Postpartum depression Flashcards
postpartum “blues”
tearfulness, lability, reactivity predom. mood: happiness peaks 3-5 days after delivery unrelated to environmental stressors/ psychiatric hx present in 50-80% of women
hormone withdrawal hypothesis: estrogen
receptors concentrated in the brain
“blues” correlate w/ magnitude of drop
homone withdrawal hypotheses: progesterone metabolite (allopregnanolone)
GABA agonists; CNS GABA levels & sensitivity may decrease during pregnancy as an adaptation
the reduced brain GABA may recover more slowly in women w/ “blues”
oxytocin peripheral effects include?
uterine contraction
milk ejection
oxytocin general info
receptors concentrated in brain
new receptors are induced by estrogen during pregnancy
disruption prevents/ decreases maternal behavior
oxytocin in pregnancy
social attachment/bonding
pair-bonding/ intimacy
parental behavior
a subset of women may be vulnerable to mood d/o’s at times of hormonal flux, such as?
premenstrual, postpartum, perimenopausal
regardless of environmental stress
the nml heightened emotional responsiveness caused by__________may predispose to depression in the context of high stress & low social support
oxytocin
major depression key sx’s
at least 1 of following, for 2 wks
- depressed mood most of the day, nearly every day
- diminished interest or pleasure in all
major depression associated sx’s
changes in wt & appetite
- insomnia/ hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- feeling worthless/guilty
- impaired concentration, indecisiveness
- thoughts of death
clinical features of postpartum depression
depressed, despondent &/or emotionally numb sleep disturbance, fatigue, irritability loss of appetite poor concentration feelings of inadequacy ego-dystonic thoughts of harming baby
confounds in dx depression during pregnancy- overlapping sx’s
sleep disturbance
increased appetite
decreased energy
changes in concentration
confounds in dx depression during pregnancy: illness w/ similar sx’s
anemia
thyroid dysfunction
GDM
characteristics of postpartum depression
- begins w/in 4 wks of birth
- clinical presentation peaks 3-6 mo after delivery
- postpartum period considered up to 1 yr
- related to environmental stressors
regardless of culture, the risks of postpartum depression are similar
previous episodes of depression significant loss of life stress unwanted/unplanned pregnancy prior fetal loss unexpected birth outcomes marital confict socioeconomic status low social support
postpartum psychoses heterogeneous group of d/o’s
bipolar d/o major depression w/ psychotic features schizophrenia spectrum d/o's medical conditions drugs (amphetamines, hallucinogens, bromocriptine)
postpartum psychoses onset
usually w/in 3 wks of postpartum
postpartum psychoses: sx’s
delusions hallucinations insomnia confusion/disorientation rapid mood swings waxing & waning
factors that that may contribute to risks associated w/ antenatal depression
rindirect effects: reduced prenatal care, less optimal nutrition
poor appetite & wt loss: socioeconomic deprivation, increased use of cigarettes & alcohol
direct effects: changes in cortisol & HPA axis development
effects of untreated depression on OB complications
low birth wt
premature birth
pre-eclampsia
effects of antenatal depression on offspring
newborns cry excessively & are more inconsolable
babies (up to age 1) have poorer growth & increased risk of infxn
children (up to age 5) have more difficult temperaments, more distress, sadness, fear, shyness, frustration
early consequences of untreated postpartum depression for offspring
sometimes none distrubed mother-infant relationship cortisol elevation (baby & mother) FTT physical injury/ death
later consequences of prolonged maternal depression for offspring
depression
behavioral disturbance, including conduct d/o
reduced cognitive abilities
more school problems (truancy, dropping out)
role reversal
effects of maternal stress & anxiety during pregnancy
altered fetal hemodynamics & mvnt lower gestational age lower infant birth wt lower apgar scores enduring changes in cortisol measures in offspring- so far observed up to age 10
