Postpartum Depression

Question 1

What is the prevalence of depression during and after pregnancy?

Answer 1

~10% perinatal, 7% first 3mths postpartum, ~20% within 12mths postpartum

Question 2

How prevalent are postpartum “blues”?

Answer 2

30-50%, peaks 3-5d after delivery. d/t hormone and neurotransmitter fluctuations

Question 3

Major depression can be diagnosed when sx’s are prevalent for how long?

Answer 3

at least 2 weeks of depressed mood and diminished interest/pleasure in activities

Question 4

What is the DDx for postpartum depression ?

Answer 4

hypothyroidism, gestational DM, anemia, normal lack of sleep/energy

Question 5

What are risk for postpartum depression?

Answer 5

partner conflicts, low SES, low social support, fetal loss, stress, Hx depression, unwanted Pg,

Question 6

What are sx’s of postpartum psychoses?

Answer 6

delusion (baby is possessed), hallucinations, insomnia, confusion/disorientation, rapid mood swings

Question 7

Advantages of Edinburgh Postnatal Depression Scale?

Answer 7

• Easy to score
• Specifically designed for peripartum use
• Well validated during pregnancy and postpartum
• Cross-culturally validated; available in over 20 languages
• Cutoff is 10-13 out of 30

Question 8

What are advantages of the PCQ 9?

Answer 8

• Easy to score
• Items & scores linked to DSM-IV depression criteria
• Can use to assess & track treatment response
• Can use same tool for non-peripartum patients in clinic
• cutoff is >5, up to 27
• response to tx = 50% reduction in 8wks

Question 9

What are pharmacologic tx options?

Answer 9

No approved antidepressants for Pg/lactation. SSRIs first line. Avoid lithium and anticonvulsants (teratogenic).