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Depression During Pregnancy

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Over the past 18 years, my interest in prenatal depression grew ... Change in rates occurs during puberty and the onset of menses. Young Women and Depression ... – PowerPoint PPT presentation

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Title: Depression During Pregnancy


1
Depression During Pregnancy
  • Kathleen S. Peindl, M.S., Ph.D.
  • Associate Professor in Psychiatry
  • Thomas Jefferson University
  • Philadelphia, PA 19107

2
Over the past 18 years, my interest in prenatal
depression grew for two reasons. First, it has
become increasingly clear that prenatal
depression is a risk factor for recurrent
depression throughout the female life cycle.
Second, both prenatal and postpartum depression
adversely affect child development. Breaking the
cycle of depression through identification,
education and treatment is one of my goals.
3
Depression During Pregnancy Learning Objectives
  • To understand what prenatal depression is
  • To learn about a tool for depression screening
  • To understand some consequences of the illness
  • To learn about treatments of depression during
    pregnancy

4
Performance Objectives Depression During Pregnancy
  • To be able to recognize depression during
    pregnancy
  • To know the risk factors for depression during
    pregnancy
  • To know some cost of the illness to the mother
    and infant
  • To understand treatments for the disease

5
Depression Onset in Young Adult Women
  • Depression in females is 2 times higher than the
    rate found in males
  • Change in rates occurs during puberty and the
    onset of menses

6
Young Women and Depression
  • Women, aged 22, with major depressive disorder
    had first onset of illness in adolescence
  • 44 had their first episode of major depression
    during pregnancy

7
What is Depression During Pregnancy
  • Diagnosis
  • Symptoms
  • Difficulty with Diagnosis
  • Prevalence Rates of Detection of Illness

8
Diagnosis of Depression
  • Most Mental Health Professionals use DSM-IV
    criteria as the standard to diagnose Psychiatric
    Disorders
  • The Prime-MD is used in general clinical settings
    to diagnose common psychiatric disorders and will
    code the disease using DSM-IV Criteria

9
Symptoms of Depression and of Normal Pregnancy
  • Pregnancy
  • Sleep Disturbances
  • Weight Gain
  • Appetite Disturbances
  • Fatigue
  • Depression
  • Sadness
  • Loss of interest
  • Sleep disturbances
  • Weight loss/gain
  • Guilt/Worthlessness
  • Thoughts of death
  • Appetite disturbances
  • Fatigue

10
Difficulty with Diagnosis of Illness
  • 50 of women have undiagnosed depression in an
    obstetric/gynecology clinic
  • The rate of detection may be as low as 0.8 among
    pregnant women

11
Prevalence of Depression During Pregnancy
  • Assessments method for determining prevalence
    rates of depression during pregnancy fall into
    three categories
  • Self-reported symptoms
  • Distress
  • Structured psychiatric interviews using Standard
    Diagnostic Criteria
  • Real Prevalence worldwide is around 10 in
    pregnant adult women

12
Valid Tool for Screening for depression during
pregnancy
  • A Tool for screening must access only affective
    and cognitive symptoms
  • Edinburgh Postnatal Depression Scale

13
Recognition of Depression During Pregnancy
  • Awareness of depression during pregnancy starts
    with screening. On the Edinburgh Postnatal
    Depression Scale, the score would be gt10.

14
Risk Factors for Depression During Pregnancy
  • Race and Ethnicity increased rates among
    African-American and Hispanic populations
  • Adolescents
  • Single status
  • Low Socio-economic status (world-wide risk
    factor)
  • Uninsured status
  • Personal History of Depression
  • Family History of Depression

15
Consequences of Depression During Pregnancy
  • Two sets of consequences need to be identified
    for depression during pregnancy
  • A. Those affecting the mother
  • B. Those affecting the fetus

16
Depression and the Mother
  • Women with Prenatal Depression have
  • Poor prenatal care and health behaviors
  • Poor weight gain and nutrition
  • Fatigue and loss of functioning
  • Disturbed sleep
  • Use of drugs including cigarettes and illicit
    drugs

17
Prenatal Depressive Symptoms and Fetal
Development
  • Increase in Preterm Delivery
  • Mean gestational age 29.5 weeks
  • Reduction in birth weight of 9.1 grams for every
    one point increase in a self-report measure of
    depression in low-SES group
  • 4-fold increase in low birth weight babies in an
    African-American population

18
More Childhood Outcomes
  • At birth the risk of unconsolability is 2.64
  • High Scores on the Childhood Behavioral Checklist
    for Externalizing for children whose mothers had
    prenatal depression

19
Treatment of Depression During Pregnancy
  • Experts differ on optimal treatment

20
Risk Benefit Ratio
  • Discontinuation of treatment before conception
  • Continuation of Treatment until conception
  • Treatment if illness severe maintain through
    pregnancy

21
Exposure of Psychotropic Medication to Fetal Brain
  • Morphological teratogenesis
  • Behavioral teratogenesis

22
Morphological Teratogenesis
  • Embryonic Period weeks 2-8
  • Fetal Period (months 4-9)

23
Behavioral Teratogenesis
  • Little is known about effects of medication
    treatment for prenatal depression
  • Depressive symptoms do adversely effect
    behavioral outcomes in offspring

24
FDA Classification for Antidepressants use during
pregnancy
  • Antidepressant medication used to treat depression

25
FDA Category A
  • Controlled studies show no risk
  • No Antidepressants are Category A

26
FDA Category B
  • Inadequate number of human studies, animal
    findings are negative
  • Animal studies show risk but human studies do not
    show risk
  • Bupropion is category B

27
FDA Category C
  • Risk cannot be ruled out. Human studies are
    lacking.
  • Animal studies show risk or there are few animal
    studies completed.
  • Following list are category C

28
FDA Category D
  • Negative risk to the fetus
  • No Antidepressants in this category

29
FDA Category X
  • Contraindication for Pregnancy
  • Fetal Risk outweighs benefits

30
Successful Treatment
  • Successful Treatment also found with Therapy
    Interpersonal Psychotherapy
  • No risk of exposure to the fetus
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