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Archive for October, 2014

Exercise for the prevention and treatment of antenatal depression

By Meg Fluharty

This blog originally appeared on the Mental Elf blog on 19th September 2014

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Depression occurring during pregnancy, known as antenatal depression, is very common; affecting 10-13% of women (Gavin et al, 2005), which can result in premature labour, low birth weight, and a compromised mother-child relationship (Li et al, 2009; Mancuso et al 2004).

The current treatments include antidepressants and psychotherapy (Field et al, 2009; Rethorst et al 2009). However, antidepressant use may result in adverse effects during pregnancy and psychotherapy often has lengthy waiting lists (Einerson et al 2010, Parker et al; 2008).

Exercise is also recommended as a treatment option for mental and physical health during pregnancy, by NICE (NICE, 2006), the Royal College of Obstetricians and Gynaecologists (RCOG, 2006) and the American College of Obstetricians and Gynaecologists (Artal & O’Tool, 2006).

This study is the first systematic review and meta-analysis of randomised controlled trials (RCTs) investigating the effectiveness of exercise as a treatment option in antenatal depression (Daley et al, 2014).

Exercise balls are a popular training aid and also a soft place to grab a few minutes sneaky shut-eye.

“Balls to exercise” Insert exclamation mark or question mark as you see fit.

Methods

The authors conducted a literature search of multiple electronic databases, and studies were selected for inclusion if they were RCTs which compared exercise with usual care, a control group or another comparator. Studies were also included which recruited non-depressed, at risk, and depressed participants as the review focused on both prevention and treatment of antenatal depression. Studies were excluded if the intervention was less than 6 weeks (Daley et al, 2014).

The primary outcome was change in depression score between baseline and final antenatal follow-up. The means and standard deviations of the different depression scores were extracted, or calculated if necessary. The standardised mean different (SMD) was calculated in order to summarise the effects across the trials. For the meta-analysis, a random effects model was used, with subgroup analyses in depressed vs. non-depressed patients and aerobic vs. non-aerobic exercise conditions (Daley et al, 2014).

Results

Included studies

Six out of a total of 919 papers were chosen for inclusion in the review and analysis. Studies were primarily excluded if they were not RCTs, did not measure depression, or compared exercise interventions.

All six studies investigated exercise as an intervention versus a control:

  • 2 studies used standard prenatal care
  • 2 used a waiting list
  • 1 used social support
  • 1 used parent education sessions as the control groups

The interventions ranged from 8-12 weeks and were categorised as either aerobic exercise or non aerobic.

In total, there were 406 pregnant women, whose ages ranged from 14-38 and were recruited from 16 weeks gestation.

One study included non-depressed women, and 5 studies included either at risk or participants depressed at baseline (Daley et al, 2014).

Meta-analysis results

  • There was a reduction in depression scores in the exercise groups versus the comparator groups (SMD -0.46, 95%CI -0.87 to 0.05, p=0.03, I2= 68%)
  • There was no difference between women who were:
    • Non-depressed at baseline (SMD -0.74; 95% CI -1.22 to -0.27, p=0.002)
    • Depressed at baseline (SMD -0.41; 95% CI -0.88 to 0.07, p=0.09, I2=70%)
  • There was no difference between:
    • Aerobic exercise interventions (SMD -0.74: 95% CI -1.22 to -0.27 p=0.002)
    • Non-aerobic exercise interventions (SMD -0.41; 95% CI -0.88 to 0.07, p=0.09, I2 =70%)

Exercise during pregnancy may be effective at reducing depression, but bigger and better RCTs are needed before we can be sure of this finding.

Exercise during pregnancy may be effective at reducing depression, but bigger and better RCTs are needed before we can be sure of this finding.

Discussion

Daley et al (2014) present the first meta-analysis of trials investigating the effectiveness as a treatment for antenatal depression. NICE (NICE, 2006), Royal College of Obstetricians and Gynaecologists (RCOG, 2006), and the American College of Obstetricians and Gynaecologists (Artal & O’Tool, 2006) have all stated that women should consider exercise during pregnancy for mental health benefits, and this review provides evidence to support those guidelines.

However, there are a number of limitations that should be considered:

  • The results show a small to moderate effect size, based on a small number of low to moderate quality studies
  • The studies varied greatly and contained large confidence intervals, which may result in imprecise estimates
  • 5 of the 6 studies were based on women with depression, so the authors cannot conclude whether exercise can be used to prevent depression in pregnancy
  • Tests of subgroup differences in exercise category were based on a single trial, therefore future studies should examine a larger range of exercises (aerobic and non-aerobic)
  • No studies reported on adverse events
  • Publication bias was not investigated due to the small number of trials

Future research should be based on a larger sample, include a wider range of exercise categories, investigate possible adverse events, and include non-depressed women.

While we're waiting for the new research into antenatal depression, don't forget that exercise in pregnancy has all sorts of other important benefits.

While we’re waiting for new research to be published, don’t forget that exercise in pregnancy does of course have all kinds of other undeniable benefits.

Links

Daley AJ, Foser L, Long G, Paler C, Robinson O, Walmsley H, Ward R. The effectiveness of exercise for the prevention and treatment of antenatal depression: a systematic review with meta-analysis. BJOG 2014; DOI: 10.1111/1471-0528.12909 [PubMed abstract]

Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005;106:1071–83. [PubMed abstract]

Li D, Liu L, Odouli R. Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod 2009;24:146–53.

Mancuso RA, Schetter CD, Rini CM, Roesch SC, Hobel CJ. Maternal prenatal anxiety and corticotropin-releasing hormone associated with timing of delivery. Psychosom Med 2004;66:762–9. [PubMed abstract]

Field T, Deeds O, Diego M, Hernandez-Reif M, Gauler A, Sullivan S, et al. Benefits of combining massage therapy with group interpersonal psychotherapy in prenatally depressed women. J Body Mov Ther 2009;13:297–303. [PubMed abstract]

Rethorst CD, Wipfli BM, Landers DM. The antidepressive effects of exercise: a meta-analysis of randomized trials. Sports Med 2009;39:491–511. [PubMed abstract]

Einerson A, Choi J, Einerson TR, Koren G. Adverse effects of antidepressant use in pregnancy: an evaluation of fetal growth and preterm birth. Depress Anxiety 2010;27:35–8 [PubMed abstract]

Parker GB, Crawford J, Hadzi-Pavlovic D. Quantified superiority of cognitive behavioural therapy to antidepressant drugs: a challenge to an earlier meta-analysis. Acta Psychiatr Scand 2008;118:91–7 [PubMed abstract]

Royal College of Obstetricians and Gynaecologists. Exercise in Pregnancy. Statement No. 4. London: RCOG, 2006.

Antenatal and postnatal mental health: Clinical management and service guidance. NICE CG45, Feb 2007.

Artal R, O’Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med 2003;37:6–12. [PubMed abstract]

– See more at: http://www.thementalelf.net/mental-health-conditions/depression/exercise-for-the-prevention-and-treatment-of-antenatal-depression/#sthash.oDvrzRsY.dpuf

How I ended up on the other side of the world

By Sarah Griffiths

My New Year’s resolution this year was to get out of Bristol for a bit. I love living in Bristol and enjoy my PhD research, which is what brought me to the city in the first place. But the weather was pretty miserable in January and, after a year and a half, perhaps I was starting to take the place for granted. I decided that it would be a good time to look into some of the great opportunities there are to travel in academia.

I had heard that it was possible to get funding to visit a foreign university through the Worldwide Universities Network (WUN) during your PhD. The WUN is an association of 16 universities around the world who have decided to cooperate to promote international research collaboration. I looked at the research that was being done at each of these universities to see if any fitted with my PhD topic and found Face Lab at the University of Western Australia. Face Lab, I learned, was doing some fascinating research on the nature of emotional expression coding in typical development and in autism. Perth also looked like a pretty fun place to spend some time so I decided to apply.

I got in touch with Professor Gill Rhodes who leads Face Lab and asked if she would have me for a visit for a few months and she kindly agreed. I then went ahead and filled in the application form. This involved writing a research proposal, including details of how the exchange would benefit the university and myself. Additionally I was to submit a CV and supporting statements from my supervisor and the Head of School in Bristol, and Gill at UWA. There are two calls for applications a year: one in February, which I went for, and one in November. A few months later I heard that my application had been accepted and I was going to be spending 3 months in Perth in the autumn!

Cycle path

I’ve now been in Perth for 2 weeks and I’m so glad that I decided to come. The people I have met both in the University and out have been incredibly friendly and helpful. I’ve found accommodation in a great area in a complex that has a pool (!) Everyday I get to cycle along the river to the university, looking out for dolphins that supposedly live there.

I’ve also found that working in a different lab has renewed my interest in research. A change of environment and the opportunity to discuss new ideas with experts you wouldn’t otherwise meet is a great remedy for any mid-PhD disenchantment. Here I’m working on a project about recognition of emotion in a crowd of faces. This is a topic that is complimentary to my PhD research but different enough to be new and exciting. I hope that when I return to Bristol I will bring back new ideas and fresh enthusiasm to my PhD, as well as a tan! I will let you know in 10 weeks time. In the meantime, if this has inspired you to take part in some “academic tourism” (as one other WUN funded visitor I met this week called it), the next deadline for the WUN researcher mobility funding is in 7th of November so get applying!

Sarah is a PhD student in TARG researching emotion recognition in children with autism spectrum disorder. You can follow her on Twitter @SarahGriff90 and see her academic profile on the University of Bristol website.