Postpartum Mood Disorders

Question 1

Postpartum Blues

Answer 1

“baby blues”

-occurs w/in first few days, resolves w/in 10-14 days

No medical intervention required

Question 2

Postpartum Depression

Answer 2

PPD
mood disorder characterized by severe depression that occurs w/in first 6-12 months postpartum

depressed mood or loss of interest or pleasure in daily activities for at least 2 wks + 4 of the following sx:

• significant weight loss or gain (>5% in a month)
• insomnia or hypersomnia
• changes in psychomotor activity, agitation, or retardation
• decreased energy or fatigue
• feelings of worthlessness or guilt
• decreased ability to concentrate or inability to make decisions
• recurrent thoughts of death or suicide attempt

Question 3

PPD Questionnaire

Answer 3

questions rated from 0-3

score of 9 or more or indicating any suicidal ideation must be referred for care immediately

less than 9 but showing signs of depression then make appropriate referral (counseling, antidepressant therapy)

have them take questionnaire again at later appointment to see if improvements are occurring

Question 4

PPD Medical Management

Answer 4

mild PPD: psychotherapy
moderate PPD: psychotherapy and antidepressants
severe PPD or suicidal ideation: psychotherapy, antidepressants, electroconvulsive therapy, inpatient care.

Question 5

Postpartum Psychosis

Answer 5

most severe form of postpartum mood disorders (a variant of bipolar disease)

usually occurs w/in the first 1 to 4 weeks postpartum

RF: hx of bipolar disorder, prior psychoses, OCD, lack of support

Management: provide safety of the woman and infant

Question 6

PTSD

Answer 6

facts about labor and birth are distorted, reality doesn’t match expectations

RF: hx prior trauma and/or prior psychiatric hx and women who undergo emergency c-sections

Medical tx: therapy and antidepressant meds

Question 7

Paternal Postnatal Depression: RF

Answer 7

primary risk factor: maternal PPD

Question 8

Breastfeeding and Psychiatric Meds

Answer 8

evaluate lactation category of med (L1-L5) b/c ALL meds pass into breastmilk since most are lipid soluble and are then transferred via passive diffusion to baby

Question 9

Amount of Psychiatric Meds Breastfed Baby is Exposed To

Answer 9

depends on:

• factors specific to each medication
• dosage
• frequency of dosing and feeds (short acting is better than long acting)
• rate of maternal drug metabolism
• gestational age and liver function!