Postpartum Depression

Presented by:

Nicole D. Swain, LPC, NCC, ACS, ACT

Behavioral Health & Cognitive Therapy Center

Why Treat?

• Behavioral problems: sleep problems, aggression and hyperactivity

• Cognitive delays: walk and talk later, problems in school

• Social problems: difficulty developing relationships, socially withdrawn, aggressively act out

• Emotional problems: lower self-esteem, higher levels of anxiety

• Psychological problems: high risk of developing depression

Who?

• Across all cultures

• 12 - 20%* of all women having a

– live birth– still birth– miscarriage– abortion

Etiology

• Biology

– Sudden change in hormone levels– Poor diet– Lack of efficient sleep– Pain

Continued

• Stress

– Sudden change in lifestyle– Change in level of marital support– Societal expectation of the “Happy Mother”

Risk Factors

• Women with a previous history of depression or anxiety

• Stressful event during pregnancy (trauma)

• Premature or Complicated birth

• Women with previous history of PPD (55%)

• Illness

– Diabetes (50% more likely)

– Thyroiditis (33% more likely)

Symptoms of “Baby Blues”

• 65 to 80% of all women

• Duration - first two weeks, symptoms usually begin 3-4 days after event

• Mood swings

• Sleep disturbance

• Irritable

• Weepy

• Worry

• Resolves in 4 weeks

Symptoms of PPD

• Duration post “baby blues”

• Significant decline in self care

• Lack of interest in baby

• Negative feelings towards baby

• Lack of concern for yourself

continued

• Uncontrollable crying

• Insomnia• Panic Attacks

• Thoughts of death

Assessment

• Clinical Interview

– Patient– Family / Significant others

• Formal Assessment Tools

Clinical Interview

• DSM IV-R Criteria for Major Depressive Disorder:

– duration lasting more than two weeks• Ask questions about:

– Appetite– Sleep– Daily Self Care– Mood– SI/HI

Clinical Interview Question Screen

• 2 Question Screen *Sensitivity 98%, Specificity 67% -79%

– During the past month have you often been bothered by feeling down, depressed or hopeless?

– During the past month have you often been bothered by little interest or pleasure in things?

Formal Assessment Tools

• PHQ-9

• Edinburgh Postnatal Depression Scale

– English & Spanish versions– Score over 10 indicative of depression

• Max score 30

• Pay particular attention to question #10 (SI/HI)

Treatment

• Cognitive Behavioral Therapy• Interpersonal Therapy• Medication• Self-help support

CBT & Interpersonal Therapy

• The only two non-pharmacological interventions that have demonstrated empirical effectiveness in helping reduced mild to moderate depressive symptoms and improved social adjustment in women experiencing PPD.

• Both short term

• Represents the only alternative for women who are prefer no medication (e.g. won’t take because of breastfeeding)

CBT

• CBT: effective in targeting negative thoughts

– Teaches about:

• Automatic thoughts

• Common cognitive distortions

• Assumptions & Beliefs

– Skills:

• Examining and Challenging Cognitive Distortions

• Thought Records

• Cost-Benefit Analysis

• Asking for Things That are Important to Me

Medication

• Tricyclics

– Elavil - YES

– Doxetin - NO

• SSRI’s

– Prozac (only FDA approved during pregnancy)

– Zoloft* (considered best choice breastfeeding)

– Paxil*, Celexa*, Effexor* (in order)

*Levels of medication that reach the baby through breastfeeding are either low or undetectable

Self Help Support

• Depression after Delivery: National foundation that provides support and information for PPD. http://www.depressionafterdelivery.com

• Postpartum Progress: the most widely read US based blog focused specifically on postpartum depression, anxiety and psychosis. http://postpartumprogress.typepad.com/weblog/

• Marce Society: an international society for the understanding, prevention and treatment of mental illness related to childbearing. http://www.marcesociety.com/

Resources

• US Department of Health & Human Services: http://www.womenshealth.gov/faq/depression-pregnancy.cfm

• American Academy of Family Medicine: http://familydoctor.org/online/famdocen/home/women/pregnancy/ppd/general/379.html

• National Institute of Mental Health: http://newsinhealth.nih.gov/2005/December2005/docs/01features_02.htm

• International Lactation Consultant Association: http://www.ilca.org

• Postpartum Support International: http://postpartum.net/resources/