The effect of Citrus aurantium capsule on postpartum depression in women

Document Type : Original Article

Authors

1 Instructor, Department of Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran.

2 Assistant Professor, Department of Psychiatry, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.

3 Assistant Professor, Department of Pharmacology, Cellular and Molecular Research Center, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.

4 BC of Midwifery, Student Research Committee, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.

5 M.Sc. of Epidemiology, Meta-Analysis Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.

Abstract

Introduction: Postpartum depression is a common public health problem in the first year after birth. Low mood, feeling guilty, loss of appetite, difficulty in falling asleep are some symptoms of this condition. Depression can cause serious problems for the child, mother and family. This study was performed with aim to determine the effect of Citrus aurantium on postpartum depression in women.
Methods: This randomized clinical trial was conducted on 49 mothers referred to the Sabzevar health and treatment centers in 2017. Participants had the score of 14-28 on the Beck Depression Inventory-Second Edition (BDI-II), and their depression was confirmed by a psychiatrist through interview. They were randomly (with random blocking method) assigned to the treatment group (orange blossom 500 mg/Bid+ fluoxetine 20 mg) and control group (fluoxetine 20 mg plus placebo). Treatment was started on week 8 after delivery and continued for 8 weeks. Data were analyzed using SPSS software (version 16) and Kolmogrov-Smirnov, Chi-square, Independent and paired t‑test and Mann–Whitney test. P<0.05 was considered statistically significant.
Results: The mean score of depression after the intervention in Citrus aurantium group was 9.2±4.02 and in control group was 17.12±3.56; there was a significant difference between two groups (p>0,001). Also, after the intervention, 15 women (62.5%) in Citrus aurantium group and 1)4%( in control group were without postpartum depression.
Conclusion: The use of Citrus aurantium along with fluoxetine in the treatment of mild to moderate postpartum depression is more effective than fluoxetine alone. So, it can be used as an alternative in treatment of postpartum depression.

Keywords


  1. Kordi M, Nasiri S, Moddares M, Ebrahimzadeh S. Evaluating the effect of progressive muscle relaxation training with guided imagery on the severity of depressive symptoms in postpartum period. Iran J Obstetet Gynecol Infertil 2012; 15(8):17-24. (Persian).
  2. Sadock BJ, Sadock VA. Kaplan and Sadock’s synopsis of psychiatry-behavioral sciences/clinical psychiatry. 10th ed. Philadelphia: Lippincott Williams and Wilkins; 2007. P. 857-69.
  3. Edalati Fard F, Mirghafourvand M, Mohammad Alizadeh S, Farshbaf A, Asghari M. The relationship between diet and postpartum depression in postpartum women in Tabriz. Iran J Obstetet Gynecol Infertil 2016; 18(182):1-10. (Persian).
  4. Veisani Y, Sayeh Miri K. Prevalence of postpartum depression in Iran- A systematic review and meta-analysis. Iran J Obstetet Gynecol Infertil 2012; 15(14):21-9. (Persian).
  5. Zare Z, Golmakani N, Shareh H, Shakeri MT, Khadem Ghaebi N. Factors related to marital satisfaction in primiparous women during postpartum period. J Midwifery Reprod Health 2014; 2(2):120-7.
  6. Saee Ghare Naz M, Mohaddesi H, Edalatnemun R. The predisposing factors of postpartum depression in women referring to selected health centers in Urmia in 2015. J Urmia Nurs Midwifery Facul 2017; 14(11):918-25. (Persian).
  7. McDonagh MS, Matthews A, Phillipi C, Romm J, Peterson K, Thakurta S, et al. Depression drug treatment outcomes in pregnancy and the postpartum period: a systematic review and meta-analysis. Obstet Gynecol 2014; 124(3):526-34.
  8. Effati DF, Mohammad AC, Zaree S, Mohammadi A, Mirghafourvand M. Effect of lavender cream with or without footbath on anxiety, stress and depression of women in postpartum: a clinical randomized controlled trial. Iran J Obstetet Gynecol Infertil 2017; 20(10):52-61. (Persian).
  9. Namazi M, Amir Ali Akbari S, Mojab F, Talebi A, Alavi Majd H, Jannesari S. Aromatherapy with citrus aurantium oil and anxiety during the first stage of labor. Iran Red Crescent Med J 2014; 16(6):e18371.
  10. Sharifipour F, Bakhteh A, Mirmohammad A. Effects of Citrus aurantium aroma on post-cesarean anxiety. Iran J Obstet Gynecol Infertil 2015; 18(169):12-20. (Persian). 
  11. Kennedy J. Herb and supplement use in the US adult population. Clin Ther 2005; 27(11):1847-58.
  12. Amin B, Nakhsaz A, Hosseinzadeh H. Evaluation of the antidepressant-like effects of acute and sub-acute administration of crocin and crocetin in mice. Avicenna J Phytomed 2015; 5(5):458-68.
  13. Kamalifard M, Farshbaf-Khalili A, Namadian M, Herizchi S, Ranjbar Y. Comparison of the effect of lavender and bitter orange on depression in menopausal women. Int J Women Health Reprod Sci 2017; 5(3):224-30.
  14. Sharifipour F, Mirmohammad AM, Hashemzadeh M. Comparison of the effect of citrus arantium and salvia officinalis aroma on post-cesarean section pain. Iran J Obstetet Gynecol Infertil 2017; 20(2):41-9. (Persian).
  15. Hashemi Shahraki F, Namjoo AR, Rafieian-Kopaei M. Antidepressant- like effect of essential oil of Lavandula stoechas L. and Citrus aurantium L. in Balb/C mice using forced-Swim test. J Shahrekord Univ Med Sci 2016; 17:53-60. (Persian).
  16. Masten AS. Bitter orange extracts and constituents: review of toxicological literature. National toxicology program, national institute of environmental health sciences, national institutes of health, US department of health and human services. Contract 2004; 104:1-73.
  17. Imura M, Misao H, Ushijima H. The psychological effects of aromatherapy-massage in healthy postpartum mothers. J Midwifery Women Health 2006; 51(2):e21-7.
  18. Saketi S, Bananej M, Jahromy MH. Effect of Citrus aurantium L. essential oil and its interaction with fluoxetine on anxiety in male mice. J Behav Brain Sci 2014; 4(7):285.
  19. Mahmoodi M, Shamsi-Meimandi M, Foroumadi AR, Raftari SH, Asadi Shekari M. Anti-depressant effect of sour orange flowers extract on Lipopolysaccharide-induced depressive-like behaviors in rat. J Kerman Univ Med Sci 2005; 12(4):244-51. (Persian).
  20. Leite M, Fassin Jr J, Baziloni EM, Almeida RN, Mattei R, Leite JR. Behavioral effects of essential oil of Citrus aurantium L. inhalation in rats. Rev Braz Pharm 2008; 18:661-6.
  21. Jackson G. Beck depression inventory. Occup Med 2016; 66:174-5.
  22. Beck AT, Steer RA, Garbin MG. Psychometric properties of the beck depression inventory: twenty-five years of evaluation. Clin Psychol Rev 1988; 8(1):77-100.
  23. Smarr KL, Keefer AL. Measures of depression and depressive symptoms: beck depression Inventory‐II (BDI‐II), Center for Epidemiologic Studies Depression Scale (CES‐D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire‐9 (PHQ‐9). Arthritis Care Res 2011; 63(S11):S454-66.
  24. Motabi F, Fata L, Moloodi R, Ziai K, Jafari H. Development and validation of depression- related beliefs scale. Iran J Psychiatry Clin Psychol 2011; 17(3):208-17.
  25. Wang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Braz J Psych 2013; 35(4):416-31.
  26. Dobson SK, Mohamadkhani P. Psychometric characteristics of beck depression inventory– II in patients with major depressive disorder in the recovery period relative. Rehabilitation 2006; 8(29):80-6.
  27. Choi SY, Kang P, Lee HS, Seol GH. Effects of inhalation of essential oil of Citrus aurantium l. var. amara on menopausal symptoms, stress, and estrogen in postmenopausal women: a randomized controlled trial. Evid Based Complement Alternat Med 2014; 2:1-7.
  28. Banaiyan G, Rasti Boroujeni E, Shirmardi M. Comparison of the effect of Citrus aurantium and diazepam on preoperative anxiety. J Shahrekord Univ Med Sci 2009; 10(4):13-8. (Persian).
  29. Kalani Z, Emtiazy M, Lotfi MH, Dehghan K. Comparison of Citrus aurantium and oxazepam tablets efficacy on preoperative anxiety in patients undergoing coronary artery bypass graft surgery. J Shahid Sadoughi Univ Med Sci 2015; 23(3):1968-75. (Persian).
  30. Stohs SJ. Assessment of the adverse event reports associated with Citrus aurantium (bitter orange) from April 2004 to October 2009. J Functional Foods 2010; 2(4):235-8.
  31. Chan YY, Li CH, Shen YC, Wu TS. Anti-inflammatory principles from the stem and root barks of Citrus medica. Chem Pharm Bull 2010; 58(1):61-5.
  32. Akhlaghi M, Shabanian G, Rafieian-Kopaei M, Parvin N, Saadat M, Akhlaghi M. Citrus aurantium blossom and preoperative anxiety. Rev Bras Anesthesiol 2011; 61(6):702-12.