Postpartum Depression Flashcards
Postpartum Mood Disorders
Postpartum blues
Postpartum depression
Postpartum psychosis
Postpartum anxiety disorder
% of new mothers with postpartum blues
50-85%
Time Course of Postpartum Blues
Begins 48 hours after delivery
Peaks 3-5 days
Lasts around 2 weeks
Etiology of Postpartum Blues
Coping with a new child
Risk Factors for Postpartum Blues
Hx of depression
Depressive symptoms during pregnancy
Family Hx of depression
Premenstrual or OCP associated mood changes
Stress around child care
Psychosocial impairment in the areas of work, relationships, & leisure activities
Symptoms of Postpartum Blues
Mood lability Tearfulness Sadness or elation Anxiety Irritability Insomnia Decreased concentration
Treatment for Postpartum Blues
Supportive with reassurance to the woman & family
Allow woman enough rest
Someone to help take care of the infant & night
Careful monitoring for the development of postpartum depression
Onset for Postpartum Psychosis
Within 2 weeks of delivery
Women with what are more likely to commit suicide or infanticide
Postpartum Psychosis
Pathogenesis of Postpartum Psychosis
Hormonal factors
Genetic factors
Currently thought of as a manifestation of bipolar disorder
Risk Factors for Postpartum Psychosis
First pregnancy Hx of bipolar disorder Hx of puerperal psychosis Family Hx of puerperal psychosis Recent discontinuation of lithium or other mood stabilizers
Symptoms of Postpartum Psychosis
Delusions Hallucinations Thought disorganization Severe insomnia Suicidal ideation Homicidal ideation Aggression Agitation Impulsivity
Treatment of Postpartum Psychosis
Acute hospitalization Antipsychotics Therapy ECT if pharmacotherapy unsuccessful MEDICAL EMERGENCY
Postpartum Anxiety Disorders
OCD
Panic disorder
GAD
PTSD
Define Obsession
Idea or thought that continually preoccupies or intrudes on a person’s mind
Define Compulsions
Irresistible urge to behave in a certain way, especially against one’s conscious wishes
Risk Factors for Postpartum Depression
Marital conflict
Stressful life events, lack of social support for pregnancy
Lack of emotional/financial support
Living without a partner
Unplanned pregnancy, previous miscarriage
Having contemplated terminating the pregnancy
Poor relationship with one’s own mother
High # of visit’s to prenatal clinic
Congenitally malformed child
Personal Hx of bipolar disorder
Symptoms for Postpartum Depression
Irritability & anger
Significant anxiety with panic attacks
Feelings of inadequacy & failing as a mother
Feelings of guilt
Feelings of hopelessness or despair
Feeling of being overwhelmed or unable to care for the baby
Not bonding to the baby
Typical: insomnia, weight changes, decreased libido, decreased energy levels
Postpartum Depression Screening
Edinburgh postnatal depression scale (EPDS)
Postpartum depression screening scale (PDSS)
BECK depression inventory
Personal interview
What medical causes need to be ruled out when considering postpartum depression?
Anemia
Diabetes
Thyroid disorders
6 Stages of Postpartum Depression
Denial Anger Bargaining Depression Acceptance PTSD
Symptoms of Men’s Postpartum Depression
Increased anger & conflict with others
Increased use of ETOH or other drugs
Frustration or irritability
Violent behavior
losing weight without trying
Isolation from family & friends
Being easily stressed
Impulsiveness & taking risks
Feeling discouraged
Increases in complaints about physical problems
Ongoing physical symptoms
Problems with concentration & motivation
Loss of interest in work, hobbies & sex
Working constantly
Frustration or irritability
Misuse of prescription medication
Increased concerns about productivity & functioning at school or work
Fatigue
Experiencing conflict between what you think & how you are
Thoughts of suicide
Treatment Options for Postpartum Depression
Psychotherapy: interpersonal, CBT, group therapy
Considerations with Breastfeeding in Postpartum Depression
Risk vs. benefits
Evaluation of infant
Medications for Postpartum Depression Treatment
TCAs SSRIs SNRIs Other antidepressants Benzodiazepine Sedative hyponotics
TCAs for Treatment of Postpartum Depression
Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Doxepin (Silenor)
SSRIs for Treatment of Postpartum Depression
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Escitalopram (Lexapro)
SNRIs for Treatment of Postpartum Depression
Duloxetine (Cybalta)
Venlafaxine (Effexor XR)
Other Antidepressant for Treatment of Postpartum Depression
Bupropion SR/XL
Budeprion SR/XL
Mirtazipine (Remeron)
Trazodone (generic only)
Benzodiazepines for Treatment of Postpartum Depression
Oxazepam (Serax) Alprazolam (Xanax) Temazepam (Restoril) Lorazepam (Ativan) Clonazepam (Klonopin) Diazepam (Valium)
Sedative Hypnotics for Treatment of Postpartum Depression
Zaleplon (Sonata)
Zolpidem (Ambien)
Escopiclone (Lunesta)
Optional Treatment for Postpartum Depression
ECT
Postpartum Blues
Incidence: 50-85%
Duration: 2-3 days, resolves within 10 days
Symptoms: tearfulness, fatigue, depressed affect, irritability
Treatment: reassurance, watchful waiting
Postpartum Depression
Incidence: 10-15%
Duration: 2 weeks to 12 months
Symptoms: depressed affect, anxiety, symptoms worse at night, poor concentration, decreased libido
Treatment: antidepressants, psychotherapy
Postpartum Psychosis
Incidence: 0.1-0.2%
Duration: typically days to 6 weeks
Symptoms: delusions, confusion, sleep disturbances, unusual behavior, emotional liability
Treatment: antipsychotics, antidepressants, inpatient hospitalization
