant, neutral, and pleasant images. RESULTS: The negativity bias at pre-treatment predicted the rate of response to BA, while the positivity offset did not. LIMITATIONS: Only one treatment condition was used in this study and untreated depressed participants were not enrolled, limiting our ability to compare the effect of BA. CONCLUSIONS: Baseline negativity bias may serve as a signal for patients to engage in and benefit from the goal-directed BA strategies, thereby accelerating rate of response.

Transdermal estradiol treatment during breastfeeding: maternal and infant serum concentrations.

We examined estradiol (E2) and estrone (E1) concentrations in breastfeeding mother-infant dyads. The mothers had postpartum depression and were participants in a randomized clinical trial with three treatments (transdermal E2, sertraline, and placebo). Neither infant E1 and E2 concentrations nor infant growth differed across the treatments. Transdermal E2 administration of 50 to 200 mcg/day for breastfeeding women did not affect infant E1 or E2 concentrations or infant growth.

Differences in the neural correlates of affective responses in depressed and healthy women.

We aimed to characterize the extent to which there were differences in neural activation between female participants who were diagnosed with or without depression while viewing negative and neutral imagery. The study enrolled 105 medication-free, right-handed female participants between 17 and 63 years who met criteria for current Major Depressive Disorder (n=47) or no prior psychiatric diagnoses (n=58). All participants completed a clinical assessment and underwent a functional Magnetic Resonance Imaging (fMRI) scan while responding to an implicit affect task that required them to identify the location of ideographs embedded in one of four corners of each valenced image. When unpleasant (termed negative) stimuli were presented, depressed relative to healthy participants showed significantly decreased activation of the left amygdala and right Inferior Parietal Lobe (IPL). When activation was assessed during the negative versus neutral condition, depressed relative to healthy participants showed significantly increased activation in the Anterior Cingulate Cortex (ACC) and the left IPL. Notably, within-group analyses of healthy participants under the negative condition showed that depressive severity was positively correlated with activation in the left amygdala and left IPL. Our findings suggest that depression influences bottom-up and top-down processing of unpleasant information.

Obsessions and Compulsions in Postpartum Women Without Obsessive Compulsive Disorder.

BACKGROUND: To describe the prevalence of obsessions and compulsions and the specific symptoms present in postpartum women without obsessive compulsive disorder (OCD). METHODS: In this prospective cohort, women were screened with the Yale Brown Obsessive Compulsive Scale at 2 weeks postpartum. Demographics and comorbid psychiatric symptoms were compared between women with screen-positive OCD, screen-negative OCD but with some endorsed symptoms (subclinical OCD), and no OCD symptoms. The prevalence of each specific set of obsessive and compulsive symptoms and the rate of impairment from those symptoms were compared. RESULTS: Of the 461 women included, 52 (11.2%) screened positive for OCD, while 173 (37.5%) reported experiencing subclinical obsessions or compulsions. This subclinical OCD was associated with an increased rate of depression (24%) and state-trait anxiety (8%) compared with women who did not endorse experiencing any obsessions or compulsions. Aggressive, religious, and somatic obsessions as well as obsessions with symmetry, when present, were most likely to result in OCD screen positivity. CONCLUSIONS: Nearly half of all women who screen negative for OCD experienced obsessions or compulsions that did not result in OCD screen positivity. However, the presence of these subclinical obsessions and compulsions is associated with an increased rate of depression or anxiety.

Neural substrates of negativity bias in women with and without major depression.

BACKGROUND: The functional localization of negativity bias, an influential index of emotion information processing, has yet to be identified. METHOD: Depressed (n=47) and healthy participants (n=58) completed a clinical interview for DSM-IV Axis I disorders, symptom checklists, a behavioral task to measure negativity bias, and then viewed positive and negative images of social and nonsocial scenes during an event-related fMRI task. Two subsamples of participants with high (i.e., 75%; n=26) and low (i.e., 25%; n=26) negativity bias scores were as included in subsequent analyses to examine neural differences. RESULTS: Depressed participants with a higher, relative to lower, negative bias showed significantly greater neural activation in the left inferior frontal gyrus. CONCLUSION: High negativity bias evokes a distinctive pattern of brain activation in the frontal cortex of depressed participants. Increased activation occurred in the left inferior frontal gyrus, related to Brodmann area 44, which is associated with language and semantic processing, response inhibition, and cognitive reappraisal. This finding may reflect an abnormality in integrative emotional processing rather than processing of individual emotional dimensions in depressed participants with negativity bias.

Affective reactivity differences in pregnant and postpartum women.

Reactions to emotional cues, termed affective reactivity, promote adaptation and survival. Shifts in affective reactivity during pregnancy and postpartum may invoke altered responses to environmental and biological changes. The development and testing of affective reactivity tasks, with published normative ratings for use in studies of affective reactivity, has been based on responses provided by healthy college students. A comparison of the healthy norms with ratings provided by peripartum women has yet to be conducted, despite its value in highlighting critical differences in affective reactivity during peripartum phases. This study compared arousal ratings of unpleasant, neutral, pleasant, and threat stimuli from the International Affective Picture System (IAPS; Lang, P.J., Bradley, M.M., Cuthbert, B.N. 2008. International Affective Picture System (IAPS): Affective Ratings of Pictures and Instruction Manual (Technical Report A-8). University of Florida, Gainseville, FL.) between three samples: (a) women measured during pregnancy and again at postpartum, (b) age-matched nonpregnant women, and (c) college-aged women from the normative sample used to test the stimuli. Using mixed-design GLMs, results showed that the pregnant and postpartum women and the age-matched women showed suppressed arousal relative to the college-age women. Additionally, postpartum women showed increased arousal to unpleasant/threat images compared to other types of images. The data suggest that future research on peripartum women should include affective reactivity tasks based on norms reflective of this specific population.

Sertraline and breastfeeding: review and meta-analysis.

We examined the risk-benefit profile of sertraline treatment during breastfeeding, summarized the available literature on sertraline use, presented previously unpublished data, and performed a correlation-based meta-analysis of sertraline serum levels in mother-infant pairs. We conducted a search of PubMed and the National Library of Medicine LactMed database. We performed a meta-analysis to examine correlations between maternal and infant serum sertraline levels in the existing literature and in previously unpublished data. Of 167 available infant sertraline levels, 146 (87.4 %) were below the limit of detection, and the meta-analysis found no significant relationship between maternal and infant sertraline concentrations. Of 150 infant desmethylsertraline levels, 105 (70.0 %) were below the limit of detection. The correlation analysis revealed a significant relationship between maternal and infant desmethylsertraline concentrations, but this metabolite has only a fraction of the activity of sertraline. A significant relationship was also found for the sum of sertraline and desmethylsertraline, which stems primarily from the contribution of desmethylsertraline. Sertraline is a first-line drug for breastfeeding women due to documented low levels of exposure in breastfeeding infants and very few adverse events described in case reports. Based on the current literature, neither routine serum sampling nor genotyping is warranted for breastfeeding mothers taking sertraline and/or their infants. Routine pediatric care is appropriate monitoring for breastfed infants of women who take sertraline monotherapy.

The impact of perinatal depression on the evolution of anxiety and obsessive-compulsive symptoms.

We sought to examine the evolution of postpartum anxiety, obsessions and compulsions over time, and the influence of depression on their clinical course. This was a prospective cohort of obstetric patients enrolled at a tertiary care women's hospital. Women were recruited immediately postpartum and followed for 6 months. Women were screened for depression, state-trait anxiety, and obsessive-compulsive symptoms and dichotomized by the presence of depression. Four hundred sixty-one women agreed to participate in the study and completed the 2 weeks postpartum assessment; 331 (72 %) women completed the assessment at 6 months postpartum. At 2 weeks postpartum, 28 (19.9 %) women with depression had anxiety symptoms, compared to 4 (1.3 %) women who screened negative for depression (p < 0.001). Similarly, 36 (25.7 %) women with depression endorsed obsessions and compulsions compared to 19 (8.4 %) women without depression (p < 0.001). A significant interaction effect was present with anxiety over time such that by 6 months postpartum, there were no differences in symptoms in women with and without depression (p = 0.860). Conversely, the differences in obsessions and compulsions between depressed and non-depressed women persisted (p = 0.017). Women with postpartum depression are more likely to experience comorbid state-trait anxiety and obsessive-compulsive symptoms in the immediate postpartum period. While state-trait anxiety symptoms tend to resolve with time, obsessive-compulsive symptoms persist. Understanding these temporal trends is critical to tailor appropriate monitoring and treatment.

Frontal alpha EEG asymmetry before and after behavioral activation treatment for depression.

BACKGROUND: Mid-frontal and mid-lateral (F3/F4 and F7/F8) EEG asymmetry has been associated with motivation and affect. We examined alpha EEG asymmetry in depressed and healthy participants before and after Behavioral Activation treatment for depression; examined the association between alpha EEG asymmetry and motivational systems and affect; and evaluated the utility of alpha EEG asymmetry in predicting remission. METHODS: Depressed (n=37) and healthy participants (n=35) were assessed before and after treatment using a clinical interview, a task to measure baseline EEG, and questionnaires of behavioral activation and inhibition, avoidance, and affect. RESULTS: Alpha EEG asymmetry was significantly higher in depressed than healthy participants at pre-treatment, positively correlated with negative affect and behavioral inhibition, and inversely correlated with lower behavioral activation sensitivity. CONCLUSIONS: Heightened alpha EEG asymmetry in depressed participants was significantly associated with increased behavioral inhibition and negative emotion and was independent of clinical remission.

Spatial affect learning restricted in major depression relative to anxiety disorders and healthy controls.

Detecting and learning the location of unpleasant or pleasant scenarios, or spatial affect learning, is an essential skill that safeguards well-being (Crawford & Cacioppo, 2002). Potentially altered by psychiatric illness, this skill has yet to be measured in adults with and without major depressive disorder (MDD) and anxiety disorders (AD). This study enrolled 199 adults diagnosed with MDD and AD (n=53), MDD (n=47), AD (n=54), and no disorders (n=45). Measures included clinical interviews, self-reports, and a validated spatial affect task using affective pictures (IAPS; Lang, Bradley, & Cuthbert, 2005). Participants with MDD showed impaired spatial affect learning of negative stimuli and irrelevant learning of pleasant pictures compared with non-depressed adults. Adults with MDD may use a "GOOD is UP" heuristic reflected by their impaired learning of the opposite correlation (i.e., "BAD is UP") and performance in the pleasant version of the task.

Affective information processing in pregnancy and postpartum with and without major depression.

Adults with clinical depression exhibit systematic errors in their recognition and interpretation of affective stimuli. This study investigated the extent to which depression and phases of pregnancy and postpartum influence affective processing of positive and negative information, and the extent to which affective information processing in pregnancy predicts depressive symptoms in postpartum. Data were collected from 80 unmedicated women, diagnosed with major depressive disorder (MDD) or with no psychiatric disorder and between ages 18 and 44 years, during 32-36 weeks of pregnancy and during 6-8 weeks postpartum. All completed a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) Axis I review, symptom reports, and a computer task measuring affective information processing. Significant group differences were found in which postpartum women with major depression were less responsive to negative stimuli, with lower ratings of intensity and reactions to negative pictorial stimuli, compared with postpartum healthy women. Also, lower ratings of the intensity and reactions to negative stimuli during pregnancy among depressed women predicted postpartum depression severity, even after controlling for depressive severity and affect ratings in pregnancy. Blunted affective reactivity to negative stimuli is a characteristic of depression that was observed among depressed women during pregnancy and postpartum in our study.

Exploring sudden gains in behavioral activation therapy for Major Depressive Disorder.

Understanding the onset and course of sudden gains in treatment provides clinical information to the patient and clinician, and encourages clinicians to strive for these sudden clinical gains with their patients. This study characterizes the occurrence of sudden gains with Behavioral Activation (BA; Martell, Addis, & Jacobson, 2001), and the extent to which pre-treatment dysfunctional depressive thinking predicts sudden gains during treatment. We enrolled a sample of adults (n = 42) between ages 18-65 diagnosed with primary Major Depressive Disorder. All participants completed a 16-week course of BA, with clinical and self-report assessments at pre-, mid- and post-treatment. Results indicated that sudden gain and non-sudden gain participants showed differential improvement across treatment. No significant effects emerged for the dysfunctional cognitive style as a predictor of sudden gain status. Sudden gains may result from interaction of non-specific factors with the BA techniques implemented during early phases of therapy.

How do depressed and healthy adults interpret nuanced facial expressions?

This study investigates the discrimination accuracy of emotional stimuli in subjects with major depression compared with healthy controls using photographs of facial expressions of varying emotional intensities. The sample included 88 unmedicated male and female subjects, aged 18-56 years, with major depressive disorder (n = 44) or no psychiatric illness (n = 44), who judged the emotion of 200 facial pictures displaying an expression between 10% (90% neutral) and 80% (nuanced) emotion. Stimuli were presented in 10% increments to generate a range of intensities, each presented for a 500-ms duration. Compared with healthy volunteers, depressed subjects showed very good recognition accuracy for sad faces but impaired recognition accuracy for other emotions (e.g., harsh, surprise, and sad expressions) of subtle emotional intensity. Recognition accuracy improved for both groups as a function of increased intensity on all emotions. Finally, as depressive symptoms increased, recognition accuracy increased for sad faces, but decreased for surprised faces. Moreover, depressed subjects showed an impaired ability to accurately identify subtle facial expressions, indicating that depressive symptoms influence accuracy of emotional recognition.