Post-partum depression II Flashcards
Postpartum depression occurs in [] % of women
Develops most frequently in first [] months but can occur anytime in [] year
Postpartum depression occurs in 10-18% of women
Develops most frequently in first 4 months but can occur anytime in 1st year
What are the hormonal causes of PPD? [5]
Get decrease in levels of:
* Oestrogen within 48 hrs
* progesterone within 48hrs
* Cortisol
* CRH
* ACTH
.
BUT: women without PPD also suffer from this.
PPD also suffer from different transcripts of oestrogen and progesterone metabolism (how the body handles O&P)
What is the name of the progesterone metabolite important in PPD and which receptor does it work on? [2]
Progesterone metabolite allopregnanolone (ALLO) is a involved with GABA receptor and is a neurosteroidal transmitter
Without antidepressants - what can you give to reduce the number of PPD symptoms? [1]
Progesterone
How do oestrogen levels change after birth? [1]
Why do reduced levels of oestrogen affect mood in PPD? / Why is giving it good? [1]
The change of what family of enzymes alter oestroen levels after delivery? [1]
What do have to be careful with oestrogen therapy? [1]
Oestrogen levels acutely fall
Oestrogen gives rise to increased serotonin
Monoamine oxidases (family of enzymes) rise after birth till day 4-6: causes oestrogen levels to be depressed (and therefore depressive symptoms)
Oestrogen therapy has a bell curve effect (bad at extreme high / lows)
Describe the non-hormonal causes of PPD? [2]
Physcosocial factors (no consistent obstetric factors - to do wtih the surrounding environment)
Biological vulnerability (previous history of depression / Fx / history of antenatal depression / previous Hx of PPD: 90% recurrence)
- Gestational diabetes indepedently associated with increased PPD
- Not breastfeeding baby
- Sleep disturbance (treatment of insomnia in 3rd trimester - reduces the risk)
What tests would you do to exclude a medical cause for mood distubance? [2]
Thyroid dysfunction
Anaemia
Failure to treat PPD may cause what with regards to relationship with baby? [1]
Failure to treat or inadequate treatment may result in deterioration of relationship between mother and child
What is link between returning to work and PPD? [2]
More at risk if you go back to work too soon.
But if working again at 12 months risk of PPD goes down
Explain why giving oestrogen alone / in combination w/ antidepressants is beneficial for PPD [1]
Breast feeding surpresses the start of menstruation - so oestrogen levels are also depressed
How long is pharmacotherapy treatment recommended for PPD? [1]
6-12 months (takes an initial 2-4 weeks to start seeing symptoms reduced anyway)
Which anxiolytics may be recommended as an adjunctive treatment for PPD? [2]
Explain MoA [1]
Lorazepam and clonazepam
GABA benzodiazepines (enhances GABA activity)
What is brexanolone aka? [1]
What is MoA? [1]
allopregnanlone (a progesterone metabolite)
- Modulates synaptic GABA-receptors and extrasynaptic GABA-A receptors: (GABA is an inhibitory receptor)
- Allows GABA that binds to receptor to have a bigger effect on the GABA receptor Makes patients feel open and feeling of relaxtion
Which type of antidepressant drugs are useful in women with sleep disturbance?
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic antidepressants (TCAs)
Which type of antidepressant drugs are useful in women with sleep disturbance?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which type of antidepressant drugs are useful in women with sleep disturbance?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following is an SNRI?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following is an SNRI?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following is an TCA?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following is an TCA?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following does not cause nausea in mother?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following does not cause nausea in mother?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of growth retardation in chiild?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of growth retardation in chiild?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of omphalocele and heart septal defects for fetus / neonate??
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of omphalocele and heart septal defects for fetus / neonate??
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of tachycardia and urinary retention in neonate and fetus?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of tachycardia and urinary retention in neonate and fetus?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Describe the onset of postnatal psychosis compared to PPD? [1]
Psychosis: dramtic early onset (48-72hrs)
PPD: after two weeks
How do you treat postnatal psychosis? [3]
Mood stabilizer: (lithium, valproic acid and carbamazepine)
In combination with antipsychotic medications and benzodiazepines
electroconvulsive therapy is well tolerated and rapidly effective
Which mood stabilisers would give for postnatal psychosis? [3]
- lithium
- valproic acid
- carbamazepine
Which drugs prescribed should women avoid breastfeeding [2] (and why) [1]
valproic acid and carbamazepine should avoid breastfeeding
Linked to hepatotoxicity in the infant
Why should you monitor affect of mood stabiliser lithium? [2]
Can be toxic and if breastfeed monitor levels of lithium and thyroid function
Explain how anti-psyc. drugs can lead to hyperprolactinemia
Anti-psychotic drugs work by inhibiting dopamine release
Dopamine inhibits prolactin release: reduced dopamine causes hyperprolactinemia (increased breast milk - can cause pain)
Which disease massively increases likelihood of post-natal pysc.?
Bi-polar
What is impact of PPD on infants?
Children more likely to exhibit behavioural problems and delays in cognitive development, emotional and social dysregulation and early onset depressive illness
What can you give to prevent PPD in pregnancy? [1]
Omega-3 (fish oil etc)
Describe pathophysilogy of pre-menstrual dysphoric disorder (PMDD)
What is used to treat? [1]
Symptoms start at late luteal phase: corpus luteum is shutting down and you lose progesterone
Ends soon after menstruation starts
Use ALLO to treat
PMDD patients have lower []
PMDD patients have lower ALLO (Allopregnanolone)
How do SSRIs influence ALLO levels? [1]
SSRIs may enhance sensitivity of GABAA or promote formation of more ALLO
