Depression & Labs value Flashcards
depression
aka major depressive disorder (MDD)
range from mild - severe
range from 12-30% highest among women of low SES
20% in pregnancy
pregnancy may trigger recurrent of depressive symptoms
no recognize by provider 50% of the cases
Emotional functional and financial consequences impact the whole family
associated risk factor for prenatal depression
prior hx depression poverty marital problems lack of partner family domestic violence chronic life work stress unplanned unwanted pregnancy
Potential problems due to untreated depression in pregnancy
poor nutrition : inadequate weight gain substance use (smoking, alcohol, drugs) Preeclampsia preterm birth postpartum depression
maternal elevated cortisol levels associated with childhood:
sleep problems
attention deficient disorder
language and cognitive impairment
s/x depression
prior depression poor social support feelings isolation despair, worthlessness fatigue prior pregnancy insomnia multiple somatic complaints/ symptoms suicide ideation weight change (often loss) unrelated to pregnancy observe eye contact observe general effect
screening & quantification
Beck Depression Inventory (BDI)
Edinburgh Postnatal Depression Scale (EPDS) both validated use in pregnancy and postpartum women
OB and psychological consult appropriate if screening is positive
management depends on severity
management mild depression
Adequate sleep, strategies to reduce stress Psychotherapy Support Exercise light therapy St john's wort
Psychotherapy
- always part of treatment regime for depression
- short or long term
- psychologist, psychiatrist, clinical nurse specialist
support
advise her to communicate her needs to others
Ask for help with housekeeping, preparing meals and other daily tasks
support group for pregnant mothers, or for women with depression
exercise
exercise reduce depression hormone cortisol provides a feeling of accopmplishment enhances self-esteem and increases serotonin (neurotransmitter key in development of depression)
light therapy
sitting in front of special light box for about 30 minutes every day
recent studies indicate efficacy in pregnancy
St john’s wort (hypericum perforatum)
studies have been short-term and not well controlled
no uniformity of dose or amount and types of ingredients not regulated by FDA)
may negatively interact with antidepressants
no evidence of teratogenicity
no enough scientific evidence to recommend use during pregnancy or breastfeeding
management of severe depression pharmaceuticals
SSRI :
* fetus exposed through placenta
*SSRI increase the amount of neurotransmitter in brain synaptic clefts
* associated with significant increase in LBW <10%
* Associated with 6 fold increase in PPHN ( persistent pulmonary hypertension) in recent studies
studies mixed on associated with increase spontaneous loss
* use only when risk/benefits weighed
Paroxetine (paxil)
NOT USED
Some studies report an increase in congenital malformations with use (craniosynostosis, omphalocele, heart defects)
Reasons to take antidepressants
you have been taking medicine for severe depression, and you don’t want to stop now that you are pregnant
studies show that certain antidepressants are not likely to cause birth defects
you have tried other treatment, and it hasn’t helped
you are more worried about how your depression may affect your baby than about how the medicine may affect your baby
ASk are there other reasons you might want to take antidepressants
