fbpx

Peripartum Depression

Updated : January 29, 2024





Background

Peripartum depression (PPD) is a type of major depressive disorder characterized by depression that occurs during pregnancy or within 12 months after delivery. It can manifest in various forms, such as prenatal depression and postpartum depression, that can occur during pregnancy and childbirth. It is a serious mental health condition that affects many women.

It can significantly impact the emotional well-being of the mother and the family. Symptoms of peripartum depression can include disturbed thoughts, anxiety, persistent feeling of sadness, physical symptoms such as fatigue, insomnia, difficulty concentrating, and changes in appetite.

Epidemiology

The exact prevalence of PPD is challenging to determine due to varying definitions and diagnostic criteria. However, estimates suggest globally that a significant number of pregnant women experience mental disorders, particularly depression, during and after pregnancy, with an estimated 10% during pregnancy and 13% after childbirth.

In developing countries, the prevalence of peripartum depression is higher, with approximately 15.6% during pregnancy and 19.8% women after childbirth. Risk factors for PPD include a history of depression or other mental health disorders, stress, lack of social support, and adverse life events.

Women experiencing PPD may have symptoms such as anxiety, fatigue, lack of motivation, persistent feeling of sadness, difficulty in bonding with the baby, and thoughts of self-harm.

Anatomy

Pathophysiology

The pathophysiology of peripartum depression involves a complex interaction of biological, psychological, and social factors. Hormonal changes after childbirth, such as fluctuations in estrogen, progesterone, and thyroid hormones, can impact a woman’s mood and emotional well-being, potentially leading to PPD.

These hormones can also affect the levels of neurotransmitters, such as serotonin and norepinephrine, in the brain, which can impact mood and emotional regulation. Additionally, sleep disturbances caused by these hormonal changes can further contribute to feelings of depression.

Individuals with a history of depression, anxiety, or other mental health disorders may be at an increased risk of PPD, as well as those with a family history of depression. It is also worth noting that PPD is a multifactorial condition, and the underlying causes may vary from person to person.

Etiology

The etiology of peripartum depression is not fully understood, but it is thought to be caused by a combination of biological, psychological, and social factors. Hormonal changes that occur during pregnancy and after childbirth, such as a decrease in estrogen and progesterone levels, may play a role in the development of PPD.

All women are at risk of experiencing psychiatric disorders during pregnancy and the first year after delivery due to hormonal changes and stress associated with pregnancy.

However, factors such as poverty, lack of education, migration, limited access to healthcare, violence, abuse, conflict, multiple pregnancies, and a lack of support from a partner can increase the risk. Psychological factors such as a history of depression or anxiety, stress, and lack of social support may contribute to developing PPD.

Genetics

Prognostic Factors

The prognosis varies depending on the severity of the depression and the individual’s response to treatment. With proper treatment, most women will see an improvement in their symptoms and eventually recover.

It is also important to note that some women may have chronic depression, which can last for months or even years after childbirth. In such cases, the prognosis may be less favorable and may require long-term management and treatment.

Early identification and treatment are important for improving outcomes, as untreated PPD can negatively affect the mother, the child’s development, and the family.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

bupropion 

Immediate release tablet- 100 mg orally every 12 hours. Increase the dose to 100 mg every 8 hours. If no clinical improvement is seen, maximize the dose up to 150 mg every 8 hours.

Sustained release tablet- 150 mg orally each day. Increase the dose to 150 mg every 12 hours. If no clinical improvement is seen, maximize the dose up to 150 mg every 12 hours.

Extended-release tablet- 150 mg orally each day. Increase the dose to 450 mg each day. If no clinical improvement is seen, maximize the dose up to 300 mg each day.

Aplenzin- 174 mg orally each day. Increase the dose after 4 days, to 348 mg. Do not increase the dose to more than 522 mg each day.

Forfivo XL- 450 mg orally each day
Can be utilized in patients who already are receiving 300 mg/day of bupropion



brexanolone 

For a total of 60 hours (2.5 days), administer ZULRESSO as a continuous intravenous (IV) infusion as follows:


0-4 (hrs): Initiate with a dosage of 30 mcg/kg per hour continuous intravenous (IV) infusion

4-24 (hrs): the dose be increased to 60 mcg/kg per hour continuous intravenous (IV) infusion

24-52 (hrs): the dose be increased to 90 mcg/kg per hour (For individuals who cannot tolerate 90 mcg/kg per hour, decrease dose to 60 mcg/kg per hour) continuous intravenous (IV) infusion

52-56 (hrs): reduce to 60 mcg/kg per hour continuous intravenous (IV) infusion

56-60 (hrs): reduce to 30 mcg/kg per hour continuous intravenous (IV) infusion



 

brexanolone 

For a total of 60 hours (2.5 days), administer ZULRESSO as a continuous intravenous (IV) infusion as follows:


Age: >15 years

0-4 (hrs): Initiate with a dosage of 30 mcg/kg per hour continuous intravenous (IV) infusion

4-24 (hrs): the dose be increased to 60 mcg/kg per hour continuous intravenous (IV) infusion

24-52 (hrs): the dose be increased to 90 mcg/kg per hour (For individuals who cannot tolerate 90 mcg/kg per hour, decrease dose to 60 mcg/kg per hour) continuous intravenous (IV) infusion

52-56 (hrs): reduce to 60 mcg/kg per hour continuous intravenous (IV) infusion

56-60 (hrs): reduce to 30 mcg/kg per hour continuous intravenous (IV) infusion



 

Media Gallary

References

Peripartum Depression

Updated : January 29, 2024




Peripartum depression (PPD) is a type of major depressive disorder characterized by depression that occurs during pregnancy or within 12 months after delivery. It can manifest in various forms, such as prenatal depression and postpartum depression, that can occur during pregnancy and childbirth. It is a serious mental health condition that affects many women.

It can significantly impact the emotional well-being of the mother and the family. Symptoms of peripartum depression can include disturbed thoughts, anxiety, persistent feeling of sadness, physical symptoms such as fatigue, insomnia, difficulty concentrating, and changes in appetite.

The exact prevalence of PPD is challenging to determine due to varying definitions and diagnostic criteria. However, estimates suggest globally that a significant number of pregnant women experience mental disorders, particularly depression, during and after pregnancy, with an estimated 10% during pregnancy and 13% after childbirth.

In developing countries, the prevalence of peripartum depression is higher, with approximately 15.6% during pregnancy and 19.8% women after childbirth. Risk factors for PPD include a history of depression or other mental health disorders, stress, lack of social support, and adverse life events.

Women experiencing PPD may have symptoms such as anxiety, fatigue, lack of motivation, persistent feeling of sadness, difficulty in bonding with the baby, and thoughts of self-harm.

The pathophysiology of peripartum depression involves a complex interaction of biological, psychological, and social factors. Hormonal changes after childbirth, such as fluctuations in estrogen, progesterone, and thyroid hormones, can impact a woman’s mood and emotional well-being, potentially leading to PPD.

These hormones can also affect the levels of neurotransmitters, such as serotonin and norepinephrine, in the brain, which can impact mood and emotional regulation. Additionally, sleep disturbances caused by these hormonal changes can further contribute to feelings of depression.

Individuals with a history of depression, anxiety, or other mental health disorders may be at an increased risk of PPD, as well as those with a family history of depression. It is also worth noting that PPD is a multifactorial condition, and the underlying causes may vary from person to person.

The etiology of peripartum depression is not fully understood, but it is thought to be caused by a combination of biological, psychological, and social factors. Hormonal changes that occur during pregnancy and after childbirth, such as a decrease in estrogen and progesterone levels, may play a role in the development of PPD.

All women are at risk of experiencing psychiatric disorders during pregnancy and the first year after delivery due to hormonal changes and stress associated with pregnancy.

However, factors such as poverty, lack of education, migration, limited access to healthcare, violence, abuse, conflict, multiple pregnancies, and a lack of support from a partner can increase the risk. Psychological factors such as a history of depression or anxiety, stress, and lack of social support may contribute to developing PPD.

The prognosis varies depending on the severity of the depression and the individual’s response to treatment. With proper treatment, most women will see an improvement in their symptoms and eventually recover.

It is also important to note that some women may have chronic depression, which can last for months or even years after childbirth. In such cases, the prognosis may be less favorable and may require long-term management and treatment.

Early identification and treatment are important for improving outcomes, as untreated PPD can negatively affect the mother, the child’s development, and the family.

bupropion 

Immediate release tablet- 100 mg orally every 12 hours. Increase the dose to 100 mg every 8 hours. If no clinical improvement is seen, maximize the dose up to 150 mg every 8 hours.

Sustained release tablet- 150 mg orally each day. Increase the dose to 150 mg every 12 hours. If no clinical improvement is seen, maximize the dose up to 150 mg every 12 hours.

Extended-release tablet- 150 mg orally each day. Increase the dose to 450 mg each day. If no clinical improvement is seen, maximize the dose up to 300 mg each day.

Aplenzin- 174 mg orally each day. Increase the dose after 4 days, to 348 mg. Do not increase the dose to more than 522 mg each day.

Forfivo XL- 450 mg orally each day
Can be utilized in patients who already are receiving 300 mg/day of bupropion



brexanolone 

For a total of 60 hours (2.5 days), administer ZULRESSO as a continuous intravenous (IV) infusion as follows:


0-4 (hrs): Initiate with a dosage of 30 mcg/kg per hour continuous intravenous (IV) infusion

4-24 (hrs): the dose be increased to 60 mcg/kg per hour continuous intravenous (IV) infusion

24-52 (hrs): the dose be increased to 90 mcg/kg per hour (For individuals who cannot tolerate 90 mcg/kg per hour, decrease dose to 60 mcg/kg per hour) continuous intravenous (IV) infusion

52-56 (hrs): reduce to 60 mcg/kg per hour continuous intravenous (IV) infusion

56-60 (hrs): reduce to 30 mcg/kg per hour continuous intravenous (IV) infusion



brexanolone 

For a total of 60 hours (2.5 days), administer ZULRESSO as a continuous intravenous (IV) infusion as follows:


Age: >15 years

0-4 (hrs): Initiate with a dosage of 30 mcg/kg per hour continuous intravenous (IV) infusion

4-24 (hrs): the dose be increased to 60 mcg/kg per hour continuous intravenous (IV) infusion

24-52 (hrs): the dose be increased to 90 mcg/kg per hour (For individuals who cannot tolerate 90 mcg/kg per hour, decrease dose to 60 mcg/kg per hour) continuous intravenous (IV) infusion

52-56 (hrs): reduce to 60 mcg/kg per hour continuous intravenous (IV) infusion

56-60 (hrs): reduce to 30 mcg/kg per hour continuous intravenous (IV) infusion