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INDIANA PERINATAL MOOD DISORDERS GUIDE
Symptoms, Treatment, Screening Tools & Resources
This Guide is intended as a resource for clinicians involved in the care of the Obstetrical client. This information should not be interpreted as excluding other acceptable courses of care based uponmedical judgement and patient preferences. The Guide reflects the current opinion of IPN for a standard approach to postpartum mood disorders. SIGNS & SYMPTOMS
POSTPARTUM
POSTPARTUM DEPRESSION
OBSESSIVE/COMPULSIVE
POSTPARTUM ONSET
POSTPARTUM
POSTTRAUMATIC
DISORDER
ANXIETY/PANIC DISORDER
PSYCHOSIS
STRESS DISORDER
Symptoms are insidious and can occur anytime up to a year after
birth, usually within the first three months; a period of at least two weeks of depressed mood or loss of interest in almost all activities and at least four other symptoms from the following list: • Changes in appetite or weight, sleep and psychomotor activity • Difficulty thinking, concentrating or making decisions • Recurrent thoughts of death or suicidal ideation, plans or ■ May have an effect for up to a year or longer ■ Psychosocial predictors:
• Previous episodes of depression/mood disorders • Significant loss or life stress in the last year ■ Biological risk factors:
■ Depressed mothers can physically appear to have no symptoms of depression; however, their parenting style, affect and interactions with the baby can reveal the emotional struggles the mother may BABY BLUES
be having and should be assessed for these signs and
symptoms:
• Insensitive and unresponsive parenting style • Bouts of crying with no specific reason • Mothers who feel disconnected from their infant • Impatience, irritability, restlessness, and anxiety • Feeling they are a “bad” or inadequate mother • Temporary experience of mild depression This document reflects the consensus of the Indiana Perinatal ■ Approximately 50 to 80 percent of women report having had some or Network (IPN) State Perinatal Advisory Board—a constituency ofInfants may appear
professional organizations (i.e. ACOG, AAP) and individuals (i.e. • Passive or avoidant (little eye contact with their mother or ■ Symptoms usually disappear, but some women who experience the CNMs, MDs, consumers) committed to the belief that every baby in caregiver) which mirrors the mother’s negative mood at home baby blues are at risk for developing PPD Indiana deserves to be born healthy and into a safe and nurturing • Feeding difficulties, frequent illness, and babies who display ■ Occurs during the immediate first three days after birth and can IPN documents such as this are intended to serve asPPD can cause a strained relationship between the couple,
recommendations—not as established standards or rigid rules. impaired patterns of relating/communicating between the woman ■ Women rarely pose any significant physical threat to themselves Healthcare providers must make the best decisions possible within and her family, and negative cognitive & social development of the limitations of the particular situation. All are invited to make suggestions for improving this document. Indiana Perinatal Mood Disorders Guide TREATMENT/PHARMACOLOGIC INTERVENTIONS
Early treatment is found to hasten remission, remedy maternal-infant problems and reduce insecure infant attachment. * A partial listing of medications is adapted from Sichel, D & Driscoll J (1999), Women’s Moods: What Every Woman Must Know About Hormones, the Brain and Emotional Health, New York: Harper Collin Publishers.
POSTPARTUM
POSTPARTUM DEPRESSION
OBSESSIVE/COMPULSIVE
POSTPARTUM ONSET
POSTPARTUM
POSTTRAUMATIC
PANIC DISORDER
PSYCHOSIS
STRESS DISORDER
DISORDER
Breastfeeding Guidelines for Women Receiving Antidepressants Antianxiety medications
Antianxiety medications
Mood Stabilizers:
Antidepressants
■ Balance the benefits of breastfeeding with the risks of not taking ■ Consider measuring the blood concentration in the nursing infant three weeks after medication is started; any question of toxicity ■ Be familiar with the infant’s behavior ■ Instruct the mother to take the medication when the infant is Antidepressants
Antidepressants
Antipsychotics:
Primary Prevention:
■ Pump and discard the milk for one feeding to limit baby’s ■ It often takes three to four weeks for an antidepressant to work ■ Recommendations for antidepressant medication would be at least for six to nine months or longer, from the time the woman ■ Abrupt cessation of serotonin-enhancing medications may cause Secondary Prevention:
withdrawal symptoms (“serotonin discontinuation syndrome”) such as dizziness, paraesthesia, tremor, anxiety, nausea and ■ Fluoxetine usage has been associated with irritability, sleep Tertiary Prevention:
disturbance and poor feeding in some breastfeeding infants Antidepressants
■ Selective Serotonin-reuptake inhibitors (SSRIs): Side Effects:
■ Selective Serotonin- and Norepinephrine-reuptake inhibitors (SNRIs): ■ Postpartum depression support groups ■ Counseling/interpersonal psychotherapy ■ Hospitalization when there are plans to harm oneself or the baby■ Electroconvulsive therapy (ECT) Paxil, Luvox, Zoloft and Prozac not associated with birth defects or Indiana Perinatal Mood Disorders Guide SCREENING OPTIONS FOR PERINATAL DEPRESSION
BECK’S POSTPARTUM DEPRESSION
CENTER FOR
ANTENATAL PSYCHOSOCIAL
SCREENING SCALE (PDSS)
EDINBURGH POSTNATAL
EPIDEMIOLOGIC
DEPRESSION SCALE (EPDS)
STUDIES—DEPRESSION
HEALTH ASSESSMENT TOOL
(CES-D) SCALE
■ Can be administered two weeks postpartum ■ Is a 35-item Likert response self-report scale ■ Takes five to ten minutes to administer and provides an overall severity score ■ Asks women to rate how they have been feeling over the past two weeks ■ Has a specificity of 98 percent; a sensitivity of 94 percent; and a positive ■ Designed to assess the presence, severity and type of PPD symptoms ■ Consists of seven symptom areas: Sleeping/Eating Disturbances, Anxiety/Insecurity, Emotional Lability, Mental Confusion, Loss of Self, given in the Diagnostic & Statistical ■ When time is limited, the first seven items function as a short form, which can be completed in two minutes, with item 7 sensitive to suicidal thinking ■ If the score on either the short or long form is WNL, recommendations are to administer either form every three months during the first year postpartum RESOURCES
Indiana Perinatal Mood Disorders Guide

Source: http://www.theconnectprogram.org/sites/default/files/site-content/docs/indiana_perinatal_mood_disorders_guide.pdf

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