Depression in pregnancy Flashcards
How common is depression in pregnancy?
- 7% of women are depressed outside pregnancy
- 10-15% depressed in pregnancy
- 10% depressed postnatally
Relapse rate may be up to 50% for mood disorders in pregnant women.
What are the risk factors for depression in pregnancy?
- Hx of mood and anxiety disorders
- Hx of postnatal depression
- FH of perinatal illness
- Hx of childhood abuse
- Hx of premenstrual dysphoric disorder
- Low income
- Poor social support
- Unplanned pregnancy
- Single motherhood
- Domestic violence
- Multiple children
- Young age
What are the signs and symptoms of depression?
See Psychiatry flashcards for more info.
What questions does NICE suggest to screen for depression in pregnancy?
- During the past month, have you often felt bothered by feeling low, depressed or hopeless?
- During the past month, have you often been bothered by having little interest or pleasure in doing things?
If the woman answers ‘yes’ to either of the above, then a third question should be asked:
- Is this something you need or want help with?
What are the management options for depression in pregnancy?
Antenatally:
Pre-existing: ensure decision to stop or continue medication should be an informed decision made by the woman, with access to available evidence and risk assessment.
Mild:
- Watchful waiting
- Guided self-help, computerised CBT
Moderate-severe: Risk to the fetus from the potentially harmful effects of the mother’s untreated depression on her health may outweigh any detectable risk to the fetus from antidepressants.
- IPT and CBT
- Antidepressant - sertraline first line. TCAs, SSRIs and SNRIs are the safest options.
Severe:
- ECT - no known risks to the fetus from ECT
What is the advice for patients who become pregnant whilst taking antidepressants?
- Specialist advice before stopping or switching medication
- Avoid abrupt withdrawal
- Consider a range of options with the patient including instituting psychological therapy +/- switch to a drug with fewer adverse effects.
When does NICE recommend pharmacological treatment of depression in pregnancy?
NICE recommends antidepressant medication for a woman with moderate-to-severe depression who:
- Has not responded to high intensity psychological treatment (eg, CBT).
- Declines psychological treatment.
- Has expressed a preference for medication.
- Understands the risks and benefits of the proposed medication.
Which antidepressants are safe in pregnancy?
TCAs - most evidence for amitriptyline with no risk of congenital abnormalities or adverse fetal outcomes
SSRIs - increased risk of congenital malformation in 1st trimester mostly with paroxetine. After 20 weeks, SSRIs may cause peristent pulmonary hypertension of the newborn,
SNRIs - there is less available safety information so not used routinely
What are the fetal symptoms of serotonin withdrawal syndrome? How is it managed?
- hypotonia,
- irritability,
- excessive crying,
- sleeping difficulties
- mild respiratory distress.
Self-limiting
Is lithium safe in pregnancy? What precautions should be taken?
Uncertain but treatment with lithium amy be necessary and should not be apruptly stopped. Ebstein’s anomaly may occur as a result of lithium use in pregnancy - but small study.
Antenatally - may be necessary to adjust dose and frequency of monitoring, check interaction with other pregnancy medications, discuss risks to neonate.
Postnatally- There are potential risks to the infant when a breast-feeding mother takes lithium, so mothers should be discouraged from breast-feeding. If they decide to breast-feed, the infant needs close monitoring including serum lithium levels, thyroid and renal monitoring.
What are the general complications of depression in pregnancy?
- Miscarriage - this may be mediated by antenatal exposure to antidepressants.
- Preterm delivery.
- Attempted/completed suicide.
- Increased pregnancy symptoms, pain relief in labour and worse obstetric outcome.
- Higher incidence of SGA, caesarean section but not infant mortality.
- Possible longer-term cognitive, emotional and behavioural difficulties in offspring.
- Relationship and family break-up.
Early detection of depression during pregnancy and its treatment is necessary to avoid persistence into postpartum period and sequelae such as impaired mother-infant attachments and consequences for the child.
What are some complications of untreated maternal depression on the fetus?
- causing hyperactivity and irregular fetal heart rate
- increase infants’ cortisol levels,
- impact on infant temperament,
- influence behaviour in later childhood and adolescence
Is there high risk of suicide during depression?
Women are at generally low risk of suicide during pregnancy
But it is a significant cause of maternal death in the year following birth in the UK
