Post Partum Depression

Question 1

What are the postpartum mood disorders?

Answer 1

Postpartum blues

Postpartum depression

Postpartum psychosis

Postpartum anxiety disorder

Question 2

Postpartum Blues

• onset? peak? duration?
• risk factors
• Sx
• Tx

Answer 2

Onset: 48hrs
Peak: 3-5days
Lasts 2wks

Risk factors:

• hx of depression
• depressive sx during pregnancy
• FHx of depression
• premenstrual or OCP associated mood changes
• stress around child care
• Psychosocial impairment in areas of work, relationships, and leisure activities.

Sx:

• mood lability
• tearfulness
• sadness
• anxiety
• irritability
• insomnia
• decreased concentration

Tx:

• supportive, reassurance -rest
• getting help with childcare
• resolves on own

Question 3

Postpartum Psychosis

• onset
• risk factors
• sx
• Tx

Answer 3

Onset: within 2 wks of delivery

Risk factors:

• 1st pregnancy
• Hx of bipolar disorder
• FHx of puerperal psychosis
• recent discontinuation of lithium or other mood stabilizers.

Sx:

• delusions
• hallucinations
• thought disorganization
• severe insomnia
• suicidal ideation
• homicidal ideation
• aggression
• agitation
• impulsivity

Tx:

• acute hospitilization
• anti-psychotics
• anti-depressants
• therapy
• ECT
• medical emergency!!!! at high risk for suicide!!!

Question 4

What are the postpartum anxiety disorders?

Answer 4

• OCD: obsession = intrusive thoughts (recurring thoughts)
  compulsions: recurring actions
• Panic disorder
• Generalized anxiety disorder

Posttraumatic stress disorder

Question 5

Postpartum Depression:

• MC in men or women?
• Risk factors

Answer 5

Men and women are about equally affected; Men 10-26%, Women 12-15%

Risk factors:

• marital conflict
• stressful life events
• lack of social support
• lack of emotion/financial support
• living without a partner
• unplanned pregnancy
• having contemplated terminating the pregnancy
• poor relationship with ones own mom
• high number of visits to prenatal clinic
• congenitally malformed child
• personal hx of bipolar

Question 6

Postpartum Depression :
-sx
-

Answer 6

Sx:

• irritability and anger
• significant anxiety w/ panic attacks (usually 1st sx)
• feelings of inadequacy, failure as a mother
• feelings of guilt
• feelings of hopelessness or despair
• not bonding with the baby (diff breastfeeding)
• insomnia, weight changes, decreased libido, decreased energy**

Question 7

What are some screening tests for Postpartum depression?

Answer 7

Edinburgh Postnatal Depression Scale (12 for more is positive, 5-9 reevaluate in 1mo)

Postpartum depression screening scael

BECK depression inventory

“how is your mood?”

“how have you been feeling?”

Question 8

Sx of Men Depression

Answer 8

Increased anger and conflict with others

Increased use of alcohol or other drugs

frustration

Violent behavior

losing weight without trying

isolation from family and friends

easily stressed

impulsiveness and taking risks (reckless driving and extramarital sex)

feeling discourage

ongoing physical sx like HA, digestion problems, pain.

thoughts of suicide

Question 9

Postpartum Depression :

• Tx
• what things need to be considered when choosing medications for tx of PPD?

Answer 9

Pscyhotherapy

• -CBT
• -Group Therapy
• -Interpersonal (marital and role transitions)

ECT
Anti-depressant medications (SSRI, SNRI, TCA)

Breastfeeding or nah? 
Drug transfer: 
--protein bindng 
--lipid solubility 
--molecular wt of drug 
--drug half life