In 2019, the US Preventive Providers Job Power (USPSTF) issued suggestions that every one pregnant and postpartum ladies must be evaluated to be able to decide danger for depressive sickness and really helpful that girls at elevated danger must be referred for counseling interventions. Finally the objective is to determine ladies at highest danger for depressive sickness throughout being pregnant and the postpartum interval, in order that we are able to introduce interventions designed to stop despair on this setting.
Of utmost significance is the choice of an efficient intervention. The medical literature reviews on a big selection of interventions designed to stop PPD; nevertheless, many of those interventions haven’t been examined in a number of settings. In a latest examine, researchers explored the usage of dexmedetomidine to scale back the danger of postpartum despair after supply in a gaggle of ladies present process Cesarean part.
What’s Dexmedetomidine? Why Did They Take a look at It?
Dexmedetomidine or DEX is a extremely selective α2 -adrenergic receptor ( α2 -AR) agonist. It’s used generally through the perioperative interval and has sedative, anxiolytic, and analgesic properties. It produces these results by inhibiting central sympathetic outflow by blocking alpha receptors within the brainstem and inhibiting the discharge of norepinephrine.
Plainly the concept DEX could also be used as an antidepressant got here from a 2014 examine from India the place DEX was used for anesthesia in sufferers receiving ECT; this examine famous that sufferers receiving DEX skilled much less agitation and a higher discount in depressive signs. Animal research later demonstrated DEX’s antidepressant results. Precisely how DEX works as an antidepressant will not be absolutely understood; nevertheless, DEX seems to have anti-inflammatory results and upregulates the manufacturing of brain-derived neurotrophic issue (BDNF).
Dexmedetomidine in Postpartum Girls
On this randomized, double-blind, placebo-controlled scientific trial, Zhou and colleagues recruited ladies who had been present process a Cesarean part and who skilled despair throughout being pregnant, outlined as an Edinburgh Postnatal Despair Scale (EPDS) rating of 9 or higher.
After supply, 338 members had been randomized and acquired both an intravenous infusion of DEX (0.5 μg/kg) or saline. Following this infusion, ladies within the DEX group acquired DEX (2.0 μg/kg) and the opioid analgesic sufentanil (2.2 μg/kg); the management group acquired solely sufentanil (2.2 μg/kg).
At 1 and 6 weeks after supply, depressive signs had been measured utilizing the EPDS. The members had been additionally requested about sleep, ache, and different adversarial occasions.
Prevalence of Postpartum Depressive Signs
At Week 1, 12.6% of the ladies within the dexmedetomidine group screened constructive for PPD versus 32.1% of the ladies within the management group. At 6 weeks, 11.4% of the dexmedetomidine group versus 30.3% of the management group screened constructive.
In addition they noticed another variations between the DEX and management teams:
- Insomnia scores within the DEX group had been considerably decreased from baseline to 1 and a pair of days postpartum in comparison with the management group. Nonetheless, there have been no variations in insomnia signs between the teams at 1 and 6 weeks postpartum.
- Girls within the DEX group reported much less ache at 6, 24, and 48 hours after supply than ladies within the management group.
The 2 teams skilled related charges of adversarial occasions; nevertheless, these within the DEX group had larger charges of hypotension (systolic blood strain lower than 90 mm Hg or 20% decrease than baseline).
Fascinating Examine, However Nonetheless Extra questions
This can be a very attention-grabbing examine. In a gaggle of ladies who had elevated EPDS scores throughout being pregnant, postpartum remedy with the α2-adrenergic receptor agonist dexmedetomidine was related to a 60% discount within the prevalence of postpartum dpepressive signs at weeks 1 and at week 6. This represents a major discount of danger in a gaggle of ladies who, as a result of they already had skilled depressive signs throughout regnancy, had been at elevated danger for PPD. As well as, remedy with DEX was related to improved sleep and higher ache management.
The authors of the examine ask whether or not DEX can be utilized to “forestall” postpartum despair. The truth that these ladies already had depressive signs throughout being pregnant raises the likelihood that some (or many?) ladies had been already depressed on the time they had been handled with DEX. That is primarily based on the discovering that girls with PPD usually expertise the onset of depressive signs throughout being pregnant, sometimes over the past trimester. So it’s doable that DEX might forestall postpartum despair, however we should additionally entertain the likelihood that DEX may alleviate or forestall the worsening of already current depressive signs. This publication didn’t embrace information on adjustments in depressive signs in particular person members, info that may assist to separate these prospects.
Another questions to think about:
- Would remedy with DEX cut back danger for PPD in ladies with different danger profiles, corresponding to ladies with a historical past of PPD? Or in ladies with a pregravid historical past of despair? Or ladies within the common inhabitants?
- Given that girls with insomnia throughout late being pregnant and early postpartum interval are at elevated danger for PPD, may the useful results of DEX be associated to enhancements in sleep through the early postpartum interval?
- Earlier research have indicated decrease danger of PPD in ladies with higher peripartum ache management; may the advantages seen with DEX be associated to higher ache aid?
Nonetheless, this examine supplies one other avenue of exploration for the remedy of postpartum despair, an choice that might be administered as soon as on the time of supply. Additional research are wanted to higher perceive which ladies are most probably to learn from this intervention.
A number of different α2-adrenergic receptor ( α2-AR) agonists are at present in the marketplace however will not be used as antidepressants. Clonidine or Catapres is used to deal with ADHD, anxiousness and hypertension. Tizanidine or Zanaflex is used as a muscle relaxant. To the very best of my information, now we have not seen any antidepressants that particularly goal adrenergic receptors.
Ruta Nonacs, MD PhD
Al-Mahrouqi T, Al Alawi M, Freire RC. Dexmedetomidine within the Remedy of Despair: An Up-to-date Narrative Evaluation. Clin Pract Epidemiol Ment Well being. 2023 Aug 30;19:e174501792307240.
Giovannitti JA Jr, Thoms SM, Crawford JJ. Alpha-2 adrenergic receptor agonists: a evaluation of present scientific purposes. Anesth Prog. 2015 Spring;62(1):31-9.
Zhou Y, Bai Z, Zhang W, Xu S, Feng Y, Li Q, Li L, Ping A, Chen L, Wang S, Duan Okay. Impact of Dexmedetomidine on Postpartum Despair in Girls With Prenatal Despair: A Randomized Medical Trial. JAMA Netw Open. 2024 Jan 2;7(1):e2353252.