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
