Mental Health Book

Chemical Dependency

Depressive Disorders

Pharmacology

http://www.fpnotebook.com/

Postpartum DepressionAka: Postpartum Blues

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  1. See Also
    1. Major Depression
  2. Epidemiology
    1. Postpartum Blues: 50-80% of post-partum women
    2. Postpartum Depression: 5-10% of post-partum women
    3. Postpartum Psychosis: 1-2 per thousand postpartum women
  3. Risks
    1. Prior history of psychiatric disorder
    2. Affective instability during pregnancy
    3. Lack of Social Support
  4. Symptoms
    1. Depression lasts >2 weeks (contrast with Blues)
    2. Comorbid anxiety and agitation
  5. Diagnosis
    1. See Depression Screening Tools
    2. Edinburgh Postnatal Scale
      1. http://www.aafp.org/afp/20020915/contents.html
      2. Designed specifically for postpartum depression
      3. Relies less on somatic symptoms
  6. Management
    1. Psychotherapy
    2. Consider low dose Estrogen Replacement
      1. Transdermal Estrogen postpartum
    3. Adjust social situation
      1. Longer maternity leave
      2. Return part-time
    4. For Major Depression treatment in Lactation
      1. Nortriptyline
        1. Appears safe in Lactation
      2. Selective Serotonin Reuptake Inhibitors (SSRI)
        1. May also be safe in Lactation (unclear)
        2. New data suggests safety of agents
        3. Consider checking infant drug levels
  7. References
    1. Ahokas (2000) J Clin Psychiatry 61:166

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