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Highly sensitive period up to 2 weeks after birth. About 50-85% of women experience this. Major depression that lasts for at least 2 weeks About 10-15% of women develop this. Severe form of postpartum depression 1/1,000 women develop this.
Postpartum depression
Postpartum Psychosis
Baby Blues
Characteristics:
mood
Baby Blues
Postpartum Depression
Same DSM IV criteria as for non-pregnancy related depression Symptoms usually begin in initial 12 months after delivery Symptoms often seen as normal for new mothers caring for a newborn
Symptom PPD
Hopelessness Helplessness Persistent sadness Irritability Low self-esteem Loss of pleasure in activities Mood changes Inability to adjust to role of motherhood Inability to concentrate Sleep /appetite disturbances
Etiology
No clear etiology
Possibly due to combination of:
Genetic
Screening - Tools
Becks Depression Inventory (PDI) Postpartum Depression Screening Scale (PDSS) Edinburgh Postnatal Depression Scale (EPDS)
10 item questionnaire
Each response scored 0 3, with total score of 30 possible
EPDS
Score > 12 reported as 100% sensitive and 95% specific in detecting major depression
Treatment
Psychosocial therapies
First
Cognitive-behavioral Interpersonal
Psychosocial Therapies
Group therapy
Helps
Peer-support groups
Pharmacologic Therapy
No antidepressants are approved by the FDA for use during pregnancy All psychotropic drugs are transferred through the placenta and breast milk Consider prior history SSRIs and TCAs have low detection in breastfed infant serum
Antidepressant Choice
TCAs
Desipramine
and Nortryptiline are preferred Least anti-cholinergic affects Minimize postural hypotension
SSRIs
Fluoxetine
summary