4/29 Postpartum Depression Flashcards
what % of women may experience a depressive or anxiety disorder during pregnancy or postpartum?
20%
T/F Psychiatric illness is just as common in women as in men of the same age
F - it is common twice as common in women of childbearing age than in men of the same age
Perinatal psychiatric illness may be associated with:
Decreased weight gain
Increased substance use
Decreased engagement in prenatal care
Poor quality of life for mother and family
Relationship conflict
Increased risk of maternal suicide or self-harm
Possible adverse reproductive outcomes (data inconsistent)
Strongest risk factor for perinatal psychiatric illness
family history of mood disorder
Many women are concerned about taking Rx while pregnant or breastfeeding. What would you recommend for women with
- mild illness
- moderate illness
- moderate-severe illness
mild: lifestyle changes, increased social support or psychotherapy
moderate: psychotherapy OR Rx
moderate-severe: Rx AND psychotherapy
What happens if women with history of recurrent depression stop Rx during pregnancy?
High risk of relapse of depression (~67%)
Why are women are concerned about taking SSRIs while pregnant or breastfeeding?
- No RCTs
- Most data are retrospective and observational
- Lots of confounders
- Many studies don’t control for severity of psychiatric illness
Guidelines for using Rx for depression during pregnancy?
if a mom has been on an effective Rx in the past, use that Rx
if a mom has never used an Rx before, use older meds with more data (sertraline, fluoxetine, citalopram)
use the lowest effective dose of a single medication; don’t need to taper Rx prior to delivery
T/F most antidepressant Rx are compatible with breastfeeding
True!
Some findings in babies born to mothers who have used SSRIs during pregnancy?
About 1/4 to 1/3 of babies exposed during pregnancy may have mild neurological symptoms (jitteriness, fussiness, jerky/myoclonic movements)
may be due to a serotonin toxicity syndrome.
Non-pharmacologic Rx for depression during pregnancy?
acupuncture and light therapy
ECT or rTMS (Transcranial magnetic stimulation) for severe/refractory sx
What % of women experience some mood disturbance post-partum? What % develop clinically significant postpartum depressive or anxiety disorder?
85%
20%
Sx of Postpartum depression?
same as for MDD at other times in life (SIG E CAPS)
S = Sleep disturbance I = Interest/pleasure reduction G = Guilt feelings or thoughts of worthlessness E = Energy changes/fatigue C = Concentration/attention impairment A =Appetite/weight changes P = Psychomotor disturbances S = Suicidal thoughts
Anxiety and intrusive thoughts often predominate
Consequences of postpartum depression?
Difficulty bonding with infant Decreased QOL for mother Marital discord Possible developmental and language delays in infants Risk of suicide or infanticide
How should a physician approach treatment for postpartum depression? 4 steps usually
Exclude medical causes: thyroid, anemia
Strengthen social supports
Psychotherapy: CBT or IPT
Medications: SSRIs
