Depression Flashcards
How do you counsel patient about risks of depression in pregnancy?
There is an increased risk for miscarriage, low birth weight, preterm delivery, increased risk for neonatal irritability, decreased activity and attentiveness and fewer facial expressions
How do you counsel pregnant patients on the risks/benefits of SSRI?
Risks: -SAB -Low birth weight -Poor neonatal adaptation -Persistent pulmonary hypertension Benefits: -Bonding -Functionality of patient
How do you counsel pregnant patients on the risks/benefits of benzodiazepine for anxiety?
A neonatal abstinence syndrome has been described. It might be preferable to use benzodiazepines that are less likely to accumulate in the fetus and infant such as lorazepam or clonazepam.
What are the potential risks to the neonate exposed to SSRI?
-Low birth weight -Poor neonatal adaptation -Persistent pulmonary hypertension
What are the potential risks to the neonate exposed to benzodiazepine?
Neonatal abstinence syndrome
As a general rule, do you recommend antidepressants in pregnancy?
Mild-moderate can be treated with psychotherapy (cognitive behavioral therapy- CBT or interpersonal psychotherapy - IPT). Severe symptoms should be aggressively treated.
How do you counsel patients with a history of depression about risks in the postpartum period?
There is an increased risk in the postpartum period for depression
If a patient presented with suicide thoughts, how do you address the situation in your office?
-Send patient to emergency room via ambulance
What exceeds hemorrhage and hypertensive disorders as a cause of maternal mortality?
Suicide
What are the signs and symptoms of depression?
-Insomnia -Decreased appetite -Decreased libido
What are the signs of mania?
-Inflated self-esteem or grandiosity -Feeling rested after 3 hours of sleep -Engaging in risky behaviors that worry friends and family
What is EPDS?
The Edinburgh Postnatal Depression Scale (EPDS) - 10 questions
What are the risks of using tricyclic antidepressants?
in utero exposure increases jitteriness, irritability, convulsions in the neonate
What is the stepwise approach to treatment of depression prior to pregnancy?
What is the stepwise approach to treatment of pregnant patient with depression that is NOT taking antidepressants?
Assess if they have moderate to severe symptoms (suicidal or psychosis), if no then see if they have had psychotherapy before, if no then psychotherapy but if yes then see if they have failed it in the past, if yes then medication. If they have other confounding disease like panic disorder, eating disorder and bipolar then refer to a psychiatrist.
What is the stepwise approach to treatment of pregnant patient on antidepressants?
Assess if patient wants to stop
If patient wants to stop assess if they have had pscyhotherapy before, if they have relapsed without medication before
Only stop medication if they do not have moderate to severe depression, have not relapsed off of medication before and psychotherapy has worked for them in the past or they have not tried it in the past.
