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Flashcards in Postpartum mood Disorders Deck (31)
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1

Postpartum Mood Disorders
4

1. Postpartum blues

2. Postpartum depression

3. Postpartum psychosis

4. Postpartum anxiety disorder

2

Postpartum blues affects what percentage of new mothers?

Time course:
1. Begins?
2. Peaks?
3. Ends?

50 to 85 % new mothers


Time Course:
1. Begins within 48 hours delivery
2. Peaks at 3 to 5 days
3. Last around 2 weeks

3

Part of the Reason women experience depression after giving birth is hormonal. Which hormone levels (3) plummet and how long after birth does this happen?

1. Estrogen
2. Progesterone
3. Cortisol

48 hours

4

Postpartum Blues—Risk factors
6

1. History of depression
2. Depressive symptoms during pregnancy
3. Family history of depression
4. Premenstrual or OCP associated mood changes
5. Stress around child care
6. Psychosocial impairment in the areas of work, relationships and leisure activities

5

Postpartum Blues: Symtpoms? 7

1. Mood lability
2. Tearfulness
3. Sadness or elation
4. Anxiety
5. Irritability
6. Insomnia
7. Decreased concentration

6

Postpartum Blues—Treatment
5

1. Supportive with reassurance to the woman & her family
2. Allowing the woman to have enough rest
3. Perhaps getting someone to take care of the infant at night
4. Generally resolves on its own
5. Careful monitoring for the development of postpartum depression!

7

Postpartum Psychosis
1. Usual time of onset?
2. Why is this a medical emergency?

1. Usual onset within 2 weeks of delivery

2. Women with PPP more likely to commit suicide or infanticide—MEDICAL EMERGENCY!


Women are more likely to experience psychosis following childbirth that at any other time in their lives

8

Postpartum Psychosis--Pathogenesis? 2

Currently thought of as a manifestation of what?

1. Research suggests hormonal and genetic factors
2. Rapid hormonal changes following childbirth may play a role as a trigger

bipolar disorder

9

Postpartum Psychosis: risk factors?
5

1. First pregnancy
2. History of bipolar disorder
3. History of puerperal psychosis
4. Family history of puerperal psychosis
5. Recent discontinuation of lithium or other mood stabilizers
(possibly older maternal age also)

10

Postpartum Psychosis
Symtpoms?
9

1. Delusions
2. Hallucinations (visual, auditory, or olfactory)
3. Thought disorganization
4. Severe insomnia
5. Suicidal ideation
6. Homicidal ideation
7. Aggression
8. Agitation
9. Impulsivity

11

Postpartum Psychosis Treatment?
4

1. Usually acute hospitalization
2. Antipsychotics**
3. Therapy
4. Electroconvulsive therapy if pharmacotherapy unsuccessful
True medical emergency!

12

Postpartum Anxiety Disorders 4

1. Obsessive Compulsive Disorder
-Obsessions
-Compulsions
2. Panic Disorder
3. Generalized anxiety disorder
4. Posttraumatic Stress Disorder

13

Postpartum Depression up to four months aftter what?

DSM IV- up to 4 months postpartum

14

Postpartum Depression
Risk factors:
10

1. Marital conflict
2. Stressful life events, lack of social support for pregnancy
3. Lack of emotional and financial support of partner
4. Living without a partner
5. Unplanned pregnancy, previous miscarriage
6. Having contemplated terminating the pregnancy
7. A poor relationship w/ one’s own mother
8. High number of visit’s to prenatal clinic
9. Congenitally malformed child
10. Personal history of bipolar disorder

15

Postpartum Depression—Symptoms
8

1. Irritability and anger
2. Significant anxiety often w/ panic attacks
3. Feelings of inadequacy, and of being a failure as a mother
4. Feelings of guilt
5. Feelings of hopelessness or despair
6. Feeling of being overwhelmed or unable to care for the baby
7. Not bonding to the baby, which further exacerbates feelings of shame and guilt
8. Typical—insomnia, weight changes, decreased libido, decreased energy levels***

Often can lead to women suffering in silence

16

PPD—Screening types of scales? 4

1. Edinburgh Postnatal Depression Scale (EPDS)
2. Postpartum Depression Screening Scale (PDSS)
3. BECK Depression inventory
4. Provider screening w/ general questions:
“How is your mood?”
“How have you been feeling?”

17

Edinburgh Postnatal Depression Scale (a score of ___or more is positive; _____—reevaluate 1 month)

12


5-9

18

Postpartum Depression: We have to rule out a medical cause such as?

Anemia
Diabetes
Thyroid Disorders

19

Describe postpartum thyroiditis in the following time frames:
1. 1 to3 months?
2. 3 to 4 months?
3. 7 to 8 months?

1. 1 to3 months
-Hyperactivity

2. 3 to 4 months
-Hypoactivity

3. 7 to 8 months
-Stabilization

Postpartum thyroiditis

20

Postpartum thyroiditis symptoms? 6


Why are pregnant women at risk for thyroiditis?

1. hair loss;
2. debilitating fatigue;
3. depression;
4. anxiety;
5. insomnia;
6. low milk supply


Pituitary gland in bony structure; swells during pregnancy- damage can occur leading to problems in the feedback mechanism to thyroid gland

21

Six Stages of Postpartum Depression

Name and describe each

1. Denial: This must be what new motherhood is like. I’ll be alright. It can’t be postpartum depression, because I’m not mentally ill. I’m sure it will wear off soon. I just need more sleep.

2. Anger: Nobody understands what I’m going through. Why me?! This is supposed to be a time of joy. I don’t deserve this. I don’t want to have to take medication. I don’t want to go to therapy. I shouldn’t have to call a doctor. This is not fair.

3. Bargaining: If I just exercise more and eat better I’ll be fine. If I take vitamins. If I could just get to the point where the baby sleeps through the night, I’ll be okay. If I get closer to God and pray more, this will surely go away. I just need to work harder.

4. Depression: I should just leave my family. I’m bringing everyone down. They all would be better off without me. My poor baby doesn’t deserve a mother like this. I’ll never get better so there’s no point in going on.

5. Acceptance: What’s happening to me isn’t normal and I can’t ignore it anymore. It’s not my fault. It is okay for me to talk to a doctor. It’s okay for me to ask for help. I can take medication or go to therapy or do whatever is necessary for my health and that of my family. Postpartum depression and anxiety are temporary and treatable with professional help.

6. PTSD: I still worry that PPD will return. I’m constantly looking over my shoulder. Every time I feel bad I’m convinced that I’ve gone back there. I feel like I’ve lost a lot of confidence in myself and I don’t know if I’ll ever get it back. I worry I hurt my child in the long-term because of how I was when he was a baby.

22

Symptoms of Men’s Depression

■Increased anger and conflict with others
■Increased use of alcohol or other drugs
■Frustration or irritability
■Violent behavior
■Losing weight without trying
■Isolation from family and friends
■Being easily stressed
■Impulsiveness and taking risks, like reckless driving and extramarital sex
■Feeling discouraged
■Increases in complaints about physical problems
■Ongoing physical symptoms, like headaches, digestion problems or pain
■Problems with concentration and motivation
■Loss of interest in work, hobbies and sex
■Working constantly
■Frustration or irritability
■Misuse of prescription medication
■Increased concerns about productivity and functioning at school or work
■Fatigue
■Experiencing conflict between how you think you should be as a man and how you actually are
■Thoughts of suicide

23

PPD Treatment
Psychotherapy types? 3

1. Interpersonal

2. Cognitive Behavioral Therapy

3. Group therapy

24

1. What does interpersonal psychotherapy include? 2

2. What does cognitive behavioral therapy include? 2

1.
-Marital strain
-Role transitions

2.
-Changing negative cognitive distortions
-Aids in developing coping behaviors

25

Medication Usage in PPD: Considerations?

Very few drugs contraindicated in breast feeding; recommended women breast feed for at least 6 months and longer if possible
-But some risk vs benefit

26

Medications for PPD
7

1. Tricyclic Antidepressants**
2. Selective Serotonin Reuptake Inhibitors
3. Serotonin/Norepinephrine Reuptake Inhibitor:
4. Other antidepressants
5. Benzos
6. Sedative hypnotics
7. Electroconvulsive therapy (ECT)

27

Tricyclic Antidepressants**
3 drugs?

SSRIs? 2 drugs are preferred?

Tricyclic Antidepressants**
1. Amitriptyline (Elavil)
2. Nortriptyline (Pamelor)
3. Doxepin (Silenor)

Selective Serotonin Reuptake Inhibitors
1. Sertraline (Zoloft)—preferred
2. Paroxetine (Paxil)—preferred

28

Serotonin/Norepinephrine Reuptake Inhibitor 2

1. Duloxetine (Cymbalta)
2. Venlafaxine (Effexor XR)—not been rated by the AAP

29

Other antidepressants? 4 drugs

1. Bupropion SR/ XL (Wellbutrin SR/XL)— “of concern”
2. Budeprion SR/XL (Wellbutrin SR/XL)
3. Mirtazipine (Remeron)
4. Trazodone (generic only)

30

Benzodiazepine
6

1. Oxazepam (Serax)
2. Alprazolam (Xanax)
3. Temazepam (Restoril)
4. Lorazepam (Ativan)
5. Clonazepam (Klonopin)
6. Diazepam (Valium)