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Bakgrund: Postpartum depression (PPD) är ett växande folkhälsoproblem, vilken drabbar mellan 10 – 20 % av barnafödande kvinnor globalt. PPD kan negativt påverka moderns funktion, social anpassning och ökar risken för självmord. Därtill kan det störa föräldrarnas välbefinnande och moderns interaktion med barnet, vilket kan medföra negativa effekter på barnets kognitiva och känslomässiga utveckling. Våld, tidigare depression och brist på socialt stöd är starka riskfaktorer för PPD. De exakta orsakerna till PPD är fortfarande oklara, vissa hormonella förändringar såväl som störningar i neurotransmission anses vara möjliga orsaker. För behandling av mild PPD är psykoterapi det första alternativet, därefter rekommenderas selektiva serotoninåterupptagshämmare (SSRI) vid måttlig till svår PPD, där sertralin och paroxetin är säkraste vid amning. Nyligen utvecklades nya läkemedel som innehåller progesteronmetaboliten allopregnanolon, såsom brexanolon och zuranolon för behandling av PPD. Syfte: Syftet med litteraturstudien var att utvärdera effekten av brexanolon, zuranolon, sertralin och paroxetin för behandling av post partum depression. Metod: Denna litteraturstudie baserades på sex randomiserande, dubbelblinda och placebokontrollerade studier framsökta via den vetenskapliga databasen PubMed. Två separata sökningar gjordes för att hitta relevanta artiklar. I den första artikelsökningen användes sökorden " neuroactive steroids in postpartum depression" medan i den andra användes sökorden " antidepressants in post partum depression". Resultat: Brexanolon och zuranolon gav upphov till statistiskt signifikant förbättring av PPD svårghetsgrad samt högre remission- och till viss del responsfrekvens jämfört med placebo efter 60 timmar respektive 15 dagar. Intag av sertralin visade blandat resultat. I en studie gav sertralin signifikant högre remission- och responsfrekven jämfört med placebo, efter sex veckors behandling. Men i den andra studien gav sertralin endast en signifikant förbättring av PPD svårghetsgrad jämfört med placebo och ingen skillnad i remission- och responsfrekvens efter 12 veckors behandling. Paroxetin gav en statistiskt signifikant högre remissionfrekvens jämfört med placebo efter åtta veckors behandling. Slutsats: Resultaten tyder på att brexanolon, zuranolon, sertraline och paroxetin har god effekt mot PPD, med en fördel för brexanolon och zuranolon över sertralin och paroxetin gällande bättre och snabbare effekt. Brexanolon ger en snabbt effekt (efter 60 timmar), men kan orsaka plötslig medvetslöshet och överdriven sedering. Det kan därför vara ett lämpligt val för kvinnor med mycket svår PPD, vilken kräver sjukhusvård. Zuranolondatan är lovande och verkar vara ett bättre val än de andra läkemedlen, men underlaget är begränsat av endast en studie med svår PPD. Framtida större studier med samma skattningskalor, samma utfallsmått och samma baslinjeegenskaper skulle vara användbara för att med säkerhet kunna fastslå vilken av de  läkemedlen som är det bättre valet. / Background: Postpartum depression (PPD) is a growing public health problem, affecting between 10-20% of women giving birth globally. PPD can negatively affect the mothers' function social adjustment and increases the risk of suicide. In addition, it may disturb the parents' well-being and interaction with the child, which can have adverse effects on the child's cognitive and emotional development. Violence, previous depression, and lack of social support are strong risk factors for PPD. The exact causes of PPD remain unclear. Some hormonal changes, as well as disturbances in neurotransmission, are considered possible causes. For the treatment of mild PPD, psychotherapy is used as the first alternative. Selective serotonin reuptake inhibitors (SSRIs) are often recommended at moderate to severe PPD, where sertraline and paroxetine are safest at breastfeeding. Recently, new drugs containing the progesterone metabolite allopregnanolone such as brexanolone and zuranolone were developed to treat PPD. Aim: This study aimed to evaluate the effect of brexanolone, zuranolone, sertraline, and paroxetine in treating postpartum depression. Methods: This study was based on six randomized, double-blind, placebo-controlled studies conducted through the PubMed database. Two separate searches were made to find relevant articles. The keywords "neuroactive steroids in postpartum depression" were used in the first search, while in the second search, "antidepressants in postpartum depression" were used. Results: Brexanolone and zuranolone gave statistically significant better improvement in PPD severity, remission, and partially higher response rates compared to placebo after 60 hours and 15 days, respectively. Intake of sertraline showed mixed results. In one study, sertraline gave significantly higher remission and response rates after six weeks of treatment compared with placebo. However, in the second study, sertralin gave only a significant improvement in PPD severity compared to placebo and no differences in remission and response rates after 12 weeks of treatment. Paroxetine gave a statistically significantly higher remission rate compared to placebo after eight weeks of treatment. Conclusion: The results indicate that brexanolone, zuranolone, sertraline, and paroxetine have effects against PPD, with an advantage for brexanolone and zuranolone over sertraline and paroxetine in terms of impact and onset of action. Brexanolone provides an immediate effect (after 60 hours) but can cause syncope and excessive sedation. Therefore, it may be a suitable choice for women with severe PPD, which requires hospital care. The data of zuranolon is promising and seems to be a better choice than the other drugs, but the evidence is limited by only one study in severe PPD. Future studies using similar scales, outcomes, and baseline characteristics would be helpful to determine which of the drugs is the better choice.

Social phobia is a common disorder associated with significant psychosocial impairment, representing a substantial public health problem largely determined by the high prevalence, and the lifelong chronicity. Social phobia starts in early childhood or adolescence and is often comorbid with depression, other anxiety disorders, alcohol and substance abuse or eating disorders. This cascade of comorbidity, usually secondary to social phobia, increases the disability associated with the condition. The possibility that social phobia may be a trigger for later developing comorbid disorders directs attention to the need for early effective treatment as a preventive measure. The most recent drug class to be investigated for the psychopharmacological treatment of social phobia is the SSRI group for which there is growing support. The other drug classes that have been evaluated are monoamine oxidase inhibitors (MAOIs), benzodiazepines, and beta-blockers. The SSRIs represent a new and attractive therapeutic choice for patients with generalized social phobia. Recently the first, large scale, placebo-controlled study to assess the efficacy of drug treatment in generalized social phobia has been completed with paroxetine. Paroxetine was more effective in reducing the symptoms than placebo and was well tolerated. Many now regard SSRIs as the drugs of choice in social phobia because of their effectiveness and because they avoid the problems of treatment with benzodiazepines or classical MAOIs.

Social phobia is a common disorder associated with significant psychosocial impairment, representing a substantial public health problem largely determined by the high prevalence, and the lifelong chronicity. Social phobia starts in early childhood or adolescence and is often comorbid with depression, other anxiety disorders, alcohol and substance abuse or eating disorders. This cascade of comorbidity, usually secondary to social phobia, increases the disability associated with the condition. The possibility that social phobia may be a trigger for later developing comorbid disorders directs attention to the need for early effective treatment as a preventive measure. The most recent drug class to be investigated for the psychopharmacological treatment of social phobia is the SSRI group for which there is growing support. The other drug classes that have been evaluated are monoamine oxidase inhibitors (MAOIs), benzodiazepines, and beta-blockers. The SSRIs represent a new and attractive therapeutic choice for patients with generalized social phobia. Recently the first, large scale, placebo-controlled study to assess the efficacy of drug treatment in generalized social phobia has been completed with paroxetine. Paroxetine was more effective in reducing the symptoms than placebo and was well tolerated. Many now regard SSRIs as the drugs of choice in social phobia because of their effectiveness and because they avoid the problems of treatment with benzodiazepines or classical MAOIs.