Women Flashcards
PP depression co-morbid anxiety
MORE than with regular MDD
PP epidemiology
Blues 30-70%
Depression 10-15%
Psychosis 0.1-0.2%
40% relapse with next pregnancy
24x increased risk if 1st degree relative with BAD
Percentage of fathers with PP MDD?
10%
PP psychosis
5% suicide 4% infanticide Most commonly in primiparous Due to abrupt drop in estrogen/progesterone Having a BABY GIRL is a risk factor
Peripartum mood episodes
80% untreated
20-30% treated
Prevalence in women vs. men?
More MDD ONLY during reproductive years
Equal BAD but more mixed and rapid cycling
BAD women at higher risk for depressive episodes during perimenopause AND post menopause periods
Equal schizophrenia but bimodal distribution and WORST EVOLUTION postmenopausal
AKA Estrogen is protective
Estrogen
Increases synthesis and bioavailability of serotonin and norepinephrine
ESTROGEN IS AN ANTAGONIST OF DOPAMINE
So postpartum abrupt drop = abrupt increase in dopamine which may contribute to postpartum psychosis.
T3: Estrogen > Progesterone
Progesterone
ANXIOLYTIC
SEDATIVE
ANTIEPILEPTIC
T1: Progesterone > Estrogen
PMDD during which phase?
LUTEAL phase
Onset usually > 35yo, worsens with age
OCP with drosperinone
PMDD tx with SSRIs
Rapidly increase progesterone (allopregnanolone) in brain so effect happens in days and can take intermittently (aka mechanism is not through serotonin reuptake inhibition).
Perimenopausal MDD and hormones?
Estrogen effective (transdermal > PO) Progesterone not effective
Postmenopausal MDD and hormones?
NEITHER estrogen or progesterone effective
Health risks with estrogen
Increase with age
Increased DVT/PE
Increased breast/uterine cancer
CVD
Limit treatment duration to 3-5 years
Perimenopause and response to ADs?
Less to SSRIs
More to SNRIs
With HRT, increases response to SSRIs
Suicide in peripartum period
SUICIDE IS THE MOST FREQUENT CAUSE OF MORTALITY AMONG WOMEN DURING PERIPARTUM PERIOD IN DEVELOPED COUNTRIES
