Postpartum Depression Flashcards
3 etiologies of PP depression?
physiologic- fall of hormones PP, fatigue
emotional- post event let down
cultural- isolation from former life, less attractive PP, “super mom syndrome”
risk factors for PP depression?
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
what % of women will experience transient “baby blues” w/in first 2 wks following delivery?
50-80%
what % of women experience PP psychosis w/in first 4 wks following delivery?
0.1 - 0.2%
what % of women experience major depression during PG?
9.4-12.7%
what % of women have major depressive episodes in 3 mos PP?
21.9%
what % of women may not believe they had pPD?
1/3
which group of moms are esp at high risk for PPD?
primips
what makes up the spectrum of PPD?
transient PP blues (“baby blues”)
PPD
PP psychosis (medical emergency)
4 types of PPD?
baby blues
adjustment disorder of PP period
major depression in PP period
PP psychosis
~ what % experience baby blues? onset? duration? etiology?
~70% experience onset: 3-5 d PP severity: mild to moderate present in all cultures studied appears unrelated to environmental stressors
definition of “blues”?
heightened reactivity not necessarily clinical depression mood swings occurs 3-5 d after birth self-limiting if occurs, at increased risk for PPD
physical sxs of baby blues?
lack of sleep low E loss of appetite food cravings fatigue after sleep
mental sxs of baby blues?
anxiety worry lack of confidence sad overwhelmed mixed with joy and calm
behavior sxs of baby blues?
worrying for no reason excitable oversensitive irritable impatient restless
adjustment d/o of PP period occurs in what %? how does it manifest?
occurs in ~20% of birthing mothers
manifests as excessive difficulties adjusting to motherhood
not as severe in PPD
duration of adjustment d/o? what can it lead to?
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
what % have PPD start after 6 wks? after weaning? at return of menstruation? when starting oral contraceptive?
6 wks PP: 40%
weaning: 20%
menstruation: 16%
oral contraceptives: 14%
how does PPD manifest?
sxs of depression, often marked anxiety/agitation and obsessions about harm coming to the baby
can develop gradually or abruptly after birth
incidence of PPD? onset? duration?
~10% experience
onset: 6 wk- 1 yr
duration: wks to months
sxs: baby blues + others
physical sxs of PPD?
changes in appetite H/A numbness and tingling chest pn palpitations hyperventilation decreased libido insomnia hypersomnia
mental sxs of PPD?
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
behavioral sxs of PPD?
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
sxs frequently seen in PPD?
marked agitation and anxiety
mother cannot sleep even when baby is sleeping
obsession and compulsions about the baby
PP obsessions?
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
PP compulsions?
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
are PP mother’s at risk for harming their baby?
no- very low risk of actually harming their baby, more at risk of hurting themselves
incidence of PP psychosis? onset? severity? duration? RFs? ssxs?
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
how to tx PP psychosis?
MEDICAL EMERGENCY
need to refer out for hospitalization most likely
sxs of PP psychosis?
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
physical sxs of PP psychosis?
refusal to eat
excessive E
compulsive activity
inability to sleep
mental sxs of PP psychosis?
extreme confusion loss of memory hallucinations delusions agitation suidical
behavior sxs of PP psychosis?
suspicious paranoia irrational preoccupation w/trivia aversion to baby violent suicidal
management of PP psychosis?
prevention listening reassurance rest nutrition exercise breastfeeding referral to support group/counseling naturopathic meds allopathic meds
supportive tx options we can provide?
supplements/homeopathics
counseling, individual and/or group
support groups
pharmacological intervention
how to prevent PP psychosis?
La Leche League play group mom's group friends and family PP doula educate the family!
dx of PPD?
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
what is the edinburgh PN depression scale?
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
knowing referral sources that utilize what 4 things is especially important to know?
do they accept Medicaid?
do they utilize a sliding fee?
will they develop a payment plan?
do they offer free counseling?
how can exercise help?
home based exercise programs result in improvement of depression
better scores on screening depression scales
decreased fatigue
drug of choice for PPD while breastfeeding?
SSRIs
when prescribing look into half-life, effect on libido and wt
usu give in those who haven’t had PPD before
4 steps of recovery process of PPD?
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
