postpartum depression
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Epidemiology
- twice as common as major depression unrelated to childbirth in women of childbearing age
History
- previous psychiatric history
- psychosocial stressors
- domestic violence (40%)[6]
Clinical manifestations
- major depression developing after delivery
- onset
- prenatal 11%, 0-6 weeks postpartum 66%, 6 weeks-12 months 22%[5]
- 4-6 weeks[1]
- depressive episodes within the first year of delivery do not cluster around the postpartum period (Sweden)[11]
- severe fatigue, anhedonia, irritability, poor concentration, insomnia & tearfulness[8]
Complications
- short stature of children[7]
- persistent & severe depression following childbirth is associated with increased risk for adverse outcomes throughout childhood[10]
Differential diagnosis
Management
- screening at 6 week postpartum visit
- selective serotonin re-uptake inhibitor (SSRI)
- zuranolone (Zurzuvae) may work faster than SSRI (within 2 weeks)[12]
- monitor babies of treated mothers for developmental milestones
- do NOT use lithium carbonate
- nutritional therapy may be of benefit
- a mix of tryptophan, tyrosine, & blueberry juice may prevent postpartum depression[9]
More general terms
Additional terms
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
- ↑ Prescriber's Letter 8(8):47, 2001 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=170823&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Prescriber's Letter 11(8): 2004 Treatment of Antenatal and Postpartum Depression Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200810&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Journal Watch 25(8):66, 2005 Stowe ZN, Hostetter AL, Newport DJ. The onset of postpartum depression: Implications for clinical screening in obstetrical and primary care. Am J Obstet Gynecol. 2005 Feb;192(2):522-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15695997
- ↑ 5.0 5.1 Registered Nurses Association of Ontario (RNAO) Nursing best practice guidelines on postpartum depression http://www.rnao.org/bestpractices/PDF/BPG_Post_Partum_Depression.pdf
- ↑ 6.0 6.1 Woolhouse H et al Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study BJOG 7 DEC 2011 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22145631 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2011.03219.x/abstract
- ↑ 7.0 7.1 Surkan PJ et al Impact of Maternal Depressive Symptoms on Growth of Preschool- and School-Aged Children Pediatrics, Published online September 10, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22966023 <Internet> http://pediatrics.aappublications.org/content/early/2012/09/04/peds.2011-2118.abstract
- ↑ 8.0 8.1 Stewart DE, Vigod S Postpartum Depression. N Engl J Med 2016; 375:2177-2186. December 1, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27959754 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1607649
Rothaus C Postpartum Depression. Now@NEJM. Dec 1, 2016 http://blogs.nejm.org/now/index.php/postpartum-depression/2016/12/01/ - ↑ 9.0 9.1 Dowlati Y, Ravindran AV, Segal ZV et al. Selective dietary supplementation in early postpartum is associated with high resilience against depressed mood. Proc Natl Acad Sci U S A 2017 Mar 28; 114:3509 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28289215 <Internet> http://www.pnas.org/content/114/13/3509
- ↑ 10.0 10.1 Netsi E, Pearson RM, Murray L et al Association of Persistent and Severe Postnatal Depression With Child Outcomes. JAMA Psychiatry. Published online January 31, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29387878 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2670696
Weissman MM. Postpartum Depression and Its Long-term Impact on Children. Many New Questions. JAMA Psychiatry. Published online January 31, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29387871 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2670692 - ↑ 11.0 11.1 Silverman ME, Reichenberg A, Lichtenstein P, Sandin S. Is depression more likely following childbirth? A population- based study. Arch Womens Ment Health 2018 Jul 14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30008084
- ↑ 12.0 12.1 Deligiannidis KM et al. Zuranolone for the treatment of postpartum depression. Am J Psychiatry 2023 Jul 26; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37491938 https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.20220785
Deligiannidis KM et al. Effect of zuranolone vs placebo in postpartum depression: A randomized clinical trial. JAMA Psychiatry 2021 Sep 1; 78:951. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34190962 PMCID: PMC8246337 Free PMC article https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2781385