Diagnosis, Pathophysiology, and Management of Mood Disorders in Pregnant and Postpartum Women

University of Toronto, Toronto, Ontario, Canada
Obstetrics and Gynecology (Impact Factor: 5.18). 04/2011; 117(4):961-77. DOI: 10.1097/AOG.0b013e31821187a7
Source: PubMed


Mood disorders disproportionately affect women across the lifespan. Mood disorders in pregnancy and the postpartum period are common and have profound implications for women and their children. These include obstetric and neonatal complications, impaired mother-infant interactions, and, at the extreme, maternal suicide and infanticide. Because obstetrician-gynecologists are often the first (and sometimes the only) point of contact for young women in the health care system, familiarity with the presentation and treatment of depressive illness in the perinatal period is imperative. The goal of this review is to synthesize essential information on depressive illness in the perinatal period with a focus on its most common and severe presentations, major depressive disorder and bipolar disorder. Accurate diagnosis of unipolar major depressive disorder from bipolar disorder can facilitate the selection of the best possible treatment alternatives. Counseling may be sufficient for perinatal women who have mild to moderate depression, but women who are severely depressed are likely to require antidepressant treatment. Women with bipolar disorder are at high risk for relapse if mood stabilizer medication is discontinued, and they are vulnerable to relapse near the time of delivery. Comanagement of their care with psychiatrists will increase their chances of avoiding a recurrence of illness.

Download full-text


Available from: Kimberly Ann Yonkers, May 09, 2014
51 Reads
  • Source
    • "In the presence of a de-afferented neuronal pathway , the effect of a pleasurable stimulus from falling in love or recreational stimulants could be greatly amplified. Childbirth may act in a similar way, as the rapid withdrawal of high levels of oestrogen leaves hypersensitised dopaminergic receptors [34]. Antidepressants may not always give pleasure per se, but they may act on precisely the monoamine pathways that we hypothesise become hypersensitised in depression. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Bipolar disorder, characterised by extreme cyclical variations in mood between depression and mania, is a common, debilitating and sometimes fatal psychiatric condition with an unclear aetiology. In this paper we propose a hypothesis for the development of bipolar disorder through which neuroplastic changes in response to an index depressive episode leads to the amplification of subthreshold pleasurable stimuli that then drive conversion into a manic state. This 'pleasure deafferentation hypothesis' is reached through a discussion of the neuroscientific basis of deafferentation at the level of the neuron and its role in the development of various neurological and psychiatric phenomena before a case for deafferentation as applied to bipolar disorder is justified and its implications discussed.
    Medical Hypotheses 09/2015; DOI:10.1016/j.mehy.2015.09.023 · 1.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Many women suffering from major depressive disorder during pregnancy are hesitant to initiate or continue antidepressant treatment during preconception planning, conception, pregnancy, and lactation (perinatal period). Over the past few decades, various psychotherapeutic approaches have been found to be efficacious for depression in general population research. Several observational and quasi-experimental studies also suggest that psychotherapy can be a safe first-line treatment for perinatal women with mild to moderate depression. This article summarizes findings to date regarding the use of psychotherapy for depression occurring during pregnancy and describes the adaptations made to tailor the treatment to the unique needs of women in the perinatal period.
    Current Psychiatry Reports 08/2011; 13(6):459-66. DOI:10.1007/s11920-011-0230-2 · 3.24 Impact Factor
  • Source
    Obstetrics and Gynecology 09/2011; 118(3):708; author reply 708-9. DOI:10.1097/AOG.0b013e31822bd7e3 · 5.18 Impact Factor
Show more