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
potential effects of postpartum depression on relationships
altered roles w/in the couple altered roles w/in extended family establishing alt. caregiver patterns that become difficult to change later impaired communication psychiatric sx's in partner
risk of suicide from untreated major depression during pregnancy
overall risk may be greater than in non-pregnant women
risk may be increased when: pregnancy is unwanted, esp. when wanted abortion but couldn’t obtain; partner abandoned woman during pregnancy; woman has had prior pregnancy loss &/or death of CH
infanticide d/t postpartum depression
rare; greater risk w/ psychotic sx’s
rarely has hx of abusing CH
most often part of a suicide attempt
no anger toward baby; wish not to abandon baby &/or not to burden others w/ baby
rarely attempt to conceal; often self-report
thoughts of harming baby: low risk
common in non-psychotic PPD mother doesn't want to harm baby thoughts are ego-dystonic mother takes steps to protect baby mother has no delusions/hallucinations related to harming baby
ego-dystonic thoughts
obsessive in nature & odd/frightening to mother
thoughts of harming baby: high risk
mom has delusional beliefs about baby
thoughts of harming baby are ego-syntonic
mom has hx of violence
mom has labile mood &/or impulsive behavior
ego-syntonic thoughts
mother thinks they are reasonable &/or feels tempted to act on them
potential effects on mother-infant relationship
brain & CNS development: interplay bet. genes & experiences, early interactions directly affect how the brain is “wired”, HPA axis-stress response sx impact
Attachment: infants of depresed mothers are at high risk for developing an insecure attachment relational problems bet. infants & their ?
caegivers are connected to early social, emotional, & behavioral problems for CH
