Postpartum depression is triggered by childbirth and possibly additionally by the intensity of pain experienced during childbirth. If epidural anesthesia is used, is the incidence of postoperative depression affected? Dr. Dong-Xin Wang, Department of Anesthesiology and Surgical Intensive Care, Peking University First Hospital, Beijing, China, and colleagues report on a cohort of 214 nulliparous women presenting for planned vaginal delivery at an urban Chinese hospital. The results of their analysis appear in this month’s edition of Anesthesia & Analgesia in the article titled “Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study.” Dr. Katherine L. Wisner, Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and coauthors wrote “Double Duty: Does Epidural Labor Analgesia Reduce Both Pain and Postpartum Depression?,” the study’s accompanying editorial.
After appropriate education and consent, 107 of these women chose to have epidural analgesia; the other half received no analgesia. The women who received epidural analgesia had lower pain scores at delivery and had a significant decrease in the risk for postpartum depression (14% vs. 36%). In multivariable logistic regression, attendance at childbirth classes and breastfeeding after delivery were also independently associated with a decreased risk for depression.
Both the authors and the editorialists note that postpartum depression is a multifactorial syndrome and that cause and effect were not established in this observational study. Biologic plausibility in the connection between acute pain and subsequent depression has been established in other models, but confounders of the present study might include education level, socioeconomic status, and the cultural norms of the patients. A larger study of the connection between analgesia and subsequent depression is needed.