Preventing Postpartum Depression With Intranasal Oxytocin

Postpartum depression (PPD) is a debilitating disorder which imposes a threat to mother and
infant health. An estimated 600,000 American women suffer from PPD annually, making it one of
the most frequent complications of pregnancy. Available secondary preventive interventions
are often ineffective, which calls for identifying novel means for prevention. Impaired
mother-infant bonding is a hallmark of PPD. Depressed mothers may have difficulties
developing maternal feelings and providing sensitive care. In turn, impaired bonding may
worsen mother's depression. Conventional pharmacotherapy does not help with bonding
impairment.

This study will attempt to fill in the current gap in effective preventive interventions for
pregnant mothers at risk. Evidence in postpartum mothers indicates that high peripartum OXT
levels are associated with enhanced maternal behavior and low levels with depression. Data
also indicates that in depressed mothers, OXT levels may decrease during the first days
following childbirth rather than increase as is the norm. Therefore, the investigators will
test the therapeutic effects of OXT in women at risk for PPD. It is hypothesized that
administration of IN-OXT (total daily dose 48 IU) over the course of four days from as early
as day one postpartum in comparison to placebo will 1) enhance mother-infant bonding, 2)
reduce depressive and anxiety symptoms at 5 days postpartum, and 3) facilitate child
development.

Inclusion Criteria:

- Third-trimester pregnant women being followed at the MGH Obstetrics Program

- At risk of postpartum depression (PPD)

Exclusion Criteria:

- Failure to participate in regular prenatal check-ups

- Current diagnosis DSM-5 mental disorder pertaining to psychosis or substance abuse

- Suicidality

- Obstetric complication (e.g., preeclampsia, excessive hemorrhaging)

- Use of potentially confounding or interacting medications

- Complicating pediatric medical condition in the newborn.