Psych - Depression in Women Flashcards
Differences in the prevalence of mental disorders in men and women
Women are more likely to experience ANXIETY and PANIC DISORDERS, phobias, PTSD, OCD and depression
MEN on the other hand will more commonly suffer from impulse control issues and substance abuse disorders
Females are MORE LIKELY TO ATTEMPT SUICIDE, but MEN ARE MORE LIKELY TO DIE AS A RESULT OF SUICIDE
PREMENSTRUAL DYSTHYMIC DISORDER
The CYCLIC appearance of physical, emotional and behavioral symptoms during the LUTEAL PHASE of the menstrual cycle (second half of cycle)
PMS? Sounds similar, right? NO! PMS (premenstrual syndrome) affects 30% of menstruating women, and is characterized by symptoms that do not interfere with normal functional activities.
PMDD is a MORE SEVERE CONDITION that MARKEDLY INTERRUPTS REGULAR FUNCTION –> only affects 1-2% of women
Dx of PMDD
It is PROSPECTIVE –> once the disorder is suspected, a patient must RECORD HER DAILY MOOD FOR TWO CONSECUTIVE CYCLES in order to confirm the premenstrual initiation of symptoms
Diagnostic criteria:
AT LEAST ONE of the following –> depressed mood, anxiety, affective lability (mood swings), or anger/irritability
AND –> Decreased interest, difficulty concentrating, lethargy, appetite changes, sleep changes, out of control sensation, or physical symptoms (breast tenderness, headaches, joint aches, bloating, weight gain)
NEED 5 SYMPTOMS TO CONFIRM THE DIAGNOSIS!!!!
It also must INTERFERE with daily functioning, and must NOT be an exacerbation of another disorder (MDD, BPD, Panic disorder, dysthymic disorder, or a personality disorder)
Treating PMDD
Can be effectively controlled with pharmacologic therapy
SSRI provide RAPID RELIEF of symptoms in up to 70% of patients, and thus are considered FIRST LINE
GnRH agonists act by providing negative feedback in the pituitary, DECREASING FSH/LH RELEASE
Although GnRH analogs are 70% effect, they induce hypogonadal side effects: BONE LOSS, HOT FLASHES, VAGINAL DRYNESS
Should only be considered when SSRI do NOT work!
Mood Disorders and PREGNANCY
- 5% of women develop a new episode of depression during pregnancy
- 5% develop depression postpartum (50% of them had depression DURING pregnancy as well)
Hx of depression, stressful life events or marital problems will predispose preggos more!
CONSEQUENCES TO THE MOM/FETUS – poor self care, poor nutrition, poor sleep, increased risk for self medication with drugs, alcohol and tobacco; increased risk for high risk behaviors; suicide risk!
Children of depressed parents are at a GREATER RISK for psychiatric illness and social/educational difficulties!
SSRI and Pregnancy
There are concerns with their use during pregnancy, but they are effective
There is a low risk of miscarriage; however, there is also a risk in untreated pregnancies
The development of BIRTH DEFECTS is possible, but not clear
PAROXETINE IS KNOWN TO CAUSE FETAL CARDIAC ABNORMALITIES!!!!!!
Rare 3rd trimester condition = PERSISTENT PULMONARY HTN; 1-2 babies/1000 births
DISCONTINUATION SYNDROME –> seen in the fetus; jitteriness, increased tone, respiratory distress, seizures! Usually resolves in 72 hours;
Take women who are currently taking an SSRI off when they are preggo?
THEY WILL PROBABLY RELAPSE INTO DEPRESSION!
68% relapsed (50% of them during first trimester; 90% by the end of the 2nd trimester)
Must gauge the risks and benefits of giving SSRI to preggos! Each case must be assessed individually
Bipolar Disorder during Pregnancy
Overall risk recurrence during pregnancy is 71%
Recurrence is greater in women that discontinued mood stabilizers (time to relapse reduced AND duration longer)
Use of mood stabilizers during pregnancy –> RISK TO FETUS –> Ebstein’s Anomaly (valve defect), increased baby weight, FLOPPY BABY syndrome, need to ensure adequate hydration and monitoring; Valproic acid is associated with the HIGHEST RISK of all major malformations
Postpartum Blues
Affect up to 80% of women following delivery
This condition is characterized by MILD MOOD SWINGS and is TRANSIENT in nature; symptoms OFTEN RESOLVE IN TWO WEEKS!! But some may progress to postpartum depression
Postpartum Depression
50% of patients who have suffered from perinatal depression will also experience postpartum depression
This disorder typically presents 4-12 weeks following delivery and affects up to 15% of postpartum women
Women who experience postpartum depression are 50% likely to experience a recurrence with subsequent pregnancies!!!!
Psychotherapy and pharmacotherapy are used to treat (SSRI are safe for nursing!)
Postpartum Psychosis
RARE (1/1000 deliveries)
Condition is associated with bipolar or schizoaffective disorder, and often the newborn is at HIGH RISK for INJURY due to the mother’s psychosis
Women with a history of BPD have a 20-30% chance of developing PPP
Can be given MOOD STABILIZERS or ANTI-PSYCHOTICS if necessary, and close follow up is highly needed
Perimenopause Related Depression
Depressive episodes occurring during the transition to menopause
For many patients, this is the first such episode, indicating the role of HORMONES in the condition
Studies have correlated the spontaneous remission in some females with a decreasing FSH level; furthermore, estradiol has been used to relieve depressive symptoms in many of these patients, but usually antidepressants are used
Symptoms – vasomotor (hot flashes, night sweats); sleep disturbances, depression, mood swings, cognitive changes (memory impairment, concentration difficulties)
