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Peripartum depression

Definition
Peripartum depression is a mood disorder occurring during pregnancy or within the first year postpartum.
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Pathophysiology
The development of peripartum depression is believed to be influenced by a combination of hormonal changes, particularly in estrogen and progesterone, imbalances in neurotransmitters like serotonin, and psychosocial elements such as stress, lack of social support, and previous mental health issues.
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Epidemiology
The prevalence of peripartum depression in the US is estimated at 13-19% in females.
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Disease course
Clinically, peripartum depression presents with persistent feelings of sadness, anxiety, and irritability. Patients may experience a loss of interest or pleasure in activities they once enjoyed, changes in appetite or sleep patterns, and difficulty concentrating. In severe cases, there may be thoughts of self-harm or harming the infant.
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Prognosis and risk of recurrence
The prognosis of peripartum depression can be serious if left untreated. It can negatively impact maternal-infant bonding and child development and can also have detrimental effects on the overall health of the mother.
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Key sources
The following summarized guidelines for the evaluation and management of peripartum depression are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2023), the United States Department of Defense (DoD/VA 2022), the Canadian Task Force on Preventive Health Care (CTFPHC 2022), the U.S. Preventive Services Task Force (USPSTF 2019), the The Scottish Intercollegiate Guidelines Network (SIGN 2012), and the American Psychiatric Association (APA 2010).
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Guidelines

1.Screening and diagnosis

Indications for screening: as per AAFP 2023 guidelines, obtain screening for depression during the peripartum period in all pregnant individuals.
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  • Screening tools

2.Diagnostic investigations

Initial evaluation
Assess for the presence of suicidal ideas, homicidal ideas, and psychotic symptoms in patients with peripartum depression.
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Assess parenting skills for the infant and for other children in the patient's care.
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3.Medical management

Antidepressants: as per AAFP 2023 guidelines, offer SSRIs if pharmacologic therapy is chosen, but avoid using paroxetine and fluoxetine during pregnancy if possible.
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  • Hormonal therapy

4.Nonpharmacologic interventions

Psychotherapy: as per AAFP 2023 guidelines, offer psychotherapy in patients at increased risk of peripartum depression.
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  • Exercise

  • Herbal products

5.Therapeutic procedures

Electroconvulsive therapy: consider offering electroconvulsive therapy for the treatment of depression during pregnancy in patients with psychotic or catatonic features, having severe symptoms or not responding to medications, or preferring treatment with electroconvulsive therapy.
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