Postpartum Depression

Pregnancy does not protect against mental illness. Rates are 10-12%

The symptoms of depression and pregnancy overlap.

People are reluctant to seek help.

 

Epidemiology

 

Onset is within 3-6 months or even later;

 

Causes and Risk Factors

Biological: estrogen, progesterone, endorphins, thyroid, etc

Psychosocial:

 

 

 

 

Symptoms

 

mood- sad, depressed, tearful, irritable

anhedonia

energy

weight/appetitie: low, or eating for comfort

change in sleep

fatigue/agitation

guilt bad mother

poor concentration

 

suicide and homicide

obsessive thoughts (am I a good parent? will I harm the baby?

"Some ladies feel worried about their parenting. Do you every fear you'll hurt the baby by mistake? Do you ever think you might intentially hurt the baby?"

Bipolar and psychosis functional inquiries.

 

 

 

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Diagnosis

 

Ask about atttitudes towards the baby..

 

Edinburough postpartum depression scale: who is at risk?

 

Labs: CBC, TSH, free T4, drug screen

 

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Causes and Risk Factors

 

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Treatments

Recognize and ask

Involve partner as ally/support/monitor

 

responds well to therapy

can refer to a post-partum depression unit

 

individual psychotherapy: IPT, CBT

marital therapy

partner therapy

contraception

Psychosis is an emergency and requires immediate intervention.

 

Medications

are they breastfeeding?

sertraline is currently (2009) the safest SSRI. Avoid paroxetine

Clomipramine is best if OCD is present.

MotherRisk is a valuable resource for clincians and parents.

 

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Course and Prognosis

 

Risks associated with untreated depression in pregnancy

Consequences of no treatment

 

Risk of recurrence

Subsequent pregnancies: 30-50%

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