Postpartum Depression

Question 1

PPD

Answer 1

• Most common medical problem faced by new mothers
• Most common unrecognized OB complication
• Appears as indicator of chronic depression
• Appears as continuum of depression

Question 2

Common perinatal psychiatric disorders

Answer 2

• Depression during pregnancy
• Postpartum baby blues 50-80%
• Not considered a disorder
• Most have transient S/S (2wk in duration
• Impairs function
• Meets DSV-IV criteria for MDD
• Postpartum psychosis 1-3:1000
• Usual onset is in 1st 4 wk
• Severe functional impairment
• Possible paranoia, mood shifts, delusions, hallucinations, SI, HI

Question 3

Perinatal Depression Rates

Answer 3

• AHRQ: Prevalence of depression similar PP and non-pregnancy
• Onset of new depression higher in first 5wk
• Primapara moms higher risk in first 3mo
• Highest risk 10-19d
• WHO PPD 8-12%
• Others report 15-20%, peaks at:
• 6wk for MDD
• 2-3mo for minor depression
• 6mo is second peak
• Higher rates of 40-60% in:
• Low income mothers
• Pregnant and parenting teens

Question 4

What causes PPD?

Answer 4

• Genetic susceptibility + MAjor life events + hormonal changes = PPD
• Is it the major hormonal changes?
• No hormone consistently. Potentially: high estrogen/progesterone; Thyroid hormone; Testosterone; Cholesterol; CRH and cortisol
• Prolonged elevation of gonadal steroids in pregnancy precipitates depression and PP worsens preexisting

Question 5

Who gets PPD?

Answer 5

• Personal Hx of depression
• Other psychiatric Dx: Bipolar, schizophrenia, MDD, PMDD
• Substance abuse Hx
• Teen mothers
• Single mothers
• Marital discord
• Family or IPV
• Poor social support
• Lower SES

Question 6

Mothers with higher risk

Answer 6

• Family psych Hx
• Poor relationship w/mom
• Not breastfeeding
• Unemployment
• Child care stressors
• Sick leave in pregnancy, due to hyperemesis, uterine irritability, or psych disorder
• Personality disorders
• Gestational DM
• Bipolar
• Contemplation of terminating pregnancy
• Hx of pregnancy loss

Question 7

Paternal PPD

Answer 7

• 5% rates in men
• In new fathers:
• 8% of new fathers in 3mo
• 26% of fathers from 3-6mo
• 9% of fathers from 6-12mo

Question 8

Characteristics of mood symptoms in the perinatal period

Answer 8

• Anxiety/agitation ***
• Depressed mood
• Irritability
• Lack of interest in newborn
• Impaired concentration or feeling overwhelmed
• Feelings of dependency

Question 9

Baby Blues symptoms

Answer 9

• Fatigue
• Inability to sleep
• Lack of appetite
• Labile feelings
• Anxious
• Mild mood changes
• Sensitive reactions to criticism

Question 10

PPD S/S

Answer 10

• Anxious/agitated
• Excessive/irrational worry
• Sad, irritable, angry
• Insomnia
• Disinterest in ADLs
• Lack of pleasure in baby
• Disinterest in baby or other children
• Guilt, hopelessness, helpless, worthless
• Labile moods +/- uncontrollable crying
• Anhedonia
• Constant fatigue/exhaustion
• Appetite changes
• Lack of concentration/focus
• Feels bad/inadequate mother

Question 11

PP Psychosis S/S

Answer 11

• Extreme insomnia
• Rapid mood swings
• Confusion
• Disorientation
• Incoherent statements
• Elevated suicide/infanticide risk