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Peripartum depression
Background
Overview
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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Risk factors
Risk factors for postpartum depression include a history of depression, anxiety, or other mood disorders, high stress levels, inadequate support from a partner, adverse life events such as marital discord or financial instability, and lifestyle factors including sleep disruption, suboptimal self-care, and challenges with breastfeeding.
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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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Guidelines
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 Society of Obstetricians and Gynaecologists of Canada (SOGC 2024), the American Academy of Family Physicians (AAFP 2023), the American College of Obstetricians and Gynecologists (ACOG 2023), the Canadian Task Force on Preventive Health Care (CTFPHC 2022), the ...
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Screening and diagnosis
Indications for screening: as per SOGC 2024 guidelines, assess mental health status at each visit throughout pregnancy and in the year following pregnancy, with particular attention in cases of perinatal loss.
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Screening tools
Diagnostic investigations
Medical management
General principles: as per SOGC 2024 guidelines, ensure shared decision-making regarding treatment options, taking into account the patient's values, beliefs, and preferences.
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Antidepressants
Hormonal therapy
Nonpharmacologic interventions
Psychosocial support: as per SOGC 2024 guidelines, obtain additional monitoring and provide support in cases of perinatal death or losing custody of the infant, as these circumstances increase the patient's vulnerability to mental illness.
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Psychotherapy
Exercise
Herbal products
Therapeutic procedures
Electroconvulsive therapy: as per APA 2010 guidelines, 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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Patient education
Preconception counseling
As per SOGC 2024 guidelines:
Review the health history during mental health assessments, and discuss risk factors during preconception counseling and/or during pregnancy.
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Refer patients taking certain pharmacologic agents (such as antidepressants, antipsychotics, anxiolytics, mood stabilizers, and anticonvulsants) for preconception counseling by their healthcare provider. Obtain consultation with a psychiatrist if the patient is already pregnant, particularly for patients with bipolar disorder or schizophrenia.
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Perinatal counseling