Preparation for Child Psych PRITE and Boards
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==Introduction== | ==Introduction== | ||
| − | General overview of depression can be found in the main article. | + | General overview of depression can be found in the main [[Depression|article]]. |
| − | ==Epidemiology== | + | ==Epidemiology and Risk== |
* The incidence of MDD during pregnancy is 7.5%, while period prevalence is 12.7%. | * The incidence of MDD during pregnancy is 7.5%, while period prevalence is 12.7%. | ||
| + | * The strongest risk factor is a history of postpartum MDD with a previous pregnancy (25-50% recurrence rate) | ||
* Depression during pregnancy is associated with increased risk of pre-term birth and low birth-weight ([http://www.ncbi.nlm.nih.gov/pubmed/20921117 Meta-analysis], Grote 2010) | * Depression during pregnancy is associated with increased risk of pre-term birth and low birth-weight ([http://www.ncbi.nlm.nih.gov/pubmed/20921117 Meta-analysis], Grote 2010) | ||
* Women treated with '''SSRI's''' have 2-3x greater risk for preterm birth and delivering low-birth-weight infants, compared to women not treated with SSRIs. | * Women treated with '''SSRI's''' have 2-3x greater risk for preterm birth and delivering low-birth-weight infants, compared to women not treated with SSRIs. | ||
| + | * Despite in-utero SSRI exposure, there was no effect in infant growth at 12-mo in a prospective observational [http://www.ncbi.nlm.nih.gov/pubmed/23511234 study], i.e., premature and low-weight babies caught up. | ||
| + | |||
| + | ==Diagnosis== | ||
| + | * '''Baby blues''' refers to a brief period (<10days) of depressed mood and mild dysfunction '''without''' suicidality. | ||
| + | ** prevalence if "baby blues" is 80% [http://www.aafp.org/afp/2010/1015/p926.html] | ||
| + | * postpartum depression is DSM-IV specifier for major depressive disorder, ("with postpartum onset") defined as onset within four weeks of delivery. | ||
| + | ** feeling of guilt and worthlessness often dominate, while depressed mood is less common. | ||
| + | ** up to 60% of women with postpartum MDD may have obsessive/intrusive thoughts about harming the infant. | ||
| + | ** MD must rule out '''postpartum autoimmune thyroiditis''' (8% of postpartum women), which can mimic MDD | ||
==Treatment== | ==Treatment== | ||
| + | *Interpersonal therapy and cognitive behavior therapy are effective in treating MDD with postpartum onset. | ||
| + | *Light therapy has not been shown to be effective in patients with postpartum major depression. | ||
| + | *SSRIs are affective in moderate and severe depression; they are generally considered safe in breastfeeding. | ||
==References== | ==References== | ||
| − | [http://www.ncbi.nlm.nih.gov/pubmed/20921117] Groto NK | + | [http://www.ncbi.nlm.nih.gov/pubmed/20921117] Groto NK, et.al. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010 Oct;67(10):1012-24 |
| + | |||
| + | [http://www.ncbi.nlm.nih.gov/pubmed/23511234] Wisner KL, et.al. Does Fetal Exposure to SSRIs or Maternal Depression Impact Infant Growth? Am J Psychiatry. 2013 May 1;170(5):485-93. | ||
| + | |||
| + | [http://www.aafp.org/afp/2010/1015/p926.html] Hirst KP., et.el. Postpartum Major Depression. Am Fam Physician. 2010 Oct 15;82(8):926-933 | ||
| + | |||
[[Category:Disorders]] | [[Category:Disorders]] | ||
| − | + | [[Category:Advanced topics]] | |
Latest revision as of 08:08, 5 May 2013
Introduction
General overview of depression can be found in the main article.
Epidemiology and Risk
- The incidence of MDD during pregnancy is 7.5%, while period prevalence is 12.7%.
- The strongest risk factor is a history of postpartum MDD with a previous pregnancy (25-50% recurrence rate)
- Depression during pregnancy is associated with increased risk of pre-term birth and low birth-weight (Meta-analysis, Grote 2010)
- Women treated with SSRI's have 2-3x greater risk for preterm birth and delivering low-birth-weight infants, compared to women not treated with SSRIs.
- Despite in-utero SSRI exposure, there was no effect in infant growth at 12-mo in a prospective observational study, i.e., premature and low-weight babies caught up.
Diagnosis
- Baby blues refers to a brief period (<10days) of depressed mood and mild dysfunction without suicidality.
- prevalence if "baby blues" is 80% [1]
- postpartum depression is DSM-IV specifier for major depressive disorder, ("with postpartum onset") defined as onset within four weeks of delivery.
- feeling of guilt and worthlessness often dominate, while depressed mood is less common.
- up to 60% of women with postpartum MDD may have obsessive/intrusive thoughts about harming the infant.
- MD must rule out postpartum autoimmune thyroiditis (8% of postpartum women), which can mimic MDD
Treatment
- Interpersonal therapy and cognitive behavior therapy are effective in treating MDD with postpartum onset.
- Light therapy has not been shown to be effective in patients with postpartum major depression.
- SSRIs are affective in moderate and severe depression; they are generally considered safe in breastfeeding.
References
[2] Groto NK, et.al. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010 Oct;67(10):1012-24
[3] Wisner KL, et.al. Does Fetal Exposure to SSRIs or Maternal Depression Impact Infant Growth? Am J Psychiatry. 2013 May 1;170(5):485-93.
[4] Hirst KP., et.el. Postpartum Major Depression. Am Fam Physician. 2010 Oct 15;82(8):926-933