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Flashcards in Postpartum Depression Deck (35):
1

Postpartum Mood Disorders

Postpartum blues
Postpartum depression
Postpartum psychosis
Postpartum anxiety disorder

2

% of new mothers with postpartum blues

50-85%

3

Time Course of Postpartum Blues

Begins 48 hours after delivery
Peaks 3-5 days
Lasts around 2 weeks

4

Etiology of Postpartum Blues

Coping with a new child

5

Risk Factors for Postpartum Blues

Hx of depression
Depressive symptoms during pregnancy
Family Hx of depression
Premenstrual or OCP associated mood changes
Stress around child care
Psychosocial impairment in the areas of work, relationships, & leisure activities

6

Symptoms of Postpartum Blues

Mood lability
Tearfulness
Sadness or elation
Anxiety
Irritability
Insomnia
Decreased concentration

7

Treatment for Postpartum Blues

Supportive with reassurance to the woman & family
Allow woman enough rest
Someone to help take care of the infant & night
Careful monitoring for the development of postpartum depression

8

Onset for Postpartum Psychosis

Within 2 weeks of delivery

9

Women with what are more likely to commit suicide or infanticide

Postpartum Psychosis

10

Pathogenesis of Postpartum Psychosis

Hormonal factors
Genetic factors
Currently thought of as a manifestation of bipolar disorder

11

Risk Factors for Postpartum Psychosis

First pregnancy
Hx of bipolar disorder
Hx of puerperal psychosis
Family Hx of puerperal psychosis
Recent discontinuation of lithium or other mood stabilizers

12

Symptoms of Postpartum Psychosis

Delusions
Hallucinations
Thought disorganization
Severe insomnia
Suicidal ideation
Homicidal ideation
Aggression
Agitation
Impulsivity

13

Treatment of Postpartum Psychosis

Acute hospitalization
Antipsychotics
Therapy
ECT if pharmacotherapy unsuccessful
MEDICAL EMERGENCY

14

Postpartum Anxiety Disorders

OCD
Panic disorder
GAD
PTSD

15

Define Obsession

Idea or thought that continually preoccupies or intrudes on a person's mind

16

Define Compulsions

Irresistible urge to behave in a certain way, especially against one's conscious wishes

17

Risk Factors for Postpartum Depression

Marital conflict
Stressful life events, lack of social support for pregnancy
Lack of emotional/financial support
Living without a partner
Unplanned pregnancy, previous miscarriage
Having contemplated terminating the pregnancy
Poor relationship with one's own mother
High # of visit's to prenatal clinic
Congenitally malformed child
Personal Hx of bipolar disorder

18

Symptoms for Postpartum Depression

Irritability & anger
Significant anxiety with panic attacks
Feelings of inadequacy & failing as a mother
Feelings of guilt
Feelings of hopelessness or despair
Feeling of being overwhelmed or unable to care for the baby
Not bonding to the baby
Typical: insomnia, weight changes, decreased libido, decreased energy levels

19

Postpartum Depression Screening

Edinburgh postnatal depression scale (EPDS)
Postpartum depression screening scale (PDSS)
BECK depression inventory
Personal interview

20

What medical causes need to be ruled out when considering postpartum depression?

Anemia
Diabetes
Thyroid disorders

21

6 Stages of Postpartum Depression

Denial
Anger
Bargaining
Depression
Acceptance
PTSD

22

Symptoms of Men's Postpartum Depression

Increased anger & conflict with others
Increased use of ETOH or other drugs
Frustration or irritability
Violent behavior
losing weight without trying
Isolation from family & friends
Being easily stressed
Impulsiveness & taking risks
Feeling discouraged
Increases in complaints about physical problems
Ongoing physical symptoms
Problems with concentration & motivation
Loss of interest in work, hobbies & sex
Working constantly
Frustration or irritability
Misuse of prescription medication
Increased concerns about productivity & functioning at school or work
Fatigue
Experiencing conflict between what you think & how you are
Thoughts of suicide

23

Treatment Options for Postpartum Depression

Psychotherapy: interpersonal, CBT, group therapy

24

Considerations with Breastfeeding in Postpartum Depression

Risk vs. benefits
Evaluation of infant

25

Medications for Postpartum Depression Treatment

TCAs
SSRIs
SNRIs
Other antidepressants
Benzodiazepine
Sedative hyponotics

26

TCAs for Treatment of Postpartum Depression

Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Doxepin (Silenor)

27

SSRIs for Treatment of Postpartum Depression

Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Escitalopram (Lexapro)

28

SNRIs for Treatment of Postpartum Depression

Duloxetine (Cybalta)
Venlafaxine (Effexor XR)

29

Other Antidepressant for Treatment of Postpartum Depression

Bupropion SR/XL
Budeprion SR/XL
Mirtazipine (Remeron)
Trazodone (generic only)

30

Benzodiazepines for Treatment of Postpartum Depression

Oxazepam (Serax)
Alprazolam (Xanax)
Temazepam (Restoril)
Lorazepam (Ativan)
Clonazepam (Klonopin)
Diazepam (Valium)

31

Sedative Hypnotics for Treatment of Postpartum Depression

Zaleplon (Sonata)
Zolpidem (Ambien)
Escopiclone (Lunesta)

32

Optional Treatment for Postpartum Depression

ECT

33

Postpartum Blues

Incidence: 50-85%
Duration: 2-3 days, resolves within 10 days
Symptoms: tearfulness, fatigue, depressed affect, irritability
Treatment: reassurance, watchful waiting

34

Postpartum Depression

Incidence: 10-15%
Duration: 2 weeks to 12 months
Symptoms: depressed affect, anxiety, symptoms worse at night, poor concentration, decreased libido
Treatment: antidepressants, psychotherapy

35

Postpartum Psychosis

Incidence: 0.1-0.2%
Duration: typically days to 6 weeks
Symptoms: delusions, confusion, sleep disturbances, unusual behavior, emotional liability
Treatment: antipsychotics, antidepressants, inpatient hospitalization