This application is a competing continuation of MH-R01 53735, """"""""Prevention of Recurrent Postpartum Major Depression"""""""". The original study was a randomized clinical trial of immediate post-birth antidepressant administration to prevent the recurrence of postpartum-onset depression (PPMD) in women who had previous episodes of PPMD. The major findings were that the tricyclic antidepressant nortriptyline (NTP) was equivalent to placebo (PL) in preventive efficacy. However, the serotonin selective reuptake inhibitor sertraline (SERT) was significantly more efficacious than placebo in the same preventive treatment model. The primary aim of the proposed study is to test the efficacy of SERT for the prevention of PPMD in a broader population of women. SERT was determined to be efficacious for the prevention of PPMD in women who had previous episodes specifically of PPMD; therefore, all subjects had at least one child. We will replicate the successful SERT vs PL study with an expanded population of subjects. Women who have had at least one episode of MD prior to the index pregnancy will be included. We will also determine the optimal duration of preventive therapy. During the previous study, SERT was tapered and discontinued at from weeks 17-20. The protection against recurrence was quickly lost, and the risk approached that of the PL-treated group. Therefore, the period of preventive therapy will be extended to the 24 weeks. We will re-randomize the women who respond to SERT at 24 weeks to either continued SERT or PL in order to assess both the durability of and necessity for longer-term preventive therapy. We will evaluate the effects of SERT exposure to infants through breast milk on pediatric and developmental outcomes at one year. Monitoring procedures included mother and infant serum antidepressant levels. Developmental evaluations of infants through 12 months of age will be performed. Maternal MD, an exposure that clearly has a negative impact upon several aspects of child development, also will be considered as an exposure with effects on child outcomes.
| Moses-Kolko, Eydie L; Price, Julie C; Wisner, Katherine L et al. (2012) Postpartum and depression status are associated with lower [[¹¹C]raclopride BP(ND) in reproductive-age women. Neuropsychopharmacology 37:1422-32 |
| Okun, Michele L; Luther, Jim; Prather, Aric A et al. (2011) Changes in sleep quality, but not hormones predict time to postpartum depression recurrence. J Affect Disord 130:378-84 |
| Hanusa, Barbara H; Scholle, Sarah Hudson; Haskett, Roger F et al. (2008) Screening for depression in the postpartum period: a comparison of three instruments. J Womens Health (Larchmt) 17:585-96 |
| Moses-Kolko, Eydie L; Wisner, Katherine L; Price, Julie C et al. (2008) Serotonin 1A receptor reductions in postpartum depression: a positron emission tomography study. Fertil Steril 89:685-92 |
| Peindl, Kathleen S; Wisner, Katherine L; Hanusa, Barbara H (2004) Identifying depression in the first postpartum year: guidelines for office-based screening and referral. J Affect Disord 80:37-44 |
| Epperson, C Neill; Terman, Michael; Terman, Jiuan Su et al. (2004) Randomized clinical trial of bright light therapy for antepartum depression: preliminary findings. J Clin Psychiatry 65:421-5 |
| Wisner, Katherine L; Hanusa, Barbara H; Peindl, Kathleen S et al. (2004) Prevention of postpartum episodes in women with bipolar disorder. Biol Psychiatry 56:592-6 |
| Peindl, Kathleen S; Wisner, Katherine L (2003) Successful recruitment strategies for women in postpartum mental health trials. J Psychiatr Res 37:117-25 |
| Oren, Dan A; Wisner, Katherine L; Spinelli, Margaret et al. (2002) An open trial of morning light therapy for treatment of antepartum depression. Am J Psychiatry 159:666-9 |
| Wisner, K L; Perel, J M; Blumer, J (1998) Serum sertraline and N-desmethylsertraline levels in breast-feeding mother-infant pairs. Am J Psychiatry 155:690-2 |
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