Importance: Evidence emerged concerning how inflammatory arthritis and mood disorders can often occur in the same patient and show a similar clinical pattern. An overview of the rheumatological and psychiatric aspects of these diseases can certainly be useful for the improvement of patients' clinical and therapeutic management. Objective: The aim of this narrative review was to summarize existing literature about common pathogenetic and clinical aspects as a means of improving management and therapeutic approach in patients affected by rheumatoid arthritis, psoriatic arthritis and spondyloarthritis. Outcomes such as disease activity indexes and patient reported outcomes (PROs) were considered. Findings: Common pathogenetic pathways emerged between inflammatory arthritis and mood disorders. Pro-inflammatory mechanisms, such as TNFα, IL-6, IL-17 and oxidative stress factors as well as neurotransmitter alterations at the level of CNS and blood–brain barrier (BBB) cells are involved. The activation of these common pathogenetic pathways is, also, affected by the same triggers, such as smoking, stress, lifestyle, and evidence has emerged concerning the possibility of the clinical efficacy of using the same therapeutic approaches. Conclusions: The main causes of the variability in clinical studies outcomes are the rheumatological diseases considered, the prevalence of depression in the general population and in patients with rheumatological diseases and the type of depressive symptom examined. Patients affected by inflammatory arthritis can present symptoms and signs in common with mood disorders, leading to possible clinical overlap. There are still few studies analyzing this concept: they are extremely heterogeneous, both in the characteristics of the population taken into consideration and in the methods used for the definition of depressive disorder, but the suggestions of the data obtained so far are promising and deserve to be pursued.

: Psychiatric drugs have primacy for off-label prescribing. Among those, selective serotonin reuptake inhibitors (SSRIs) are highly versatile and, therefore, widely prescribed. Moreover, they are commonly considered as having a better safety profile compared to other antidepressants. Thus, when it comes to off-label prescribing, SSRIs rank among the top positions. In this review, we present the state of the art of off-label applications of selective serotonin reuptake inhibitors, ranging from migraine prophylaxis to SARS-CoV-2 antiviral properties. Research on SSRIs provided significant evidence in the treatment of premature ejaculation, both with the on-label dapoxetine 30 mg and the off-label paroxetine 20 mg. However, other than a serotoninergic syndrome, serious conditions like increased bleeding rates, hyponatremia, hepatoxicity, and post-SSRIs sexual dysfunctions, are consistently more prominent when using such compounds. These insidious side effects might be frequently underestimated during common clinical practice, especially by nonpsychiatrists. Thus, some points must be addressed when using SSRIs. Among these, a psychiatric evaluation before every administration that falls outside the regulatory agencies-approved guidelines has to be considered mandatory. For these reasons, we aim with the present article to identify the risks of inappropriate uses and to advocate the need to actively boost research encouraging future clinical trials on this topic.

Background: Perinatal depression (PND) is a major complication of pregnancy and many risk factors have been associated with its development both during pregnancy and postpartum. The transition to motherhood activates the attachment system. The aim of our study was to investigate the relationship between women’s attachment style (AS) and PND in pregnancy, and 1 month after childbirth, in a large cohort of women. We hypothesized that different patterns of AS were associated with either antenatal or postnatal depression. We, further, explored the role of other possible risk factors such as life-stress events. Methods: A final sample of 572 women was enrolled. At the third trimester of pregnancy, clinical data sheet and self-report questionnaires (ASQ, PSS, LTE-Q, and EPDS) were administered. One month after delivery, EPDS was administered by telephone interview. Results: We found 10.1% of the women with depression during pregnancy and 11.1% in the postpartum period. The first logistic regression showed that ASQ-CONF subscale (OR = 0.876, p < 0.0001), ASQ-NFA subscale (OR = 1.097, p = 0.002), foreign nationality (OR = 2.29, p = 0.040), low education levels (OR = 0.185, p = 0.012), PSS total score (OR = 1.376, p = 0.010), and recent life adversities (OR = 3.250, p = 0.012) were related to EPDS ≥ 14 during pregnancy. The second logistic regression showed that ASQ-PRE subscale (OR = 1.077, p < 0.001) and foreign nationality (OR = 2.88, p = 0.010) were related to EPDS ≥ 12 in the postpartum period. Conclusions: Different dimensions of anxious insecure AS were, respectively, associated with either antenatal or postnatal depression. These findings support the literature investigating subtypes of perinatal depression. The PND may be heterogeneous in nature, and the comprehension of psychopathological trajectories may improve screening, prevention, and treatment of a disorder which has a long-lasting disabling impact on the mental health of mother and child. We provided a rationale for targeting an attachment-based intervention in this group of women.

Antenatal depression may be distinct from postpartum depression in terms of prevalence, severity of symptoms, comorbidities, prognosis, and risk factors. Although risk factors for perinatal depression have been identified, it is unclear whether there are differences in the onset of perinatal depression (PND). This study explored the characteristics of women requiring mental health support during pregnancy or postpartum. A sample of 170 women (58% in pregnancy; 42% postpartum) who contacted the SOS-MAMMA outpatient clinic was recruited. Clinical data sheets and self-report questionnaires (EPDS, LTE-Q, BIG FIVE; ECR; BSQ; STICSA) were administered, hypothesizing possible risk factors, such as personality traits, stressful life events, body dissatisfaction, attachment style, and anxiety. Hierarchical regression models were carried out in the pregnancy (F_10;36 = 8.075, p < 0.001, adjR2 = 0.877) and postpartum groups (F_10;38 = 3.082, p < 0.05, adjR2 = 0.809). Recent stressful life events and conscientiousness were associated with depression in both the pregnant (29.3%, 25.5% of variance) and postpartum groups (23.8%, 20.7% of variance). In pregnant women, “openness” (11.6%), body dissatisfaction (10.2%), and anxiety (7.1%) symptoms were predictive of depression. In the postpartum group, “neuroticism” (13.8%) and insecure romantic attachment dimensions (13.4%; 9.2%) were the strongest predictors. Perinatal psychological interventions should consider the differences between mothers with depression during pregnancy and postpartum.