February 4th, 2010 
In a study to be presented February 4 at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting, The Pregnancy Meeting ™, in Chicago, researchers will unveil findings that show that acupuncture may be an effective treatment for depression during pregnancy.
“Depression during pregnancy is an issue of concern because it has negative effects on both the mother and the baby as well as the rest of the family,” said Dr. Schnyer, one of the study’s authors.
About 10% of pregnant women meet criteria for major depression and almost 20% have increased symptoms of depression during pregnancy. The rates of depression in pregnant women are comparable to rates seen among similarly aged non-pregnant women and among women during the postpartum period, but there are far fewer treatment studies of depression during pregnancy than during the postpartum period.
Dealing with depression is difficult for pregnant women because the use of anti-depressants poses concerns to the developing fetus and women are reluctant to take medications during pregnancy.
In the study, an evaluator-blinded randomized trial, 150 participants who met the Diagnostic & Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for Major Depressive Disorder were randomized to receive either acupuncture specific for depression (SPEC, n=52) or one of two active controls: control acupuncture (CTRL, n=49) or massage (MSSG, n=49). Treatments lasted eight weeks (12 sessions). Junior acupuncturists masked to treatment assignment needled participants at points prescribed by senior acupuncturists. Massage therapists and patients were not blinded. The primary outcome was the Hamilton Rating Scale for Depression, administered by blinded raters at baseline and after four and eight weeks of treatment. Data were analyzed using mixed effects models and by intent-to-treat.
The results showed that the women who received SPEC experienced a significantly greater decrease in depression severity compared to the combined controls or CTRL acupuncture alone. They also had a higher response rate (63.0%) than the combined controls or CTRL acupuncture alone. Symptom reduction and response rates did not differ significantly between controls (CTRL 37.5% and MSSG 50.0%). Mild and transient side effects were reported by 43/150 participants (4 in MSSG; 19 in CTRL, 20 in SPEC). Significantly fewer participants reported side-effects in MSSG than the two acupuncture groups.
“The results of our study show that the acupuncture protocol we tested could be a viable treatment option for depression during pregnancy” said Dr. Schnyer.
Related
- Ear Acupuncture Curbs Back Pain in Pregnant Women
A special acupuncture technique can help ease lower back and pelvic pain in pregnant women, new research shows.
In a study, women who had pressure needles held in place with tape at three acupuncture points in their ears for one week, were more likely to experience significant reductions in lower back and pelvic pain than those who had the needles placed at three “sham” points or women in a control group who didn’t get real or fake acupuncture.
Pregnant women often suffer from pain in the lower back and pelvis — and this can set the stage for chronic pain later on, Dr. Shu-Ming Wang of the Yale School of Medicine in New Haven, Connecticut and colleagues note in the American Journal of Obstetrics & Gynecology.
Ear acupuncture might offer a drug-free way to help ease pain in these women, Wang and colleagues say.
They randomly assigned 159 women in the 25th to 38th week of pregnancy to receive real acupuncture, acupuncture delivered to points that would theoretically not affect pain in the pelvic or lower back area, and a control group.
Every woman was also instructed to use self-care as needed, including resting, taking acetaminophen, and applying warm and cold compresses.
All of the 152 women who completed the two-week study reported some degree of pain reduction and improvement in their ability to function.
A 30 percent or greater reduction in pain was reported by 81 percent of women in the acupuncture group, 59 percent of women in the sham acupuncture group and 47 percent of women in the control group. The difference between the sham and control groups wasn’t statistically significant.
Thirty-seven percent of women in the acupuncture group were pain-free after a week of acupuncture, compared to 22 percent in the sham group and 9 percent of the control group. Improvements in function were significantly greater among women who had real acupuncture compared to those who got the fake version or received no treatment.
But the pain relief didn’t persist for some; a week after the end of acupuncture treatment, 68 percent of those who received the real thing still had a 30 percent or greater reduction in pain compared to the beginning of treatment, while 32 percent in the sham acupuncture group and 18 percent of the control group sustained this level of pain reduction. There was no significant difference among the groups in the percentage remaining free of pain two weeks into the study.
The only side effect was temporary tenderness in the ear area, reported by one woman in the acupuncture group and three in the sham acupuncture group.
The treatment is inexpensive, the researchers note, at a cost of $17 to $20 for a pack of 100 needles, and it takes about three minutes for the needles to be put in place if an experienced person is doing the job.
- Stress, Anxiety Can Up Risk of Depression in Pregnancy
Stress, history of depression, lack of social support and unintended pregnancy are among the major factors that contribute to increased risk of depression in pregnant women, a new study shows.
Other important factors are maternal anxiety, domestic violence and having public insurance coverage, said the University of Michigan researchers, who reviewed 159 studies conducted between 1980 and 2008.
The study appears in the January issue of the American Journal of Obstetrics & Gynecology.
Depression, which occurs in about 12.7 percent of pregnant women, can cause problems for mothers and babies, including pre-term delivery, preeclampsia, sleep disturbances and disrupted mother-infant bonding.
It’s important for physicians to know how to identify depression in pregnant women, said the study authors, who noted that not all women who test positive on depression screening tests have or will develop clinical depression.
“We are hoping that [health-care] providers can use the presence or absence of risk factors such as those identified in our study to enhance their assessments for depression in addition to the information they obtain from the screening test,” study author Dr. Christie A. Lancaster, a clinical lecturer in the obstetrics and gynecology department at U-M, said in a news release.
- Depression while pregnant ‘linked to violent behaviour in children’
Mothers who suffer from ‘baby blues’ while pregnant are four times as likely to have children who become violent teenagers, a new study shows.
The link remained even if the mothers did not suffer depression after their children were born.
Research has previously suggested that postnatal depression can affect a child’s subsequent behavior.
But experts from Cardiff and Bristol universities and King’s College London believe that theirs is one of the first studies to look at the effects of suffering depression before a child’s birth.
Many women are depressed during their pregnancy and research by Tommy’s, the baby charity, suggests that it may even be more common before the birth of a child than after.
It is estimated that as many as between 10 and 15 per cent of women could suffer the condition while they are expecting.
Prof Dale F Hay, from Cardiff University, who led the latest study, said: “Much attention has been given to the effects of postnatal depression on young infants, but depression during pregnancy may also affect the unborn child.”
The study looked at 120 mothers from the Bristol area.
The researchers interviewed the women while they were pregnant, after they gave birth and when their children were aged four, 11, and 16 years old.
Their findings, published in the journal Child Development, show that women who were depressed while they were pregnant were four times as likely to have children who were violent by the age of 16 as the other mothers.
The children were also more likely to exhibit other forms of anti-social behavior, the research found.
However, the study also found that women who had been angry or disruptive teenagers themselves were more likely to go on to be depressed while they were pregnant.
Prof Hay added: “Although it’s not yet clear exactly how depression in pregnancy might set infants on a pathway toward increased anti-social behavior, our findings suggest that women with a history of conduct problems who become depressed in pregnancy may be in special need of support.”
- Talk, drug therapy may ease depression in pregnancy
Women who are depressed during pregnancy can take hope that antidepressants and/or “talk therapy” may be safe and appropriate treatment options, according to new professional guidelines made public this week.
“Depression in pregnant women often goes unrecognized and untreated in part because of concerns about the safety of treating women during pregnancy,” lead author of the guidelines, Dr. Kimberly Ann Yonkers, from Yale University, New Haven, Connecticut, said in a statement.
The guidelines on depression in pregnancy, which are based on an extensive review of prior research, were issued by the American Psychiatric Association and the American College of Obstetricians and Gynecologists.
There are both pros and cons to using antidepressants during pregnancy, the report states. The drugs can effectively treat mom’s depression, which has been linked to problems in the newborn. However, there is also evidence tying them to birth defects and reduced birth weight.
Psychotherapy may be a suitable alternative to antidepressants for some women with mild-to-moderate depression, the report indicates.
According to the report, women thinking about becoming pregnant may possibly taper or discontinue their antidepressants if they have had mild or no symptoms for 6 months or longer.
However, they may need to continue their medications if they have a history of severe, recurrent depression or other major psychiatric illness.
The guidelines suggest that women see a psychiatrist for aggressive treatment if suicidal or acute psychotic symptoms are present.
Pregnant women currently taking antidepressants may be able to remain on the medications if they discuss the pros and cons with their doctors, the guidelines state.
Depending on their mental health history, these women may attempt tapering and going off their medications if symptom-free. Pregnant women taking antidepressants may benefit from psychotherapy if symptoms are still apparent, according to the document.
Pregnant women not currently taking antidepressants may consider psychotherapy as alternative to antidepressants, the report indicates.
- Massage Reduces Depression in Pregnant Women
New research shows massage therapy reduced depression in pregnant women, and also reduced the incidence of massaged women’s babies being born prematurely.
The study was conducted by researchers at the Touch Research Institutes, where pioneering research about massage has been conducted since 1992.
Pregnant women diagnosed with major depression were given 12 weeks of massage, twice per week, by their significant other. A control group did not receive massage, according to an abstract published on www.pubmed.gov.
The massage-therapy group versus the control group not only had reduced depression by the end of the massage-therapy period, they also had reduced depression and cortisol levels during the postpartum period.
The massaged women’s newborns were also less likely to be born prematurely and low birthweight, pubmed noted, and they had lower cortisol levels and performed better on the Brazelton Neonatal Behavioral Assessment habituation, orientation and motor scales.
