postpartum depression

What is the antenatal depression prevalence in South Africa?

22-47 %

What is the postnatal depression prevalence in South Africa?

16-32%

What is the postnatal anxiety disorder prevalence in South Africa?

15-23%

What is the postnatal depression prevalence among HIV positive mothers in South Africa?

45-55%

What is the DSM-5?

A diagnostic and structural manual of mental disorders, requires experiencing at least 5 / 9 specific symptoms nearly everyday for 2 week period

What are the core symptoms of DSM?(2)

Depressed mood and decreased interest or pleasure

What are the other symptoms of DSM?(7)

1. Sleep problems

2. Suicidality

3. Appetite and weight

4. Guilt and worthlessness

5. Agitation

6. Fatigue

7. Low concentration

What are non DSM based symptoms?(4)

1. Pain

2. Anxiety

3. Vasomotor functioning

4. Sexual dysfunction

What’s the Edinburg Postnatal Depression Scale criteria?(10)

1. I have been able to laugh and see the funny side of life

2. Look forward with enjoyment

3. Blamed myself unnecessarily

4. Anxious / worried for no good reason

5. Scared / panicky for no good reason

6. Things have gotten on top of me

7. Difficulty sleeping

8. Feeling sad / miserable

9. So unhappy that you’ve been crying

10. Thought of harming myself has occurred

What are the Mallikarjun and Oyebode risk factors for postnatal depression?(6)

1. Depression and anxiety during pregnancy

2. Maternity blues

3. Stressful life events

4. Low levels of social support

5. Marital maladjustment

6. Past history

Wha take the results of PPD?(6)

1. Maternal abuse of the offspring

2. Intimate partner violence

3. Low socioeconomic status

4. Food insecurity

5. Risk of tabocco, alcohol / illicit drug use

6. Comorbidities mental and/ general medical health conditions

What are the theories that could explain the biological cause of PPD?(4)

1. Hormonal changes

2. Neuroactive peptides

3. Biogenic amines

4. Cholesterol

Which hormone raises 50x than in the menstrual cycle?

Estradiol

Which hormone raises 10x than in the menstrual cycle?

Progesterone

What happens in the hypothalamic- pituitary axis (HPA)?

Hyperactivity

Which hormones also increase?

Androgens

What is a proposed trigger for PPD but has a weak association?

Sudden withdrawal of progesterone

Which amino acids plays a role in PDD?(2)

Neuroactive peptides and biogenic amines

What is a modular of dopamine release?

Allopregnanolone

Which steroid is associated in level 3-4 weeks post partum associated with depression?

Low testosterone

What are the ranging effects of serotonin?(5)

1. Limbic

2. Prefrontal cortex

3. Pituitary cortex

4. Sexual functioning

5. Sensitive to estrogen & progesterone

Which hormone inhibits dopamine uptake in nigrostriatal and mesolimbic pathways?

Estrogen

What are the potiential complications of PDD?(4)

1. Thyroid autoimmunity

2. Maternal functioning

3. Infant affective reactivity

4. Effect on partner

What is the relationship with thyroid disease and PND?

PND risk is directly associated with thyroid autoimmunity > Lower FT3 and higher FT4:FT3 ratio

What is the effect on infants with a mother having PND?(4)

1. Increased risk of ADHD

2. Anxiety disorder

3. Language delay

4. Possible schizophrenia/ BiPD

What are the effects on the partner if the mother has PND?(5)

1. Negative impact on relationship

2. Increase risk of mental health issues

3. Depressive disorder

4. Aggression

5. Alcohol abuse

What are the targets for treatment? (9)

1. Mood

2. Sleep

3. Concentration

4. Fatigue

5. Psychomotor retardation / agitation

6. Lack of pleasure

7. Guilt and worthless

8. Appetite and weight

9. Suicidality

What does 5-HT (SSRI) treat?(5)

1. Mood

2. Sleep

3. Guilt and worthlessness

4. Appetite & weight

5. Suicidality

What does norepinephrine treat? (5)

1. Mood

2. Concentration

3. Fatigue

4. Psychomotor retardation

5. Appetite and weight

What does neurotransmitter dopamine? (5)

1. Mood

2. Concentration

3. Fatigue

4. Psychomotor / agitation

5. Lack of pleasure

What does GABA and histamine treat?

Sleep

Define bipolar disorder

A lifelong mental health condition that causes extreme shifts in mood, energy, activity levels and ability to carry out day-to-day tasks

How many patients with treatment resistant PDD are diagnosed with BiPD?

57%

Which antidepressants are high however been widely used for many years and considered safe?

TCA > tricyclic antidepressants

What are the disadvantages of TCA?(2)

1. Increase risk of preterm labour

2. May produce neonatal withdrawal > self-limiting

Effects of paroxetine? (5)

1. Congenital malformations

2. Major malformations

3. Cardiac malformations

4. Eye defects

5. Cleft palate

Effects of fluoxetine? (4)

Major congenital malformations

Cardiac malformations

VSD

Neural tube defects

What is the standard care of SSRI in pregnant woman?

Citalopram

What is the risk with citalopram?

Risk of persistent pulmonary hypertension

What is the alternative of citalopram?

Fluoxetine > be aware of its long half-life

What is another safe SSRI?

Sertraline > unclear clinical implication

What is the standard first line choice to treat bipolar disorder in pregnant women but has increase risks of congenital malformations, cardiac birth defect, miscarriages?

Lithium > 84% less likely to relapse in post part period

Starting which contraceptive within 48 hrs after childbirth is linked to a higher risk of postpartum depression?

Norethisterone enanthate

Which hormone is the “modest value for treatment of severe postpartum depression”?

Oestrogen

What is an “alternative” therapy to treat PPD that is safer with no side effects?

Massage therapy > but no significant decrease

*also include non-specific acupuncture