Evaluating the effectiveness of comprehensive primary health care in local communities: how do general practitioners work with and perceive primary health care services directly funded by government. Report to SA Health.

The South Australian Community Health Research Unit (SACHRU), Flinders University, was contracted by SA Health in 2009-2010 to conduct the study 'Evaluating the effectiveness of comprehensive primary health care in local communities: how do general practitioners work with and perceive primary health care services directly funded by government'. This research study focuses on the links between primary health care (PHC) services directly funded and managed by government and services provided by general practitioners (GPs). It complements research funded under an NH&MRC project grant that is examining evaluation of comprehensive primary health care (CPHC) by working with five PHC service sites in South Australia and one service in Alice Springs

Impact of estradiol variability and progesterone on mood in perimenopausal women with depressive symptoms

OBJECTIVE: To determine whether estradiol variability, ovulatory levels of progesterone, and VMS burden are independently associated with perimenopausal depressive symptomatology. DESIGN AND INTERVENTION: Depressive symptoms, serum levels of estradiol and progesterone, and VMS frequency were assessed weekly in an 8-week observational study. Association of mood with estradiol variability, ovulatory levels of progesterone, and VMS frequency were estimated using generalized estimating equation models. SETTING: Academic medical center. PATIENTS: Fifty unmedicated perimenopausal women with mild-to-moderate depressive symptoms (mean Montgomery-Asberg Depression Rating Scale [MADRS] score 15.5 +/- 5.3). RESULTS: During the study, 90.0% of participants had varying estradiol levels, 51.1% had ovulatory progesterone levels, and 90% had VMS. Greater estradiol variability and absence of progesterone levels consistent with ovulation, but not VMS frequency, are associated with higher levels of depressive symptoms (beta= 0.11, 95% confidence interval [95%CI] [0.04 to 0.18, p=0.001]; beta= -2.62 [95%CI -4.52 to -0.71, p=0.007], respectively), after accounting for higher BMI, lifetime history of depression, and stressful life events. CONCLUSIONS: Increasing dysregulation of ovarian hormones, but not VMS, associates with more depressive symptom burden during perimenopause. These results suggest that perimenopausal mood instability is driven by the underlying hormonal dysregulation of the menopause transition involving changes in both estradiol and progesterone

Exposure to selective serotonin reuptake inhibitors in late pregnancy increases the risk of persistent pulmonary hypertension of the newborn, but the absolute risk is low

Comment on: Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and meta-analysis. [BMJ. 2014

Complementary and alternative medicine therapies for perinatal depression

Complementary and alternative medicine therapies are increasingly sought out by people with psychiatric disorders. In this chapter, we review the evidence for several commonly used CAM therapies (i.e. omega-3 fatty acids, folate, S-adenosyl-methionine, St John\u27s Wort, bright light therapy, exercise, massage, and acupuncture) in the treatment of perinatal depression. A number of these treatments may be reasonable to consider for women during pregnancy or postpartum, but the safety and efficacy of these relative to standard treatments must still be systematically determined. Evidence-based use of complementary and alternative medicine therapies treatments for perinatal depression is discussed. Adequately powered systematic studies are necessary to determine the role of complementary and alternative medicine therapies in the treatment of perinatal depression

Complementary and alternative medicine for the treatment of depressive disorders in women

Complementary and alternative medicine (CAM) therapies are commonly practiced in the United States and are used more frequently among women than men. This article reviews several CAM treatments for depressive disorders in women, with a focus on major depressive disorder across the reproductive life cycle. The CAM therapies selected for this review (ie, S-adenosylmethionine, omega-3 fatty acids, St John\u27s wort, bright light therapy, acupuncture, and exercise) were based on their prevalence of use and the availability of randomized, placebo-controlled data. Further study is necessary to delineate the role of specific CAM therapies in premenstrual syndrome, premenstrual dysphoric disorder, antepartum and postpartum depression, lactation, and the menopausal transition

Omega-3 fatty acid supplementation for perinatal depression and other subpopulations?

While standard antidepressant medications are considered first-line treatments for moderate to severe major depressive disorder (MDD) in pregnant and postpartum women, many clinicians might be surprised to learn that there have been very few randomised, placebo-controlled trials of antidepressant exposure in utero and during breastfeeding has driven patients and clinicians to seek alternatives for treatment. While psychotherapies have received the most systematic study, omega-3 fatty acids (O3) have been rigorously studied in far more trials than antidepressants in either depression during pregnancy or postpartum depression. What is also notable about the study of O3 in perinatal depression in that in this population, O3 have usually been used as monotherapy, while in most studies of O3 for MDD in general, they have been studied adjunctively with standard antidepressants

Antidepressant use in pregnancy: a critical review focused on risks and controversies

OBJECTIVE: Conflicting data have led to controversy regarding antidepressant use during pregnancy. The objectives of this study are to i) review the risks of untreated depression and anxiety, ii) review the literature on risks of exposure to antidepressants during pregnancy, iii) discuss the strengths and weaknesses of the different study designs used to evaluate those risks, and iv) provide clinical recommendations. METHOD: MEDLINE/PubMed was searched for reports and studies on the risk of first-trimester teratogenicity, postnatal adaptation syndrome (PNAS), and persistent pulmonary hypertension (PPHN) with in utero antidepressant exposure. RESULTS: While some individual studies suggest associations between some specific major malformations, the findings are inconsistent. Therefore, the absolute risks appear small. PNAS occurs in up to 30% of neonates exposed to antidepressants. In some studies, PPHN has been weakly associated with in utero antidepressant exposure, while in other studies, there has been no association. CONCLUSION: Exposures of concern include that of untreated maternal illness as well as medication exposure. It is vital to have a careful discussion, tailored to each patient, which incorporates the evidence to date and considers methodological and statistical limitations. Past medication trials, previous success with symptom remission, and women\u27s preference should guide treatment decisions