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CANMAT Depression Guidelines (2016) > Section VI. Special Populations - Perinatal > Flashcards

Section VI. Special Populations - Perinatal Flashcards

1
Q

What is the timeline defined by ‘perinatal depression’?

A

Unipolar MDE occurring during pregnancy and in the first year postpartum

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2
Q

What % of postpartum MDE begins during pregnancy?

A

40%

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3
Q

What is the timeline of the DSM-5 specifier, ‘with peripartum onset’?

A

MDE emerges during pregnancy or in the first 4 weeks after delivery

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4
Q

What % of women have a unipolar MDE during pregnancy? % for minor depression?

A

Major 7.5%
Minor 18.4%

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5
Q

What % of women experience a unipolar MDE in first 3 months postpartum?

A

Major 6.5%
Minor 19.2%

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6
Q

What % of pregnancies are unplanned?

A

50%

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7
Q

What are the risks of untreated MDD during pregnancy?

A
  • poor nutrition
  • poor prenatal medical care
  • smoking
  • recreation drug use
  • significant suffering for woman
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8
Q

What are the risks of untreated MDD at delivery [8]?

A
  • increased risk of poor obstetrical outcomes
  • small neonates for GA
  • NICU
  • increased rates of neonatal complications
  • impaired mother-baby bonding
  • infant sleep difficulty
  • mild developmental delay
  • cognitive, behavioural, and emotional problems in baby
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9
Q

What are the 1st line recommended treatments for mild to mod depression during pregnancy?

A

CBT or IPT (level 1 evidence)

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10
Q

What are the 2nd line recommended treatments for mild to mod depression during pregnancy?

A

Citalopram
Escitalopram
Sertraline

** all level 3 evidence

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11
Q

What are the 3rd line recommended treatments for mild to mod depression during pregnancy?

A

Level 2: exercise, acupuncture, bright-light therapy

Level 3: Bupropion, Desvenlafaxine, duloxetine, fluoxetine, fluvoxamine; ECT

Level 4: Mirtazepine, TCA (caution with clomipramine), Venlafaxine; psychotherapy (Mindfulness-CBT, internet assisted CBT)

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12
Q

What is the odds ratio for CV malformation if Paroxetine used in 1st trimester?

A

1.5
Paroxetine = Category D medication

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13
Q

What is the odds ratio of spontaneous abortion when using SSRI?

A

1.5 (but, result not clinically significant)

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14
Q

At delivery, if fetus has been exposed to SSRI during trimester 3, what qualities might baby exhibit? What % of infants exhibit these qualities? How long does it take for these qualities to resolve?

A

Poor neonatal adaptation in 15 to 30%:
- jitteriness
- irritability
- tremor
- respiratory distress
- excessive crying

Symptoms likely to resolve in 2-14 days esp with supportive care

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15
Q

What medications are most likely linked with poor neonatal adaptation ‘syndrome’?

A

Paroxetine, Venlafaxine, Fluoxetine

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16
Q

What is at risk of developing if SSRI taken late (e.g., 3rd trimester)? What is the absolute risk?

A

Pulmonary HTN of the newborn (PPHN)

Absolute risk: 2.9 to 3.5 per 1000 (compared to general population 2 per 1000)

17
Q

True/ False - Breastfeeding is contraindicated during antidepressant treatment

A

False

18
Q

What are the first line recommendations for treatment of MDD in breastfeeding women?

A

CBT or IPT

19
Q

What are the 2nd line recommendations for treatment of MDD in breastfeeding women?

A

Citalopram
Escitalopram
Sertraline
Combo of SSRI + psychotherapy

20
Q

What are the 3rd line recommendations for treatment of MDD in breastfeeding women?

A
  • exercise, acupuncture, Internet CBT/ IPT
  • Fluoxetine, Fluvoxamine, Paroxetine, TCA
  • Bupropion, desvenlafaxine, duloxetine, Mirtazepine, Venlafaxine, TMS, bright light Tx
  • ECT
21
Q

How would you treat severe postpartum depression?

A

First choice meds include: citalopram, escitalopram, or sertraline
ECT (esp. with psychotic feat)

22
Q

How much lower is exposure to antidepressants by way of breastfeeding vs. in utero?

A

5 to 10 times lower via breastfeeding than exposure in utero

23
Q

Which medications have the lowest Relative Infant Dose (RID) and lowest ‘milk-to-plasma’ ratio for breastfeeding women?

A

Fluvoxamine
Sertraline
Paroxetine

24
Q

Which medications have higher rates of infant reactions?

A

Citalopram
Fluoxetine

CANMAT Depression Guidelines (2016) (9 decks)

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