Beruflich Dokumente
Kultur Dokumente
Case Presentation
Julie is a 25 year old female who just delivered her second child 3 weeks ago. She breaks down in tears for no reason and is irritable with her 3 year old. She is having trouble sleeping, and has no appetite. She admits that she feels guilty for not feeling happy about the new infant in her life. She feels she is not an effective parent to either child. She is returning to work next week and wonders how she will be able to cope.
Statistics
Depression is twice as common in women as in men 20% of women will experience depression at some point during their life One out of 10 childbearing women will experience post-partum depression 40% of women have premenstrual symptoms, 5% of these experience premenstrual dysphoric disorder (PMDD)
Family history of mood disorder Loss of a parent before age 10 History of sexual or physical abuse Use of hormones (contraception/HRT/fertility treatments) Persistent life stressors (i.e. loss of job) Loss of social support system
What Is Depression?
Psychological
Physical symptoms
Depressed mood Decreased interest in activities Feelings of guilt, hopelessness Suicidal thoughts
Gender Differences
Women have earlier onset of depression Episodes may last longer and recur more often More atypical symptoms Suicide attempts more frequent but less successful
Less substance abuse than men More anxiety symptoms than men More associated eating disorders More associated migraine headaches More feelings of guilt More seasonal depression
Psychosocial (counseling)- cognitive behavioral therapy Medications- used with counseling in cases of moderate to severe depression
Alter chemical balance in the body to enhance mood (norepinephrine, serotonin levels) Many different types- SSRIs, tricyclics, others St. Johns wort- some studies suggest a benefit Need a minimum of 2 weeks to see an effect Treatment for minimum of 6 months
Selective serotonin reuptake inhibitors- allow more serotonin to be available in the body, enhancing mood Examples: Prozac, Paxil, Zoloft, Luvox, Celexa Once daily dosing Side effects: nausea, headaches, nervousness, insomnia/fatigue, sexual dysfunction, weight gain with prolonged use
Up to 70% of depressed patients experience a loss of sexual interest If we treat the underlying depression, the libido often improves SSRIs may cause problems with libido and difficulty attaining orgasm Other medications may enhance libido- ie Wellbutrin, Effexor
Mood and anxiety symptoms that occur only during the premenstrual period, or worsen significantly during that time Can be very debilitating, with a negative impact on the quality of life and relationships Symptoms usually disappear within a few days after the period starts There are 11 identified symptoms, of which 5 must be present
Symptoms of PMDD
Depressed mood Feelings of personal rejection Decreased interest in usual activities Fatigue, no energy Marked appetite changes/cravings Insomnia or increased sleep
Anxiety- feeling on edge Irritability, anger Feeling overwhelmed Difficulty concentrating Physical symptomsbreast tenderness, headaches, bloated, muscle pain
Cause of PMDD?
Unknown, but felt by many researchers to result from an abnormal response to normal cycle of hormonal changes in the body Likely a combination of genetic, environmental, and behavioral factors Women with PMDD have greater risk of future depression during pregnancy, postpartum period, and perimenopause
Choice of treatment is aimed at the most troubling symptoms Lifestyle modification Dietary approach Vitamin supplementation Medications Cognitive/behavioral approach
Lifestyle/diet Modification
Women who engage in moderate aerobic exercise 3 times weekly have fewer premenstrual symptoms than sedentary women Low-fat, vegetarian diet has been shown to decrease duration and intensity of menstrual pain Women with a high caffeine intake have more premenstrual irritability symptoms Excess of simple carbohydrates (sugar) is associated with mood disturbances
Vitamin Supplementation
Controversial- data is conflicting Vitamin B6 100mg/day Magnesium 400 mg/day Manganese 6 mg/day Vitamin E 400 iu/day Calcium 1000 mg/day
Anti-inflammatories- effective for pain relief Oral contraceptives- suppress ovulation Diuretics when salt restriction not helpful in reducing significant fluid retention SSRIs are often first choice- daily versus premenstrual week only
Attempts to reduce negative feelings in the premenstrual period Improve feelings of self-esteem and problem solving skills Relaxation therapy may also be helpful
Post-partum Depression
1 of 10 women experience post-partum depression, but the condition is underdiagnosed May have significant impact on both mother and child Societal pressures to be good mother may prevent woman from admitting symptoms
Baby Blues
Occurs in 70-85% of women Onset within the first few days after delivery Resolves by 2 weeks Symptoms include: mild depression, irritability, tearfulness, fatigue, anxiety May have increased risk of post-partum major depression later on
Symptoms of depression that last longer than 2 weeks Usually begins 2-3 weeks after delivery May last up to one year High risk of recurrence in future pregnancies
Rare disorder (Andrea Yates?)- 0.2% women Onset within the first month after delivery Symptoms include mania, agitation, expansive or irritable mood, avoidance of the infant May have delusions or hallucinations that involve the infant- possessed by demon, etc. This is a medical emergency- needs hospitalization
Same as for major depression SSRIs work well All antidepressants are to some degree, excreted in the breast milk, but usually undetectable levels in the infants blood Avoid Prozac due to long half life- may accumulate in the infant
To Summarize.
Depression is very common in women May be more likely around times of hormonal flux- premenstrual, post-partum, perimenopause There is effective treatment available Dont hesitate to discuss symptoms with your doctor
My lady Are you depressed Come to me and I shall give you Rest.