Postpartum Depression

Question 1

3 etiologies of PP depression?

Answer 1

physiologic- fall of hormones PP, fatigue
emotional- post event let down
cultural- isolation from former life, less attractive PP, “super mom syndrome”

Question 2

risk factors for PP depression?

Answer 2

previous PPD
FHx of PPD
Hx of depression
ambivalence about PG
unhappy primary relationship
complications of labor/PP/negative birth experience
early mother-child separation
Hx of PMS
hypothyroidism
recent loss or move
isolation (lack of support network)
perfectionism
dissatisfaction w/self (eating disorder)
unresolved SAB/TAB
young age 
multiparity

Question 3

what % of women will experience transient “baby blues” w/in first 2 wks following delivery?

Answer 3

50-80%

Question 4

what % of women experience PP psychosis w/in first 4 wks following delivery?

Answer 4

0.1 - 0.2%

Question 5

what % of women experience major depression during PG?

Answer 5

9.4-12.7%

Question 6

what % of women have major depressive episodes in 3 mos PP?

Answer 6

21.9%

Question 7

what % of women may not believe they had pPD?

Answer 7

1/3

Question 8

which group of moms are esp at high risk for PPD?

Answer 8

primips

Question 9

what makes up the spectrum of PPD?

Answer 9

transient PP blues (“baby blues”)
PPD
PP psychosis (medical emergency)

Question 10

4 types of PPD?

Answer 10

baby blues
adjustment disorder of PP period
major depression in PP period
PP psychosis

Question 11

~ what % experience baby blues? onset? duration? etiology?

Answer 11

~70% experience 
onset: 3-5 d PP
severity: mild to moderate
present in all cultures studied
appears unrelated to environmental stressors

Question 12

definition of “blues”?

Answer 12

heightened reactivity not necessarily clinical depression
mood swings
occurs 3-5 d after birth
self-limiting
if occurs, at increased risk for PPD

Question 13

physical sxs of baby blues?

Answer 13

lack of sleep
low E
loss of appetite
food cravings
fatigue after sleep

Question 14

mental sxs of baby blues?

Answer 14

anxiety
worry
lack of confidence
sad 
overwhelmed
mixed with joy and calm

Question 15

behavior sxs of baby blues?

Answer 15

worrying for no reason
excitable
oversensitive
irritable
impatient
restless

Question 16

adjustment d/o of PP period occurs in what %? how does it manifest?

Answer 16

occurs in ~20% of birthing mothers
manifests as excessive difficulties adjusting to motherhood
not as severe in PPD

Question 17

duration of adjustment d/o? what can it lead to?

Answer 17

can resolve w/o tx over time, but can cause ongoing difficulties for mom
can develop into PPD if more severe and untreated
responds well to short term psychotherapy

Question 18

what % have PPD start after 6 wks? after weaning? at return of menstruation? when starting oral contraceptive?

Answer 18

6 wks PP: 40%
weaning: 20%
menstruation: 16%
oral contraceptives: 14%

Question 19

how does PPD manifest?

Answer 19

sxs of depression, often marked anxiety/agitation and obsessions about harm coming to the baby
can develop gradually or abruptly after birth

Question 20

incidence of PPD? onset? duration?

Answer 20

~10% experience

onset: 6 wk- 1 yr
duration: wks to months
sxs: baby blues + others

Question 21

physical sxs of PPD?

Answer 21

changes in appetite
H/A
numbness and tingling
chest pn
palpitations
hyperventilation
decreased libido
insomnia 
hypersomnia

Question 22

mental sxs of PPD?

Answer 22

despair
feelings of inadequacy
hopelessness
inability to cope
hyperconcern
poor memory/concentration
loss of usual interests
suicidal ideation, fantasies
repetitive fears, thoughts or images 
guilt 
emotional numbness

Question 23

behavioral sxs of PPD?

Answer 23

extreme or unusual behavior
panic
anxiety
hostility/easily angered
anger towards family/baby
phobias/fears
antisocial behavior
lack of grooming
exaggerated high or low moods
frequent sadness or crying
over concern for baby

Question 24

sxs frequently seen in PPD?

Answer 24

marked agitation and anxiety
mother cannot sleep even when baby is sleeping
obsession and compulsions about the baby

Question 25

PP obsessions?

Answer 25

commonly focused on infant
thoughts (obsessions) about hurting the infant: dropping, drowning, stabbing, putting in oven or microwave, sexually abusing infant, thoughts someone will steal or harm the infant

Question 26

PP compulsions?

Answer 26

commonly follow the obsessions as an attempt to alleviate the thought:
avoid holding baby by staircases
avoid bathing infant
hide knives
avoid kitchen area
avoid changing diapers or bathing infant
avoid leaving the house

Question 27

are PP mother’s at risk for harming their baby?

Answer 27

no- very low risk of actually harming their baby, more at risk of hurting themselves

Question 28

incidence of PP psychosis? onset? severity? duration? RFs? ssxs?

Answer 28

0.1- 0.3%
usu w/in 1st 3 wks PP
severe
duration varies
RFs: hx of bipolar affective d/o or psychosis, Fhx of psychosis, having first child
sxs: all other sxs plus more

Question 29

how to tx PP psychosis?

Answer 29

MEDICAL EMERGENCY

need to refer out for hospitalization most likely

Question 30

sxs of PP psychosis?

Answer 30

delusions: false beliefs, often of a religious nature and very frequently involving the infant
perceptual distortions: hearing or seeing things which are not present
often feelings of excessive well being or importance

Question 31

physical sxs of PP psychosis?

Answer 31

refusal to eat
excessive E
compulsive activity
inability to sleep

Question 32

mental sxs of PP psychosis?

Answer 32

extreme confusion
loss of memory
hallucinations
delusions
agitation
suidical

Question 33

behavior sxs of PP psychosis?

Answer 33

suspicious
paranoia
irrational
preoccupation w/trivia
aversion to baby
violent 
suicidal

Question 34

management of PP psychosis?

Answer 34

prevention
listening
reassurance
rest
nutrition
exercise
breastfeeding
referral to support group/counseling
naturopathic meds
allopathic meds

Question 35

supportive tx options we can provide?

Answer 35

supplements/homeopathics
counseling, individual and/or group
support groups
pharmacological intervention

Question 36

how to prevent PP psychosis?

Answer 36

La Leche League
play group
mom's group
friends and family
PP doula
educate the family!

Question 37

dx of PPD?

Answer 37

edinburgh PN depression scale 10 question self-report, max 30 points
women who report depressive sxs w/o suicidal ideation or major fxnal impairment are re-evaluated w/in 1 mo to determine state of depression

Question 38

what is the edinburgh PN depression scale?

Answer 38

designed for home or outpatient use
10 questions
can be completed in approx 5 mins
reviews feelings the previous 7 d
scored 0-3 depending on sx severity
depending on study, cut off is 14

Question 39

knowing referral sources that utilize what 4 things is especially important to know?

Answer 39

do they accept Medicaid?
do they utilize a sliding fee?
will they develop a payment plan?
do they offer free counseling?

Question 40

how can exercise help?

Answer 40

home based exercise programs result in improvement of depression
better scores on screening depression scales
decreased fatigue

Question 41

drug of choice for PPD while breastfeeding?

Answer 41

SSRIs
when prescribing look into half-life, effect on libido and wt
usu give in those who haven’t had PPD before

Question 42

4 steps of recovery process of PPD?

Answer 42

initial: still depressed, reassurance needed
transition: few good days, but also still some bad days
middle: more good days than bad, as she becomes assertive can see increased arguments with partner, encourage patience
final: coping, knows who she is again