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postpartum depression

Epidemiology: - twice as common as major depression unrelated to childbirth in women of childbearing age History: 1) previous psychiatric history 2) psychosocial stressors 3) domestic violence (40%) [6] Clinical manifestations: 1) major depression developing after delivery 2) onset a) prenatal 11%, 0-6 weeks postpartum 66%, 6 weeks-12 months 22% [5] b) 4-6 weeks [1] c) depressive episodes within the first year of delivery do not cluster around the postpartum period (Sweden) [11] 3) 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: - postpartum psychosis Management: 1) screening at 6 week postpartum visit 2) selective serotonin re-uptake inhibitor (SSRI) - zuranolone (Zurzuvae) may work faster than SSRI (within 2 weeks) [12] 3) monitor babies of treated mothers for developmental milestones 4) do NOT use lithium carbonate 5) nutritional therapy may be of benefit - a mix of tryptophan, tyrosine, & blueberry juice may prevent postpartum depression [9]

Related

depression during pregnancy major depression

General

perinatal depression complications of the puerperium

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
  2. Prescriber's Letter 8(8):47, 2001 Detail-Document#: 170823 (subscription needed) http://www.prescribersletter.com
  3. Prescriber's Letter 11(8): 2004 Treatment of Antenatal and Postpartum Depression Detail-Document#: 200810 (subscription needed) http://www.prescribersletter.com
  4. 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: 15695997
  5. 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. 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 PMID: 22145631 http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2011.03219.x/abstract
  7. Surkan PJ et al Impact of Maternal Depressive Symptoms on Growth of Preschool- and School-Aged Children Pediatrics, Published online September 10, 2012 PMID: 22966023 http://pediatrics.aappublications.org/content/early/2012/09/04/peds.2011-2118.abstract
  8. Stewart DE, Vigod S Postpartum Depression. N Engl J Med 2016; 375:2177-2186. December 1, 2016 PMID: 27959754 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. 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 PMID: 28289215 http://www.pnas.org/content/114/13/3509
  10. 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: 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: 29387871 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2670692
  11. 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: 30008084
  12. Deligiannidis KM et al. Zuranolone for the treatment of postpartum depression. Am J Psychiatry 2023 Jul 26; [e-pub]. PMID: 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: 34190962 PMCID: PMC8246337 Free PMC article https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2781385