LEARNING OBJECTIVES: * Differentiate postpartum depression (PPD) from the “baby blues” and postpartum psychosis. * Apply standardized instruments for objective screening for PPD as a routine part of care. * Discuss appropriate alternatives for the management of patients with PPD. * Identify common complications of unrecognized and improper treatment of patients with PPD. Maternal depression folowing the birth of a baby can impact the quality of life of both mother and child over the course of their lifetimes and may have life‐threatening effects.
[Show abstract][Hide abstract] ABSTRACT: Women are twice as likely to develop depression as men. Moreover, the symptoms they experience also show sex differences: women tend to develop depression at an earlier age and show more severe symptoms than men. Likewise, the response to antidepressant pharmacotherapy appears to have sex differences. These differences can partially be explained by differences in pharmacokinetic properties (i.e., absorption, distribution, metabolism, and excretion) of drugs in males and females. More recent research has shown that sex hormones may influence all these previously named pharmacokinetic processes. As concentrations of sex hormones vary throughout the female lifespan, these hormonal variations can have effects on therapeutic responses to antidepressants as well as the occurrence of adverse events. The purpose of this paper is therefore to review the literature reporting on the effects of female sex hormones on the pharmacokinetics of antidepressants and to discuss and evaluate the implications of changes in levels of sex hormones throughout life for the treatment of depression.
[Show abstract][Hide abstract] ABSTRACT: Background
Whether there are systematic differences in depression symptom expression during pregnancy, the postpartum period and outside these periods (i.e., outside the peripartum period) remains debated. The aim of this study was to use methods based on item response theory (IRT) to examine, after equating for depression severity, differences in the likelihood of reporting DSM-IV symptoms of major depressive episode (MDE) in women of childbearing age (i.e., aged 18–50) during pregnancy, the postpartum period and outside the peripartum period.Methods
We conducted these analyses using a large, nationally representative sample of women of childbearing age from the United States (n = 11,256) who participated in the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).ResultsThe overall 12-month prevalence of all depressive criteria (except for worthlessness/guilt) was significantly lower in pregnant women than in women of childbearing age outside the peripartum period, whereas the prevalence of all symptoms (except for “psychomotor symptoms”) was not significantly different between the postpartum and the nonperipartum group. There were no clinically significant differences in the endorsement rates of symptoms of MDE by pregnancy status when equating for levels of depression severity.Conclusions
This study suggests that the clinical presentation of depressive symptoms in women of childbearing age does not differ during pregnancy, the postpartum period and outside the peripartum period. These findings do not provide psychometric support for the inclusion of the peripartum onset specifier for major depressive disorder in the DSM-5.
Depression and Anxiety 11/2014; 32(2). DOI:10.1002/da.22334 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pregnant women take a variety of medications in an effort to manage symptoms and treat pre-existing illnesses. These medications not only include those prescribed by health care providers but those used for self-treatment such as over-the-counter, and herbal and dietary products. It is important that care providers be proactive and knowledgeable regarding medications, their potential side effects and alternative treatments that may be used by pregnant women. Developing a trusting relationship and working collaboratively with the pregnant woman will facilitate the development of an individualized plan of care that is evidence based and promotes proper medication management in pregnancy.
The International journal of childbirth education: the official publication of the International Childbirth Education Association 04/2015; 30(2):26.
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