The Recognition Treatment of Postpartum Depression Johna M

The Recognition & Treatment of Postpartum Depression Johna M Bott Eileen Van Dyke 3/23/06

PPD n Characterized by despair, sadness, anxiety, fears, compulsive thoughts, feelings of inadequacy, loss of libido, fatigue, & dependency n Affects upwards of 20% of women after childbirth n Major health problem that threatens the family unit as a whole

Postpartum psychosis n Emergency that requires immediate hospitalization n Presents with mania, psychotic thoughts, severe depression n Rare occurring in 1 -2 deliveries out of a thousand

Why do we care? Affects entire family unit, not just the mother n One mother described PPD as being buried alive with no chance of clawing to the surface n While mom is debilitated, child’s cognitive and social development suffers then & potentially later on in life with the development of conduct & attention disorders n Fathers also affected by stress put on marriage n

PPD screening is not being done

Screening Approximately 50% of PPD cases go undiagnosed n Although family physicians believe PPD is serious, identifiable, and treatable, screening is still not standard clinical practice in the US n Clinical signs are often not apparent unless screened for n Screening tools are out there & some are even specific for PPD n

Excuses n OB screens for that n Pediatricians screen for that at well baby visits n There are too many tools out there, I don’t know which one to use n The tools are too complex n Is that my job?

Risk Factors n Prenatal depression n Totally independent of time n Any depression during pregnancy was discovered to be a significant predictor

Risk Factors n Child care stress n Childbirth itself is a traumatic stressful event that makes the mother more vulnerable to other stressors n Any stressful event involving the care of the newborn, including the temperament of the baby which may be fussy, irritable, and difficult to console n Unhealthy infants

Risk Factors n Support or lack there of n Social, emotional, and instrumental support is very important for new mothers and either perceiving a lack of it or actually having a lack of it can be very detrimental

Risk Factors n Life stress n The number of both positive and negative stressful life events that occur during pregnancy and the postpartum period

Risk Factors n Prenatal anxiety n Marital dissatisfaction n History of previous depression n Affective illness or previous PPD episode

Medical Problems with Related Sx n Transient hypothyroidism n Anemia n Diabetes n Other endocrine disorders n Abuse situations n Infection

Treatment Options n Individual psychotherapy n Personalized care n Scheduling flexibility n Group therapy n Not for everyone n Compliance issue with scheduling conflicts n Need adequate # to participate

Treatment Options n Pharmacologic treatment Selective serotonin reuptake inhibitors (SSRIs) n All antidepressants are secreted in breast milk n Continued at least six months to ensure complete remission n n Complementary or alternative treatments n Bright-light therapy, exercise, massage therapy, & chronobiological therapies, such as wake therapy

Treatment Options n Controversial therapies n Progesterone or estrogen injections n Hospitalization n Risk of suicide or infanticide n Antipsychotics n Electroconvulsive therapy

Available Screening Tools n n n n The Beck Depression Inventory The Bromley Postnatal Depression Scale The Center for Epidemiological Studies Depression Scale The General Health Questionnaire The Inventory of Depressive Symptomatology The Zung Self-Rating Depression Scale The Edinburgh Postnatal Depression Scale The Postpartum Depression Screening Scale

The Edinburgh Postnatal Depression Scale One of the best known screening scales for PPD n Measures emotional and cognitive symptoms of PPD n Ten items scored from 0 to 3 n Only somatic sx taken into account is sleeping difficulties n Available in multiple languages n

The Postpartum Depression Screening Scale Measures 7 dimensions of PPD including sleeping/eating disturbances, anxiety/insecurity, emotional liability, cognitive impairment, loss of self, guilt/shame, & contemplating harming oneself n 35 items n Excellent sensitivity & specificity n

Conclusion n The general consensus is that both the EPDS & the PDSS are good screening scales for PPD n Practitioners may form personal preferences due to length or detail of questions n Most important thing is that a screening method is used

Summary PPD is real & very serious n Talking about PPD openly might make it less scary, educate the patient & their family n Screening at every visit is the key to the difficult recognition that is due to drastic differences in symptoms from patient to patient n Prompt treatment with effective follow-up n

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