Post Partum Depression

Question 1

What is the definition of Post Partum Depression

Answer 1

PPD is depression that lasts longer than 2 weeks

• May start during pregnancy or any time after birth up to 1 yr.
• Can involve sadness, worthlessness, guilt, lack of interest in previously enjoyable activities,the baby and may include thoughts of self harm

Question 2

What is the prevelance of PPD in new mothers and fathers?

Answer 2

1 in 7 women experience PPD and 10% of men.

-Approx 50% of PPD is thought to go undetected

Question 3

What is the second most common cause of death for post partum women?

Answer 3

Suicide- 20%

Question 4

Risk factors for PPD

Answer 4

-Previous PPD
-Premenstrual dysphoria
-Post partum blues
-Prior antenatal depression or anxiety
- Infant with low birth weight
-Infant with health challenges
-Marital conflict
-Poor social/ partner support
-Low income
Immigrant status
History or experience with abuse
-Unintended pregnancy
Young maternal age

Question 5

Protective factors towards PPD

Answer 5

• exercise
• longer breastfeeding time
• Education about PPD
• Higher perceived social support

Question 6

What are the baby blues?

Answer 6

Weepiness, crying for no reason, impatience, irritability, restlessness, anxiety, sadness, mood changes, poor concentration.
-Suggested to last a shorter duration and more mild in comparison with PPD. Lasts ~ 2 weeks

Question 7

What is the Edinburdgh Post Natal Depression Scale (EPND)

Answer 7

This is THE MOST COOMON tool used to assess PPD.
10 questions each with repspones allocated 0-3 points.
>8 pts = depression unlikely
9-11 pt= possible PPD
12-13 pt= likely suffering from depressive illness
>14 =highly probably suffering with PPD
Looking at scores over time is likely more effective than a single score.

Question 8

What is the DSM-5 diagnositc criteria for PPD

Answer 8

MDD with mood symptoms onset during pregnancy or within the first 4 weeks following birth.

• Requires that at least 5 of the below characteristics occur within a 2 week window:
• depressed mood (subjective/observed)
• loss in pleasure of activities that were once enjoyable
• changes in wt of >5% in 1 month
• insomnia or hypersomnia
• psycho motor retardation or agitation
• loss of energy
• worthlessness or guilt
• loss of concentration
• recurrent thoughts of death or suicidal attempts

Question 9

What are the therapeutic options for PPD

Answer 9

Medications- principally antidepressants. There is always a risk benefit discussion that must occur due to the potential harm these could pose for a nursing infant vs untreated PPD

Therapy- counselling sessions which try to assess the psychological aspects of PPD
-New Internet therapies with a focus on cognitive behavior therapy are beginning to emerge.