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Cited by 124Maternal Mental Health During Pregnancy and PostpartumComplementary and Alternative Medicine StudiesMedicinal Plant Extracts Effects

Complementary and alternative medicine therapies for perinatal depression

Open access
Deligiannidis, Kristina M., Freeman, Marlene P.·2014·Best Practice & Research Clinical Obstetrics & Gynaecology
DOI 10.1016/j.bpobgyn.2013.08.007PMC PMC3992885
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Abstract

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's 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.

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Crossref · 10.1016/j.bpobgyn.2013.08.007

Cites

104 of 104 references verified0 citation errors · 0 not checkable

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Claims the paper makes

0 of 111 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Omega-3 fatty acids are best studied as an augmentation treatment rather than monotherapy for MDD.

    “they are best studied as an augmentation treatment [23-25] rather than monotherapy [26].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [23] Su, 2003, Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial, Eur Neuropsychopharmacol source

      Not checked in the free run.

    • cites [24] Nemets, 2002, Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder, Am J Psychiatry source

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    • cites [25] Kumar, 1984, A prospective study of emotional disorders in childbearing women, Br J Psychiatry source

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    • cites [26] Freeman, 2006, Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry, J Clin Psychiatry source

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  • Premisecitation

    Untreated depression during pregnancy is associated with obstetrical and neonatal complications.

    “Untreated depression during pregnancy poses risks to the mother and baby, including obstetrical and neonatal complications [3-8].”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [3] Bodnar, 2009, Prepregnancy body mass index, gestational weight gain, and the likelihood of major depressive disorder during pregnancy, J Clin Psychiatry source

      Not checked in the free run.

    • cites [4] Britton, 2011, Infant temperament and maternal anxiety and depressed mood in the early postpartum period, Women Health source

      Not checked in the free run.

    • cites [5] Chung, 2001, Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes, Psychosom Med source

      Not checked in the free run.

    • cites [6] Cripe, 2011, Risk of preterm delivery and hypertensive disorders of pregnancy in relation to maternal co-morbid mood and migraine disorders during pregnancy, Paediatr Perinat Epidemiol source

      Not checked in the free run.

    • cites [7] Grote, 2010, A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [8] Jablensky, 2005, Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders, Am J Psychiatry source

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  • Premisecitation

    Postnatal depression is associated with increased risk of developmental delay and lower IQ scores.

    “increased risk of developmental delay and lower IQ scores [12]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Lindahl, 2005, Prevalence of suicidality during pregnancy and the postpartum, Arch Womens Ment Health source

      Not checked in the free run.

  • Premisecitation

    In a recent UK study, more than one quarter of pregnant women reported using a CAM therapy.

    “In a recent UK study, more than a quarter of women reported use of a CAM during pregnancy [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Wu, 2007, Use of complementary and alternative medicine among women with depression: results of a national survey, Psychiatr Serv source

      Not checked in the free run.

  • Premisecitation

    Meta-analyses of randomized controlled trials show a statistically significant antidepressant benefit of omega-3 fatty acids in mood disorders overall.

    “Meta-analyses of randomized controlled trials demonstrate a statistically significant antidepressant benefit of omega-3 fatty acids in mood disorders overall”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [23] Su, 2003, Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial, Eur Neuropsychopharmacol source

      Not checked in the free run.

    • cites [24] Nemets, 2002, Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder, Am J Psychiatry source

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    • cites [25] Kumar, 1984, A prospective study of emotional disorders in childbearing women, Br J Psychiatry source

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  • Classified as probably not a substantial claim. 11
  • May combine two claims. 23

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Women are more likely than men to suffer from MDD and anxiety disorders, for which CAM treatments are commonly pursued.

    “In general, women use CAM treatments more frequently than men, and are also more likely to suffer from disorders such as MDD and anxiety disorders, for which CAM treatments are commonly pursued [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Barnes, 2009, Complementary and alternative medicine use among adults and children: United States, 2007, Natl Health Stat Report

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Maternal suicide accounts for up to 20% of postnatal deaths in depressed women.

    “maternal suicide accounts for up to 20% of postnatal deaths in depressed women [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Bishop, 2011, The use of complementary and alternative medicine in pregnancy: data from the Avon Longitudinal Study of Parents and Children (ALSPAC), Complement Ther Med source

      Not checked in the free run.

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    Premisecitation

    Postnatal depression is associated with attachment insecurity.

    “attachment insecurity [11]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Deave, 2008, The impact of maternal depression in pregnancy on early child development, BJOG source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Women use CAM treatments more frequently than men.

    “In general, women use CAM treatments more frequently than men, and are also more likely to suffer from disorders such as MDD and anxiety disorders, for which CAM treatments are commonly pursued [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Barnes, 2009, Complementary and alternative medicine use among adults and children: United States, 2007, Natl Health Stat Report

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The number of adequately powered, well-designed randomized clinical trials of CAM treatments is limited.

    “Despite the growing prevalence of CAM use, the number of adequately powered, well-designed randomized clinical trials of CAM treatments is limited.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Depression during pregnancy is a major risk factor for postnatal depression.

    “Depression during pregnancy is a major risk factor for postnatal depression [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Gotlib, 1991, Prospective investigation of postpartum depression: factors involved in onset and recovery, J Abnorm Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Omega-3 fatty acids have well-established health benefits and particular benefits for obstetrical outcomes and infant development.

    “Omega-3 fatty acids are essential fatty acids with well-established health benefits and particular benefits for obstetrical outcomes and infant development [17,18].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [17] McGregor, 2001, The omega-3 story: nutritional prevention of preterm birth and other adverse pregnancy outcomes, Obstet Gynecol Surv source

      Not checked in the free run.

    • cites [18] Koletzko, 2008, The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations, J Perinat Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Postnatal depression is associated with difficult infant and childhood temperament.

    “including difficult infant and childhood temperament [10]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Forman, 2007, Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship, Dev Psychopathol source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Omega-3 fatty acids are among the most commonly used CAM treatments in the United States.

    “Omega-3 fatty acids are among the most commonly used CAM treatments in the United States (U.S.) [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Hibbeln, 2007, Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study, Lancet source

      Not checked in the free run.

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    Premisecitation

    In a placebo-controlled trial, folate augmentation of fluoxetine produced significantly greater improvement, most pronounced in women.

    “Folate has been studied in a placebo-controlled trial an adjunctive treatment to fluoxetine, with significantly greater improvement in the folate group, a difference most pronounced in women [43].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Papakostas, 2012, l-Methylfolate as adjunctive therapy for SSRI-resistant major depression: results of two randomized, double-blind, parallel-sequential trials, Am J Psychiatry source

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    Premisecitation

    St John's Wort at 300-1200 mg per day had an advantage over placebo and efficacy similar to tricyclic or SSRI antidepressants, with better efficacy than standard antidepressant in a subgroup with mild to moderate depression.

    “St. John’s Wort, at a daily dosage of 300-1200mg, had an advantage over placebo and efficacy similar to tricyclic or SSRI antidepressants, with better efficacy than the standard antidepressant in a subgroup of patients with mild to moderate depression [55].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [55] Murphy, 2005, Interaction of St John's Wort with oral contraceptives: effects on the pharmacokinetics of norethindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding, Contraception source

      Not checked in the free run.

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    Premisecitation

    Several placebo-controlled randomized controlled trials and two meta-analyses found SAMe at 200-1600 mg per day significantly more efficacious than placebo and equivalent to tricyclic antidepressants for depression, while a couple of studies found it equivalent to placebo.

    “Several placebo-controlled RCTs and two meta-analyses found SAMe, studied in doses of 200-1600mg per day, significantly more efficacious than placebo and equivalent to tricyclic antidepressants, in the treatment of depression, while a couple of studies report it equivalent to placebo [48-50].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [48] Bressa, 1994, S-adenosyl-l-methionine (SAMe) as antidepressant: meta-analysis of clinical studies, Acta Neurol Scand Suppl source

      Not checked in the free run.

    • cites [49] Hardy, 2002

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    • cites [50] Papakostas, 2010, S-adenosyl methionine (SAMe) augmentation of serotonin reuptake inhibitors for antidepressant nonresponders with major depressive disorder: a double-blind, randomized clinical trial, Am J Psychiatry source

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    Premisecitation

    In that trial, the DHA group had fewer very preterm births but more post-term births requiring obstetric intervention than the control group.

    “There were fewer very preterm births (<34 weeks’ gestation) in the DHA group compared with the control group but more post-term births requiring obstetric intervention in the DHA group compared with the control group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Su, 2008, Omega-3 fatty acids for major depressive disorder during pregnancy: results from a randomized, double-blind, placebo-controlled trial, J Clin Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a large randomized controlled trial of 2399 pregnant women, omega-3 supplementation did not improve postnatal depressive symptoms at 6 weeks or 6 months or offspring neurodevelopment at 18 months.

    “depressive symptoms, measured by the Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks and 6 months postnatally did not differ between groups, nor did neurodevelopmental outcomes of their offspring differ at 18 months age [34].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Su, 2008, Omega-3 fatty acids for major depressive disorder during pregnancy: results from a randomized, double-blind, placebo-controlled trial, J Clin Psychiatry source

      Not checked in the free run.

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    Premisecitation

    St John's Wort appears excreted into breast milk at undetectable to low levels, comparable to other antidepressants, with bioactive components at or below the limit of quantification in infant plasma.

    “It appears to be excreted into breast milk at undetectable to low levels, comparable to other antidepressants and its bioactive components at or below the limit of quantification in infant plasma [60].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60] Klier, 2006, St John's wort (Hypericum perforatum) and breastfeeding: plasma and breast milk concentrations of hyperforin for 5 mothers and 2 infants, J Clin Psychiatry source

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    Premisecitation

    Bright light therapy is generally well tolerated, although there is a risk of inducing mania in individuals with bipolar disorder.

    “Bright light therapy is generally well tolerated, although there is a risk of induction of mania in individuals with bipolar disorder [64,65].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [64] Golden, 2005, The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence, Am J Psychiatry source

      Not checked in the free run.

    • cites [65] Sit, 2007, Light therapy for bipolar disorder: a case series in women, Bipolar Disord source

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  • May combine two claims.

    Interpretationnone given

    Few studies have investigated the safety of St John's Wort during the perinatal period, and no published randomized controlled trials have evaluated efficacy or safety in perinatal depression.

    “Few studies have investigated the safety of St. John’s Wort during the perinatal period, and no published RCTs have evaluated efficacy or safety in perinatal depression.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Two multicentre placebo-controlled randomized controlled trials of L-methylfolate with ongoing antidepressant therapy for MDD found improvement at 15 mg per day but not at 7.5 mg per day.

    “improvement was found with 15mg per day but not the 7.5 mg per day dose [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Inskip, 2009, Women's compliance with nutrition and lifestyle recommendations before pregnancy: general population cohort study, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Current evidence may support use of 1-9 g EPA plus DHA daily for mood disorders, with more than 3 g daily requiring physician monitoring due to bleeding risk.

    “Current evidence may support the use of 1-9 g supplement of EPA + DHA daily for patients with mood disorders, though use of greater than 3 g daily should be monitored by a physician due to the risk of bleeding [27].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Golding, 2009, High levels of depressive symptoms in pregnancy with low omega-3 fatty acid intake from fish, Epidemiology source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Results from individual studies of St John's Wort were mixed, with a more robust effect in mild to moderate depressive symptoms and less evidence of effectiveness in severe MDD.

    “Results from the individual studies were mixed with a more robust effect seen in patients with mild to moderate depressive symptoms and less evidence of effectiveness in severe MDD.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [54] Roder, 2004, Meta-analysis of effectiveness and tolerability of treatment of mild to moderate depression with St. John's Wort [in German], Fortschr Neurol Psychiatr

      Not checked in the free run.

    • cites [55] Murphy, 2005, Interaction of St John's Wort with oral contraceptives: effects on the pharmacokinetics of norethindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding, Contraception source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A smaller trial of electroacupuncture versus sham acupuncture for postnatal depression found that both treatments improved depression symptoms, with no difference between groups on outcome measures.

    “A smaller study of electroacupuncture compared to sham acupuncture for the treatment of postnatal depression demonstrated that both treatments were associated with improvement in depression symptoms, with no between-group difference in outcome measures [97].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [97] Chung, 2012, Randomized non-invasive sham-controlled pilot trial of electroacupuncture for postpartum depression, J Affect Disord source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An 8-week Mother and Baby program including exercise was associated with lower EPDS scores in the intervention group at study end, but between-group significance was lost at one-month follow-up.

    “An 8-week “Mother and Baby” program, including exercise, was associated with lower EPDS scores in the intervention group at study end, but between-group significance was lost at follow up one month later [80].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] Norman, 2010, An exercise and education program improves well-being of new mothers: a randomized controlled trial, Phys Ther source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a small open study, pregnant women (N=16) receiving at least three weeks of morning bright light had a mean 49% improvement in depression scores; those completing at least five weeks had 59% improvement; no significant side effects except treatment-related nausea.

    “In participants who received at least three weeks of bright light therapy, depression scores improved by a mean of 49%; among participants who completed at least five weeks, scores improved by 59%. No significant side effects were reported, except treatment-related nausea.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [66] Oren, 2002, An open trial of morning light therapy for treatment of antepartum depression, Am J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a small double-blind study, pregnant women (N=10) randomized to bright light (7,000 lux) or dim light (500 lux) placebo for five weeks plus a five-week extension: bright light produced significantly greater antidepressant response than dim light, with significant differences at the end of the extension phase; one participant on bright light experienced hypomania that resolved upon reducing the

    “Bright light therapy produced a significantly greater antidepressant response than dim light, with significant differences at the end of the extension phase. One participant who received bright light therapy experienced hypomania, which resolved upon reduction of the duration of daily light exposure.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] Epperson, 2004, Randomized clinical trial of bright light therapy for antepartum depression: preliminary findings, J Clin Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Creating a genuinely blinded placebo condition for acupuncture research is difficult.

    “Additionally, establishing a truly blinded placebo condition for acupuncture research is challenging.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Epidemiological data suggest that regular exercise is associated with decreased risk of depressive symptoms, although not all trials have consistently demonstrated benefit.

    “epidemiological data suggest that regular exercise is associated with decreased risk of depressive symptoms [72], although not all trials have consistently demonstrated benefit [73].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [72] Strawbridge, 2002, Physical activity reduces the risk of subsequent depression for older adults, Am J Epidemiol source

      Not checked in the free run.

    • cites [73] Chalder, 2012, A pragmatic randomised controlled trial to evaluate the cost-effectiveness of a physical activity intervention as a treatment for depression: the treating depression with physical activity (TREAD) trial, Health Technol Assess source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Acupuncture is hard to assess with Western medical methods because symptom and diagnostic measures differ between studies and needling methods differ by site and study.

    “Because acupuncture is often practiced in the context of other cultural practices, it is difficult to assess through the lens of Western medicine, as diagnostic and symptom assessments may not be standardized across studies and acupuncture techniques may vary across sites and studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Massage therapy has been shown to decrease salivary and urinary cortisol levels and increase urinary serotonin and dopamine levels over the therapy period.

    “Support for its neuroendocrine effects include demonstration of message to decrease salivary and urinary cortisol levels and increase urinary serotonin and dopamine levels over the therapy period [84].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Field, 2005, Cortisol decreases and serotonin and dopamine increase following massage therapy, Int J Neurosci source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a larger randomized controlled trial of 27 pregnant women, bright light (7,000 lux) was associated with greater reduction of depressive symptoms than dim red placebo (70 lux); 81.3% of the bright light group had at least 50% reduction versus 45.5% of placebo; treatment was tolerated well without adverse effects.

    “bright light was associated with a greater reduction of depressive symptoms, with 81.3% of women receiving bright light experiencing ≥50% reduction in symptoms as compared to 45.5% who received placebo dim light. The treatment was tolerated well, without adverse effects reported [68].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68] Wirz-Justice, 2011, A randomized, double-blind, placebo-controlled study of light therapy for antepartum depression, J Clin Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Certain acupuncture points have been reported to speed cervical ripening at term and to advance labor and delivery.

    “Some acupuncture points have been reported to hasten cervical ripening at term and advance labour and delivery [94].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [94] Gaudet, 2008, Effectiveness of acupuncture for the initiation of labour at term: a pilot randomized controlled trial, J Obstet Gynaecol Can source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a small randomized trial of women with postnatal depression (N=15), both bright light (10,000 lux) and dim light (600 lux) groups experienced significant improvement from baseline, without differences in response.

    “Both groups experienced significant improvement from baseline, without differences in response.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [69] Corral, 2007, Morning light therapy for postpartum depression, Arch Womens Ment Health source

      Not checked in the free run.

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  • The paper relies on this without support.

    Omega-3 supplements are well tolerated by perinatal women and free of significant mercury or other contaminants.

    “Omega-3 fatty acid supplements have been well tolerated by perinatal women and appear free of significant levels of mercury or other contaminants.”

  • The paper relies on this without support.

    SAMe is generally well tolerated with infrequent mild side effects.

    “SAMe is generally well tolerated, with infrequently reported side effects that include mild gastrointestinal symptoms, sweating, dizziness, irritability and anxiety.”

  • The paper relies on this without support.

    St John's Wort may interact with oral contraceptives, reducing oestrogen plasma concentration and effectiveness.

    “St. John’s Wort may interact with medications including oral contraceptives, reducing oestrogen plasma concentration and effectiveness.”

  • The paper relies on this without support.

    Mood episodes are highly prevalent during pregnancy and the postpartum in the course of bipolar disorder, even if not previously diagnosed.

    “Considering the high prevalence of mood episodes during pregnancy and the postpartum in the course of bipolar disorder, even if not previously diagnosed”

  • The paper relies on this without support.

    Women often discontinue antidepressant treatment during attempts to conceive or during pregnancy.

    “women often discontinue antidepressant treatment during attempts to conceive or during pregnancy.”

  • The paper relies on this without support.

    Dietary intake of omega-3 fatty acids by perinatal women in the United States and United Kingdom is deficient.

    “dietary intake by perinatal women in the U.S. and U.K. has been noted as deficient”

  • The paper relies on this without support.

    Exercise is integral to optimal health in pregnancy and to prevention of heart disease, obesity, and diabetes, which are more common in people with MDD than in the general population.

    “Exercise is integral to optimal health in pregnancy, as well as in the prevention of heart disease, obesity and diabetes, comorbid conditions that those with MDD are more likely than the general population to develop.”

  • The paper relies on this without support.

    St John's Wort contains high concentrations of hyperforin, which induces CYP3A4 and inhibits a membrane-bound transporter that facilitates transport across the intestinal lumen and the blood-brain barrier.

    “St. John’s Wort contains high concentrations of the bioactive component hyperforin which induces the cytochrome P450 system (CYP3A4) and inhibits a membrane-bound transporter that facilitates transport across the intestinal lumen and the blood-brain barrier.”

  • The paper relies on this without support.

    The MTHFR enzyme is affected by a polymorphism common in patients with depression that impairs transformation to L-methylfolate and is associated with MDD.

    “however this enzyme is affected by a polymorphism common in patients with depression which impairs transformation to L-methylfolate and is associated with MDD.”
9 of 9

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Reasons for use of complementary health approaches include motivation to have greater control over childbearing experiences and concerns about the risks to their infants from using pharmaceuticals to treat depression.

    “Reasons for use of these approaches include motivation to have greater control over childbearing experiences and concerns about the risks to their infants from using pharmaceuticals to treat depression.46,47,49”

    From Perinatal Depression: Challenges and Opportunities (2021) · cites this paper as [49]

  • Concerns have been raised about the use of these approaches for which the evidence for full efficacy and safety remains limited.

    “However, concerns have been raised about the use of these approaches for which the evidence for full efficacy and safety remains limited.49”

    From Perinatal Depression: Challenges and Opportunities (2021) · cites this paper as [49]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • The review counts eight therapies as seven

    Minor

    The stated total is seven, but the accompanying list names eight therapies.

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Authors
Deligiannidis, K. M., & Freeman, M. P.
Affiliations
  • University of Massachusetts Chan Medical School (US)
  • Massachusetts General Hospital (US)
Corresponding author
Deligiannidis, Kristina M.
ORCID
Venue
Best Practice & Research Clinical Obstetrics & Gynaecology
Publisher
Elsevier BV
Published
2014-01
Volume
28
Issue
1
Pages
85-95
ISSN
1521-6934 (ISSN-L)
DOI
10.1016/j.bpobgyn.2013.08.007
PMC
PMC3992885
OpenAlex
W1968107818
Cited by
124
References
111
Citations by year
2025: 1 · 2024: 5 · 2023: 10 · 2022: 7 · 2021: 39 · 2020: 11 · 2019: 10 · 2018: 14 · 2017: 2 · 2016: 10 · 2015: 8 · 2014: 6 · 2013: 1
FWCI
8.50
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Best Practice & Research Clinical Obstetrics & Gynaecology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship@UMassChan (submittedVersion)
Funders
  • National Institutes of Health (UL1TR000161)
  • National Institute of Mental Health (K23MH097794)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
  • Health Sciences › Medicine › Complementary and alternative medicine › Medicinal Plant Extracts Effects
Keywords
perinatal depression, complementary and alternative medicine, omega-3 fatty acids, folic acid, S-adenosylmethionine, Hypericum perforatum, bright light therapy, physical activity, massage, acupuncture, pregnancy, postpartum depression, treatment efficacy and safety
MeSH terms
Complementary Therapies, Depression, Female, Folic Acid, Humans, Massage, Mothers, Phototherapy, Pregnancy, S-Adenosylmethionine, Exercise, Fatty Acids, Omega-3, Acupuncture Therapy, Depression, Postpartum, Dietary Supplements, Hypericum, Peripartum Period

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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