Anxiety and Depression

00:00
APGO educational topic number 29
00:02
anxiety and depression here is our
00:04
patient labora deliver which she has had
00:06
a successful pregnancy labor and
00:08
delivery she was a beautiful new baby
00:10
and feel that she’s supposed to be very
00:11
happy to start this new chapter of her
00:13
life
00:14
but depressive symptoms are very common
00:16
for women in the postpartum period there
00:18
was a confluence of hormonal shifts
00:20
major life changes an extreme sleep
00:22
deprivation that can contribute to the
00:24
development of mental health concern the
00:26
objectives of this video are to list
00:28
risk factors for postpartum blues
00:29
depression and psychosis differentiate
00:32
between postpartum blues depression and
00:34
psychosis compare and contrast treatment
00:36
options for postpartum blues depression
00:38
and psychosis and recognize appropriate
00:40
treatment options for mood disorders
00:42
during pregnancy a lactation postpartum
00:45
blues are extremely common approximately
00:48
70 to 80 percent of women report feeling
00:50
sad anxious or angry beginning two to
00:52
four days after birth postpartum blues
00:55
is characterized by tearfulness fatigue
00:57
irritability depressed affect mild
01:00
insomnia and is usually self-limited and
01:02
usually does not require any treatment
01:04
postpartum depression on the other hand
01:07
differs from postpartum blues in the
01:08
severity and the duration it is defined
01:11
as a major episode of depression that
01:13
occurs within the first four weeks or
01:15
within the first six months postpartum
01:17
the incidence of postpartum depression
01:19
is 10% and it is characterized by
01:21
pronounced feelings of sadness anxiety
01:23
and despair and interferes with
01:25
activities of daily living and the
01:27
symptoms tend to worsen with time
01:29
treatment for postpartum depression is
01:32
with antidepressant therapy and/or
01:34
psychotherapy postpartum psychosis is
01:37
the most severe form of mental disorder
01:39
in the postpartum time it is
01:41
characterized by confusion clouded
01:43
sensorium and distractibility treatment
01:46
is with antipsychotic and hour
01:48
antidepressant medications let’s now
01:50
move on to risk factors for these three
01:52
different conditions risk factors for
01:55
postpartum blues include psychosocial
01:57
stresses such as child care or
01:58
psychosocial impairment a history of
02:00
depression or a family history of
02:02
depression depressive symptoms pre
02:04
pregnancy or during the pregnancy and a
02:06
history of hormonal II sensitive mood
02:08
changes such as premenstrual syndrome or
02:10
mood changes with oral contraception for
02:13
risk factors for postpartum depression
02:15
having a history of depression is the
02:16
most significant risk factor
02:18
psychosocial stresses are also
02:20
significant risk factors a history of
02:22
physical or sexual abuse being young
02:24
that’s being an unplanned pregnancy or
02:26
thoughts of terminating the pregnancy a
02:27
lack of social and financial support
02:29
living without a partner intimate
02:31
partner violence or stressful life
02:33
events such as a marital conflict during
02:34
the 12 months prior to delivery the most
02:37
significant risk factor for postpartum
02:38
psychosis is pre-existing mental disease
02:41
such as bipolar disorder or
02:42
schizophrenia we will conclude this
02:44
video by discussing treatment options
02:46
for mood disorders during pregnancy and
02:48
the postpartum period there are over
02:50
500,000 pregnancies in the United States
02:52
that involve women who have psychiatric
02:54
illnesses that either predate or emerge
02:56
during the pregnancy an estimated one
02:58
third of pregnant women are exposed to
03:00
psychotropic medications at some point
03:02
during pregnancy simply advising women
03:05
to stop could lead to untreated maternal
03:07
psychiatric illness which could lead to
03:08
poor compliance with prenatal care
03:10
inadequate nutrition exposure to
03:12
additional medications or herbal
03:14
remedies increased alcohol or tobacco
03:16
use deficits and mother-infant bonding
03:18
disruptions within the family
03:20
environment and pregnancy complications
03:22
such as premature birth low birth weight
03:24
infants fetal growth restrictions and
03:26
postnatal complications all psychotropic
03:29
medications do cross the placenta are
03:31
present and amniotic fluid and can enter
03:33
breast milk the general treatment
03:36
concepts include that optimally there
03:38
should be shared decision-making among
03:39
obstetricians and mental health
03:41
clinicians and a single medication at a
03:43
higher dose is preferred over multiple
03:45
medications changing medications also
03:48
increases the exposure to the offspring
03:49
let’s now move to safety and efficacy
03:52
considerations for depression during
03:53
pregnancy most of our data is on SSRI
03:56
used during pregnancy and there is
03:58
limited data on the teratogenic effects
04:00
there has been concern about increased
04:02
risk of congenital cardiac malformations
04:04
with first trimester paroxetine exposure
04:06
so it is generally advisable to avoid
04:08
paroxetine and pregnancy there is
04:11
currently conflicting data on SSRI
04:13
exposure during early pregnancy and risk
04:15
of both overall and specific
04:17
malformations exposure to SSRIs latent
04:20
pregnancy has been associated with
04:22
transient neonatal complications such as
04:23
jitteriness
04:24
mild respiratory distress
04:26
to keep near the newborn we cry poor
04:29
tone and neonatal intensive care unit
04:31
admissions the use of lithium for
04:33
bipolar disease has been associated with
04:35
a small increase in the congenital
04:37
cardiac malformation of Epstein’s
04:39
anomaly for breastfeeding the amount of
04:41
medication transfer is lower with breast
04:43
feeding them with trans placental
04:44
exposure there are a few isolated cases
04:47
of adverse events that have been
04:48
reported although infant follow-up data
04:50
is limited with breastfeeding Emma the
04:52
pregnancy careful consideration should
04:54
be given to our patients overall needs
04:56
and wellness and how best to optimize
04:58
the balance between the risks of
04:59
medications with the risks of not
05:01
treating her mental health needs this
05:03
concludes the aapko video on anxiety and
05:05
depression we have discussed postpartum
05:07
blues depression psychosis as well as
05:09
recognized appropriate treatment options
05:11
for mood disorders during pregnancy and
05:13
lactation