{"id":233,"date":"2020-08-13T16:43:53","date_gmt":"2020-08-13T16:43:53","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=233"},"modified":"2021-05-09T20:43:14","modified_gmt":"2021-05-09T20:43:14","slug":"29-anxiety-and-depression","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/29-anxiety-and-depression\/","title":{"rendered":"29. Anxiety and Depression"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/aWXauuJGXIc\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 5:28<\/p>\n<input type='hidden' bg_collapse_expand='69e9c8eb9847b3008681393' value='69e9c8eb9847b3008681393'><input type='hidden' id='bg-show-more-text-69e9c8eb9847b3008681393' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9c8eb9847b3008681393' value='Hide Transcript'><button id='bg-showmore-action-69e9c8eb9847b3008681393' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9c8eb9847b3008681393' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 29<br \/>\n00:02<br \/>\nanxiety and depression here is our<br \/>\n00:04<br \/>\npatient labora deliver which she has had<br \/>\n00:06<br \/>\na successful pregnancy labor and<br \/>\n00:08<br \/>\ndelivery she was a beautiful new baby<br \/>\n00:10<br \/>\nand feel that she&#8217;s supposed to be very<br \/>\n00:11<br \/>\nhappy to start this new chapter of her<br \/>\n00:13<br \/>\nlife<br \/>\n00:14<br \/>\nbut depressive symptoms are very common<br \/>\n00:16<br \/>\nfor women in the postpartum period there<br \/>\n00:18<br \/>\nwas a confluence of hormonal shifts<br \/>\n00:20<br \/>\nmajor life changes an extreme sleep<br \/>\n00:22<br \/>\ndeprivation that can contribute to the<br \/>\n00:24<br \/>\ndevelopment of mental health concern the<br \/>\n00:26<br \/>\nobjectives of this video are to list<br \/>\n00:28<br \/>\nrisk factors for postpartum blues<br \/>\n00:29<br \/>\ndepression and psychosis differentiate<br \/>\n00:32<br \/>\nbetween postpartum blues depression and<br \/>\n00:34<br \/>\npsychosis compare and contrast treatment<br \/>\n00:36<br \/>\noptions for postpartum blues depression<br \/>\n00:38<br \/>\nand psychosis and recognize appropriate<br \/>\n00:40<br \/>\ntreatment options for mood disorders<br \/>\n00:42<br \/>\nduring pregnancy a lactation postpartum<br \/>\n00:45<br \/>\nblues are extremely common approximately<br \/>\n00:48<br \/>\n70 to 80 percent of women report feeling<br \/>\n00:50<br \/>\nsad anxious or angry beginning two to<br \/>\n00:52<br \/>\nfour days after birth postpartum blues<br \/>\n00:55<br \/>\nis characterized by tearfulness fatigue<br \/>\n00:57<br \/>\nirritability depressed affect mild<br \/>\n01:00<br \/>\ninsomnia and is usually self-limited and<br \/>\n01:02<br \/>\nusually does not require any treatment<br \/>\n01:04<br \/>\npostpartum depression on the other hand<br \/>\n01:07<br \/>\ndiffers from postpartum blues in the<br \/>\n01:08<br \/>\nseverity and the duration it is defined<br \/>\n01:11<br \/>\nas a major episode of depression that<br \/>\n01:13<br \/>\noccurs within the first four weeks or<br \/>\n01:15<br \/>\nwithin the first six months postpartum<br \/>\n01:17<br \/>\nthe incidence of postpartum depression<br \/>\n01:19<br \/>\nis 10% and it is characterized by<br \/>\n01:21<br \/>\npronounced feelings of sadness anxiety<br \/>\n01:23<br \/>\nand despair and interferes with<br \/>\n01:25<br \/>\nactivities of daily living and the<br \/>\n01:27<br \/>\nsymptoms tend to worsen with time<br \/>\n01:29<br \/>\ntreatment for postpartum depression is<br \/>\n01:32<br \/>\nwith antidepressant therapy and\/or<br \/>\n01:34<br \/>\npsychotherapy postpartum psychosis is<br \/>\n01:37<br \/>\nthe most severe form of mental disorder<br \/>\n01:39<br \/>\nin the postpartum time it is<br \/>\n01:41<br \/>\ncharacterized by confusion clouded<br \/>\n01:43<br \/>\nsensorium and distractibility treatment<br \/>\n01:46<br \/>\nis with antipsychotic and hour<br \/>\n01:48<br \/>\nantidepressant medications let&#8217;s now<br \/>\n01:50<br \/>\nmove on to risk factors for these three<br \/>\n01:52<br \/>\ndifferent conditions risk factors for<br \/>\n01:55<br \/>\npostpartum blues include psychosocial<br \/>\n01:57<br \/>\nstresses such as child care or<br \/>\n01:58<br \/>\npsychosocial impairment a history of<br \/>\n02:00<br \/>\ndepression or a family history of<br \/>\n02:02<br \/>\ndepression depressive symptoms pre<br \/>\n02:04<br \/>\npregnancy or during the pregnancy and a<br \/>\n02:06<br \/>\nhistory of hormonal II sensitive mood<br \/>\n02:08<br \/>\nchanges such as premenstrual syndrome or<br \/>\n02:10<br \/>\nmood changes with oral contraception for<br \/>\n02:13<br \/>\nrisk factors for postpartum depression<br \/>\n02:15<br \/>\nhaving a history of depression is the<br \/>\n02:16<br \/>\nmost significant risk factor<br \/>\n02:18<br \/>\npsychosocial stresses are also<br \/>\n02:20<br \/>\nsignificant risk factors a history of<br \/>\n02:22<br \/>\nphysical or sexual abuse being young<br \/>\n02:24<br \/>\nthat&#8217;s being an unplanned pregnancy or<br \/>\n02:26<br \/>\nthoughts of terminating the pregnancy a<br \/>\n02:27<br \/>\nlack of social and financial support<br \/>\n02:29<br \/>\nliving without a partner intimate<br \/>\n02:31<br \/>\npartner violence or stressful life<br \/>\n02:33<br \/>\nevents such as a marital conflict during<br \/>\n02:34<br \/>\nthe 12 months prior to delivery the most<br \/>\n02:37<br \/>\nsignificant risk factor for postpartum<br \/>\n02:38<br \/>\npsychosis is pre-existing mental disease<br \/>\n02:41<br \/>\nsuch as bipolar disorder or<br \/>\n02:42<br \/>\nschizophrenia we will conclude this<br \/>\n02:44<br \/>\nvideo by discussing treatment options<br \/>\n02:46<br \/>\nfor mood disorders during pregnancy and<br \/>\n02:48<br \/>\nthe postpartum period there are over<br \/>\n02:50<br \/>\n500,000 pregnancies in the United States<br \/>\n02:52<br \/>\nthat involve women who have psychiatric<br \/>\n02:54<br \/>\nillnesses that either predate or emerge<br \/>\n02:56<br \/>\nduring the pregnancy an estimated one<br \/>\n02:58<br \/>\nthird of pregnant women are exposed to<br \/>\n03:00<br \/>\npsychotropic medications at some point<br \/>\n03:02<br \/>\nduring pregnancy simply advising women<br \/>\n03:05<br \/>\nto stop could lead to untreated maternal<br \/>\n03:07<br \/>\npsychiatric illness which could lead to<br \/>\n03:08<br \/>\npoor compliance with prenatal care<br \/>\n03:10<br \/>\ninadequate nutrition exposure to<br \/>\n03:12<br \/>\nadditional medications or herbal<br \/>\n03:14<br \/>\nremedies increased alcohol or tobacco<br \/>\n03:16<br \/>\nuse deficits and mother-infant bonding<br \/>\n03:18<br \/>\ndisruptions within the family<br \/>\n03:20<br \/>\nenvironment and pregnancy complications<br \/>\n03:22<br \/>\nsuch as premature birth low birth weight<br \/>\n03:24<br \/>\ninfants fetal growth restrictions and<br \/>\n03:26<br \/>\npostnatal complications all psychotropic<br \/>\n03:29<br \/>\nmedications do cross the placenta are<br \/>\n03:31<br \/>\npresent and amniotic fluid and can enter<br \/>\n03:33<br \/>\nbreast milk the general treatment<br \/>\n03:36<br \/>\nconcepts include that optimally there<br \/>\n03:38<br \/>\nshould be shared decision-making among<br \/>\n03:39<br \/>\nobstetricians and mental health<br \/>\n03:41<br \/>\nclinicians and a single medication at a<br \/>\n03:43<br \/>\nhigher dose is preferred over multiple<br \/>\n03:45<br \/>\nmedications changing medications also<br \/>\n03:48<br \/>\nincreases the exposure to the offspring<br \/>\n03:49<br \/>\nlet&#8217;s now move to safety and efficacy<br \/>\n03:52<br \/>\nconsiderations for depression during<br \/>\n03:53<br \/>\npregnancy most of our data is on SSRI<br \/>\n03:56<br \/>\nused during pregnancy and there is<br \/>\n03:58<br \/>\nlimited data on the teratogenic effects<br \/>\n04:00<br \/>\nthere has been concern about increased<br \/>\n04:02<br \/>\nrisk of congenital cardiac malformations<br \/>\n04:04<br \/>\nwith first trimester paroxetine exposure<br \/>\n04:06<br \/>\nso it is generally advisable to avoid<br \/>\n04:08<br \/>\nparoxetine and pregnancy there is<br \/>\n04:11<br \/>\ncurrently conflicting data on SSRI<br \/>\n04:13<br \/>\nexposure during early pregnancy and risk<br \/>\n04:15<br \/>\nof both overall and specific<br \/>\n04:17<br \/>\nmalformations exposure to SSRIs latent<br \/>\n04:20<br \/>\npregnancy has been associated with<br \/>\n04:22<br \/>\ntransient neonatal complications such as<br \/>\n04:23<br \/>\njitteriness<br \/>\n04:24<br \/>\nmild respiratory distress<br \/>\n04:26<br \/>\nto keep near the newborn we cry poor<br \/>\n04:29<br \/>\ntone and neonatal intensive care unit<br \/>\n04:31<br \/>\nadmissions the use of lithium for<br \/>\n04:33<br \/>\nbipolar disease has been associated with<br \/>\n04:35<br \/>\na small increase in the congenital<br \/>\n04:37<br \/>\ncardiac malformation of Epstein&#8217;s<br \/>\n04:39<br \/>\nanomaly for breastfeeding the amount of<br \/>\n04:41<br \/>\nmedication transfer is lower with breast<br \/>\n04:43<br \/>\nfeeding them with trans placental<br \/>\n04:44<br \/>\nexposure there are a few isolated cases<br \/>\n04:47<br \/>\nof adverse events that have been<br \/>\n04:48<br \/>\nreported although infant follow-up data<br \/>\n04:50<br \/>\nis limited with breastfeeding Emma the<br \/>\n04:52<br \/>\npregnancy careful consideration should<br \/>\n04:54<br \/>\nbe given to our patients overall needs<br \/>\n04:56<br \/>\nand wellness and how best to optimize<br \/>\n04:58<br \/>\nthe balance between the risks of<br \/>\n04:59<br \/>\nmedications with the risks of not<br \/>\n05:01<br \/>\ntreating her mental health needs this<br \/>\n05:03<br \/>\nconcludes the aapko video on anxiety and<br \/>\n05:05<br \/>\ndepression we have discussed postpartum<br \/>\n05:07<br \/>\nblues depression psychosis as well as<br \/>\n05:09<br \/>\nrecognized appropriate treatment options<br \/>\n05:11<br \/>\nfor mood disorders during pregnancy and<br \/>\n05:13<br \/>\nlactation<\/p>\n<p><\/div>\n<hr>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 5:28<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":29,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-233","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/233","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=233"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/233\/revisions"}],"predecessor-version":[{"id":2835,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/233\/revisions\/2835"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=233"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}