Postnatal depression Flashcards
Definition
Depression illness following childbirth (usually within 6 month), can be part of bipolar or unipolar
Epidemiology
Prevalence 7-19%
Etiology
- Psychosocial: stressors, finance, violence, low employment
- Psychiatric illness: antenatal history of depression/anxiety increases risk 3-5 times
- Personality disorder: high neuroticism, low self esteem
- Genetic factors
- Sleep disturbance
- Complications of pregnancy and birth
- Young maternal age->mothers
Pathophysiology
Not exactly known
May be vulnerable to specific pueperal trigger
No major difference in hormone profile->may have abnormal sensitivity to normal physiological changes during pregnancy
Reducing the risk of postnatal depression
Professional home visits by nurses and midwives
Interpersonal psychotherapy
CBT
Edinburgh PNDS at 6 weeks
Clinical features
Depressed mood
Anhedonia
Decreased energy or increased fatiguability
Suicidal ideation
Loss of confidence/self esteem
Unreasonable feelings of self reproach or excess guilt
Poor concentration
Sleep, appetite, weight, obsessive thoughts
Risk factors
History of depression/anxiety Recent stressful life events Discontinuation of psychopharmacological therapies Sleep deprivation Genetic susceptibility Violence
Investigations
- Whooley questions
a. The questions are: “During the past month, have you often been bothered by feeling down, depressed, or hopeless?” and “During the past month, have you often been bothered by having little interest or pleasure in doing things?”
b. If the answer to either of these questions is positive, a third question is recommended: “Is this something with which you would like help?”
c. The 3 questions have a positive predictive value of 32% and a negative predictive value of 99% for major depression. - EPNDS
How does PND differ from minor mood disturbance/baby blues
- mother typically presents with mood swings ranging from elation to sadness, insomnia, tearfulness, crying spells, irritability, anxiety, and decreased concentration.
- Symptoms develop within 2 to 3 days postnatal, peak on the fifth day, and resolve within 2 weeks.
Assessing self harm/harm to baby
- Whether feels life is not worth living
- Ever thought of harming baby
- Impaired bonding, lack feeling of attachment, sense of numbness
Does not increase risk of following through - Obsessive, intrusive and aggressive thoughts
- Suicidal thoughts
- Plan
- Lethality
- Means
- Risk and protective factors
- Mental state
- History of suicidal behaviour
- Family history
- Substance use
- Strengths and supports
History
- Symptoms
- Suicide/homicide risk
- Mania/hypomania
- Complete psychiatric history
Management
- Self help, counselling, CBT, interpersonal therapy
2. Antidepressants->sertraline or paroxetine
Follow up
- Reviewed regularly
- In pharM & breast feeding->adverse effects + in premature/young/ill->monitor infant for ++sedation, irritability, changes in sleep, feeding and growth
- Develop a trusting relationship->thoughts, concerns, expectations
- Discuss risk of recurrence
Complications
- Impaired bonding
- Neglect of the baby or infanticide
- Suicide
- Bipolar
Prognosis
- Usually last for 3-6 months
- Higher risk of recurrence
- Depends on the the persistence of the adverse circumstances
- Early-onset depression (within the first 6-8 weeks), severe depression, and depression with bipolar or psychotic symptoms suggest the presence of a specific puerperal trigger,