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LONG TERM CONSEQUENCES OF PMD
LONG TERM CONSEQUENCES OF PMD
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Postpartum Depression beyond the blues

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1POSTPARTUM DEPRESSION BEYOND THE 29SAMPLE EPDS QUESTIONS. 1. I have been
BLUES. Debby Carapezza, R.N., M..S.N. able to laugh & see the funny side of
Nurse Consultant, Reproductive Health things As much as I always could Not quite
Program Utah Department of Health. so much now Definitely not so much not Not
2INCIDENCE OF DEPRESSION. Each year, at all.
15% to 20% of adults in the United States 30SAMPLE EPDS QUESITONS (Cont.). *3. I
experience a major depression The have blamed myself unnecessarily when
incidence among women is twice that of men things went wrong Yes, most of the time
and peaks between 18 to 44 years of age - Yes, some of the time Not very often No
the childbearing years. never.
3DEPRESSION IN WOMEN. Women are at 31SAMPLE EPDS QUESTIONS (Cont.). *6.
increased risk of mood disorders during Things have been getting on top of me Yes,
periods of hormonal fluctuation- most of the time I haven’t been able to
premenstrual postpartum perimenopausal. cope at all Yes, sometimes I haven’t been
4THE RANGE OF POST-DELIVERY MOOD coping as well as usual No, most of the
DISORDERS. 50% to 80% of women experience time I have coped as well as ever No, I
transient “baby blues” within the first have been coping as well as ever.
two weeks following delivery 0.1% to 0.2% 32TREATMENT. 1. Educate the woman and
of women experience postpartum psychosis her support system regarding the diagnosis
usually within the first 4 weeks following of postpartum depression.
delivery. 33TREATMENT OPTIONS. Pharmacological
5POSTPARTUM DEPRESSION. 6.8% to 16.5% intervention Counseling, individual and/or
of women experience postpartum depression group Support groups.
(PPD) also known as postpartum major 34PHARMACOLOGICAL INTERVENTION. Use of
depression (PMD) Onset can be as early as tricyclic antidepressants and selective
24 hours or as late as several months serotonin reuptake inhibitors (SSRIs) may
following delivery. be indicated for both non-nursing and
6SYMPTOMS OF POSTPARTUM DEPRESSION. nursing mothers Have low incidence of
7RANGE OF SYMPTOMS. Symptoms range- infant toxicity and adverse effects during
from mild dysphoria to suicidal ideation breastfeeding* Decisions regarding use
to psychotic depression. while breastfeeding must be on a case by
8DURATION OF SYMPTOMS. Untreated, case basis.
symptoms can last: several months into the 35OTHER CONSIDERATIONS: Provider must be
second year postpartum. familiar with agents and the hepatic
9THE ETIOLOGY OF POSTPARTUM DEPRESSION. function of mother and infant Client must
Various theories based in physiological be informed of risks/benefits of treatment
changes have been postulated: hormonal Vs. no treatment for herself and her
excesses or deficiencies of estrogen, infant unknown impact of long-term use of
progesterone, prolactin, thyroxine, medications on neurodevelopment of infant.
tryptophan, among others. 36Other Considerations - Cont. If the
10ETIOLOGY OF POSTPARTUM DEPRESSION. woman chooses to breastfeed while on
Other theories cite numerous psychosocial psychotropics, she should work
factors associated with PMD: marital collaboratively with a psychiatrist and
conflict child-care difficulties (feeding, her pediatrician If the infant experiences
sleeping, health problems) perception by insomnia or other behavior changes, his
mother of an infant with a difficult serum should be assayed for the presence
temperament history of family or personal of medication Document all discussions
depression. regarding treatment in the client’s chart.
11POSTPARTUM DEPRESSION IN UTAH. What 37TREATMENT OF DEPRESSION PATIENT
can PRAMS* data tell us? *PRAMS is an ASSISTANCE PROGRAMS. Pharmacological
ongoing, population-based risk factor treatment of depression can be effective.
surveillance system designed to identify Unfortunately, it can also be expensive.
& monitor selected maternal Costs of antidepressants vary depending on
experiences that occur before & during the drug, dose and pharmacy. Paxil® 20mg
pregnancy & experiences of the child’s qd X 30 Days = $85.39 Prozac® 20mg qd X 30
early infancy. Days = $67.79 (generic) Zoloft® 50mg qd X
12INDICDENCE OF POSTPARTUM DEPRESSION 30 days = $75.00 Elavil®, at approximately
AMONG 2000 UTAH PRAMS RESPONDENTS. 24.1% 75mg qd X 30 days = $11.39 (generic) or
of PRAMS respondents indicated that in the $37.89 (brand).
months after delivery they were moderately 38COUNSELING. Know referral sources in
to very depressed. your locale, especially those that: accept
13When the results of the survey are Medicaid utilize a sliding fee will
weighted to represent all 47,331 Utah develop a payment plan with the client
women who had a live birth in 2000, this offer free counseling Be familiar with
means an estimated 11,416 women reported indigent drug programs available through
being moderately or very depressed. various pharmaceutical manufacturers.
14Higher rates of depression were noted 39Counseling - Cont. Any woman with
among women who: symptoms of psychosis or with serious
15THE IMPACT OF POSTPARTUM DEPRESSION. suicidal/homicidal ideation should be
16LONG TERM CONSEQUENCES OF PMD. referred for emergency psychiatric
Negative impact on the infant ‘s social, evaluation.
emotional and cognitive development 2 40SUPPORT GROUPS. Numerous postpartum
month old infants of mothers with PMD had support groups are available. Contact:
decreased cognitive ability and expressed Local mental health agencies Hospitals
more negative emotions during testing. Websites.
17LONG TERM CONSEQUENCES OF PMD. Babies 41WEBSITE INFO & SUPPORT. Depression
of mothers with PMD were perceived by After Delivery -
their mothers as more difficult to care http://www.depressionafterdelivery.com
for and more bothersome. Postpartum Support International
18POSTPARTUM DEPRESSION & MATERNAL -http://www.postpartum.net/ The Postpartum
MORTALITY IN UTAH. In recent years, there Stress Center
have been two maternal deaths due to -http://www.postpartumstress.com/
suicide by women within one year of giving Postpartum Education for Parents
birth. Neither woman had been screened for -http://www.sbpep.org Office on Women’s
postpartum depression. Health
19RISK FACTORS FOR PMD. -http://www.4women.gov-pregnancy-after the
20INTERVENTIONS. SCREENING FOR PMD. baby is born-PPD.
21SCREEN ALL POSTPARTUM WOMEN FOR PMD 42Websites and Other Resources. Mental
BECAUSE A WOMAN MAY: Be unable to Health Association in Utah
recognize she is depressed. http://www.xmission.com/~mhaut/ For
22SCREEN ALL POSTPARTUM WOMEN FOR PMD information on medication while
BECAUSE A WOMAN MAY: Believe her symptoms breastfeeding, call Pregnancy RiskLine: In
are “normal” for new moms. Salt Lake City: 328-BABY (2229) Outside
23SCREEN ALL POSTPARTUM WOMEN FOR PMD Salt Lake: 1-800-822-BABY (2229).
BECAUSE A WOMAN MAY: Fear being labeled a 43SUMMARY. Postpartum depression: is
“bad mother” if she admits her maternal relatively common may have long-term
experience does not meet society’s picture consequences for mother, infant &
of bliss. family is easily missed should be screened
24SCREEN ALL POSTPARTUM WOMEN FOR PMD for can be treated successfully.
BECAUSE A WOMAN MAY: Feel she is going 44References. 1. Beck AT, Ward, CH,
crazy and fears her baby will be taken Mendelson M, Mock J, Erbaugh J. An
from her. inventory for measuring depression.
25WHEN TO SCREEN FOR PMD. At Archives of General Psychiatry. (June
preconception visit During prenatal intake 1961). 4:6:561-571. 2. Cox JL, Holden, JM,
& subsequent visits During postpartum Sagovsky R. Edinburgh Postnatal Depression
exams During infant’s WCC & WIC visits Scale (EPDS). British Journal of
When infant is seen for sick care or in ER Psychiatry. (1987). 150:782-786. 3.
At early intervention home visits At Epperson CN. Postpartum major depression:
family planning visits during the first detection & treatment. American Family
year postpartum At mother’s visits for Physician. (April 15, 1999).
routine episodic care. 59:8:2247-2254. 4. Mandl KD, Tronick EZ,
26SCREENING TOOLS. There are several Brennan TA, Alpert HR, Homer J. Infant
tools available: Edinburgh Postnatal health care use and maternal depression.
Depression Scale (EPDS) The Mills Archives of Pediatric Adolescent Medicine.
Depression & Anxiety Checklist The (1999). 153:(8):808-813. 5. Stowe Z.
Center for Epidemiological Studies Depression after childbirth: I it the
Depression Scale (CES-D) Others, often on “baby blues” or something more? Pfizer
various websites for mental health. Inc. January 1998. 6. Stowe ZN, Nemeroff
27A WORD ABOUT SCREENING TOOLS! Be CB. Women at risk for postpartum-onset
familiar with the tool - its validity and major depression. American Journal of
limitations Have a referral network Obstetrics & Gynecology. (August
available for women screening positive 1995). 173:2:639-645. 7. Utah Department
Document the screening and any referrals of Health. (2001). [Untitled]. Unpublished
made Follow-up with your client to assure Maternal Mortality Review Program data.
that she received needed assistance. 45References (cont.). 8. Utah Department
28EDINBURGH POSTNATAL DEPRESSION SCALE of Health. (2001). [Untitled]. Unpublished
(EPDS). Designed for home or outpatient PRAMS data. 9. Whiffen VE, Gotlib IH.
use Consists of 10 questions Can be Infants of postpartum depressed mothers:
completed in approx. 5 minutes Reviews temperament and cognitive status. Journal
feelings the previous 7 days Scored 0-3 of Abnormal Psychology. (1989).
depending on symptom severity Depending on 98:3:274-279.
study, cut off is 13 - 9 points.
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Postpartum Depression beyond the blues

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