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APGO educational topic number 29
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anxiety and depression here is our
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patient labora deliver which she has had
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a successful pregnancy labor and
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delivery she was a beautiful new baby
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and feel that she’s supposed to be very
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happy to start this new chapter of her
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life
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but depressive symptoms are very common
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for women in the postpartum period there
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was a confluence of hormonal shifts
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major life changes an extreme sleep
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deprivation that can contribute to the
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development of mental health concern the
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objectives of this video are to list
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risk factors for postpartum blues
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depression and psychosis differentiate
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between postpartum blues depression and
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psychosis compare and contrast treatment
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options for postpartum blues depression
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and psychosis and recognize appropriate
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treatment options for mood disorders
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during pregnancy a lactation postpartum
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blues are extremely common approximately
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70 to 80 percent of women report feeling
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sad anxious or angry beginning two to
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four days after birth postpartum blues
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is characterized by tearfulness fatigue
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irritability depressed affect mild
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insomnia and is usually self-limited and
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usually does not require any treatment
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postpartum depression on the other hand
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differs from postpartum blues in the
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severity and the duration it is defined
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as a major episode of depression that
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occurs within the first four weeks or
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within the first six months postpartum
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the incidence of postpartum depression
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is 10% and it is characterized by
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pronounced feelings of sadness anxiety
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and despair and interferes with
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activities of daily living and the
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symptoms tend to worsen with time
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treatment for postpartum depression is
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with antidepressant therapy and/or
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psychotherapy postpartum psychosis is
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the most severe form of mental disorder
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in the postpartum time it is
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characterized by confusion clouded
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sensorium and distractibility treatment
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is with antipsychotic and hour
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antidepressant medications let’s now
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move on to risk factors for these three
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different conditions risk factors for
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postpartum blues include psychosocial
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stresses such as child care or
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psychosocial impairment a history of
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depression or a family history of
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depression depressive symptoms pre
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pregnancy or during the pregnancy and a
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history of hormonal II sensitive mood
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changes such as premenstrual syndrome or
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mood changes with oral contraception for
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risk factors for postpartum depression
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having a history of depression is the
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most significant risk factor
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psychosocial stresses are also
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significant risk factors a history of
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physical or sexual abuse being young
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that’s being an unplanned pregnancy or
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thoughts of terminating the pregnancy a
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lack of social and financial support
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living without a partner intimate
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partner violence or stressful life
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events such as a marital conflict during
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the 12 months prior to delivery the most
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significant risk factor for postpartum
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psychosis is pre-existing mental disease
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such as bipolar disorder or
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schizophrenia we will conclude this
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video by discussing treatment options
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for mood disorders during pregnancy and
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the postpartum period there are over
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500,000 pregnancies in the United States
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that involve women who have psychiatric
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illnesses that either predate or emerge
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during the pregnancy an estimated one
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third of pregnant women are exposed to
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psychotropic medications at some point
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during pregnancy simply advising women
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to stop could lead to untreated maternal
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psychiatric illness which could lead to
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poor compliance with prenatal care
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inadequate nutrition exposure to
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additional medications or herbal
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remedies increased alcohol or tobacco
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use deficits and mother-infant bonding
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disruptions within the family
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environment and pregnancy complications
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such as premature birth low birth weight
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infants fetal growth restrictions and
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postnatal complications all psychotropic
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medications do cross the placenta are
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present and amniotic fluid and can enter
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breast milk the general treatment
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concepts include that optimally there
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should be shared decision-making among
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obstetricians and mental health
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clinicians and a single medication at a
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higher dose is preferred over multiple
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medications changing medications also
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increases the exposure to the offspring
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let’s now move to safety and efficacy
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considerations for depression during
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pregnancy most of our data is on SSRI
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used during pregnancy and there is
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limited data on the teratogenic effects
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there has been concern about increased
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risk of congenital cardiac malformations
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with first trimester paroxetine exposure
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so it is generally advisable to avoid
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paroxetine and pregnancy there is
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currently conflicting data on SSRI
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exposure during early pregnancy and risk
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of both overall and specific
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malformations exposure to SSRIs latent
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pregnancy has been associated with
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transient neonatal complications such as
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jitteriness
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mild respiratory distress
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to keep near the newborn we cry poor
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tone and neonatal intensive care unit
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admissions the use of lithium for
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bipolar disease has been associated with
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a small increase in the congenital
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cardiac malformation of Epstein’s
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anomaly for breastfeeding the amount of
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medication transfer is lower with breast
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feeding them with trans placental
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exposure there are a few isolated cases
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of adverse events that have been
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reported although infant follow-up data
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is limited with breastfeeding Emma the
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pregnancy careful consideration should
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be given to our patients overall needs
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and wellness and how best to optimize
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the balance between the risks of
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medications with the risks of not
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treating her mental health needs this
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concludes the aapko video on anxiety and
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depression we have discussed postpartum
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blues depression psychosis as well as
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recognized appropriate treatment options
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for mood disorders during pregnancy and
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lactation