Post Partum Depression Flashcards
What age group is depression most common?
18-59
Rate of major depression during pregnancy
9.4-12.7%
Major depression postpartum doubles
- 1% first 3mo
21. 9% in firth 12mo
Post partum blues
Predominant mood: happy
Tearfulness, mood lability, reactivity
Peaks 3-5days after delivery
50-80% of women
Which is not related to environmental stressors or psychiatric hx?
Postpartum blues
Hormone withdrawal hypotheses
Blues correlates w/ magnitude of drop in estrogen
GABA levels & sensitivity decreases
- progesterone metabolite: allopregnanolone
Oxytocin
Uterine contraction Milk ejection Social attachment/bonding Pair bonding/intimacy Parental behavior
Disruption of what hormone prevents/decreases maternal behavior?
Oxytocin
Some women are vulnerable to mood disorders during hormonal flux regardless of environmental stress
Normal high of oxytocin may predispose to depression w/high stress & low social support
Key sxs of major depression
At least 1 of the following:
- depressed most of the day
- Markedly diminished interest or pleasure in all, almost all activities most of the day, nearly every day
Associated sxs of major depression
Four or more of the following:
- changes in wt/appetite
- insomnia/hypersonic
- psychomotor agitation/retardation
- fatigue/loss of energy
- feeling worthless or guilty
- impaired concentration, indecisiveness
- thoughts of death
Post partum depression
- depressed, despondent and or emotionally numb
- sleep disturbance, fatigue, irritability
- loss of appetite
- poor concentration
- feelings of inadequacy
- ego-dystopia thoughts of harming the baby
Difficulty in diagnosing depression during pregnancy
Sxs overlap
- sleep disturbance
- increased appetite
- decreased energy
- changes in concentration
Illnesses w/ similar sxs
- anemia
- thyroid dysfxn
- GDM
Characteristics of post partum depression
Starts within 4wks of birth
Peaks 3-6mo
- related to environmental stressors
Post partum period
Up to 1year
Risks of postpartum depression
- previous episodes of depression
- significant loss or life stress
- unwanted/unplanned pregnancy
- prior fetal loss
- marital conflict
- socioeconomic Status
- unexpected birth outcomes
- low social support
Which is most dangerous?
Postpartum psychoses
Onset within 3wks postpartum
Which is composed of a heterogenous group of disorders:
- bipolar disorder
- Major depression w/ psychotic features
- Schizophrenia
- medical conditions (thyroid/low B12)
- Drugs (amphetamines, hallucinogens, bromocriptine)
Post partum psychoses
Sxs of post partum psychoses
- delusions (baby possessed by demons)
- insomnia
- hallucinations (seeing someone else’s face)
- increased confusion/disorientation
- rapid mood swings
- waxing & waning ( normal-crazy-normal)
Factors that contribute to antenatal depression
Indirect effects:
- poor nutrition
- reduced prenatal care
Poor appetite & wt loss
- socioeconomic deprivation
- alcohol & cigarettes
Direct effects
- changes in cortisol & HPA axis development
OB Complications of untreated depression
Low birth wt
Premature
Pre-eclampsia
Effects of depression on offspring
Cry excessively, inconsolable
Poor growth, high risk of infxn
Difficult temperament, sad, distressed, fear, shy, frustrated- up to 5yo
Early consequences for offspring
Bad mom-baby relationship Cortisol elevation (mom & baby)
Failure to thrive
Physical injury/death
Sometimes none
Late consequences on offspring
Depression
Reduced cognitive abilities
More school problems
Role reversal
Behavioral disturbance, including conduct disorder
