Depression in Women: From PMS to Post-partum Blues

Case Presentation
Julie is a 25 year old female who just delivered her second child 3 weeks ago. She breaks down in tears for no reason and is irritable with her 3 year old. She is having trouble sleeping, and has no appetite. She admits that she feels guilty for not feeling happy about the new infant in her life. She feels she is not an effective parent to either child. She is returning to work next week and wonders how she will be able to cope.

Statistics     Depression is twice as common in women as in men 20% of women will experience depression at some point during their life One out of 10 childbearing women will experience post-partum depression 40% of women have premenstrual symptoms. 5% of these experience premenstrual dysphoric disorder (PMDD) .

e.Risk Factors For Depression       Family history of mood disorder Loss of a parent before age 10 History of sexual or physical abuse Use of hormones (contraception/HRT/fertility treatments) Persistent life stressors (i. loss of job) Loss of social support system .

hopelessness Suicidal thoughts    Sleep disturbance Appetite/weight changes Difficulty concentrating Fatigue Decreased energy .What Is Depression?  Psychological    Physical symptoms     Depressed mood Decreased interest in activities Feelings of guilt.

Gender Differences     Women have earlier onset of depression Episodes may last longer and recur more often More atypical symptoms Suicide attempts more frequent but less successful       Less substance abuse than men More anxiety symptoms than men More associated eating disorders More associated migraine headaches More feelings of guilt More seasonal depression .

used with counseling in cases of moderate to severe depression      Alter chemical balance in the body to enhance mood (norepinephrine.cognitive behavioral therapy Medications.some studies suggest a benefit Need a minimum of 2 weeks to see an effect Treatment for minimum of 6 months . tricyclics.Treatment For Depression   Psychosocial (counseling). others St. John’s wort.SSRI’s. serotonin levels) Many different types.

allow more serotonin to be available in the body. Zoloft. Luvox. headaches. nervousness. sexual dysfunction.SSRI’s. Paxil. insomnia/fatigue.Often the First Choice     Selective serotonin reuptake inhibitors. enhancing mood Examples: Prozac. Celexa Once daily dosing Side effects: nausea. weight gain with prolonged use .

ie Wellbutrin.What’s That About Sexual Dysfunction?     Up to 70% of depressed patients experience a loss of sexual interest If we treat the underlying depression. Effexor . the libido often improves SSRI’s may cause problems with libido and difficulty attaining orgasm Other medications may enhance libido.

with a negative impact on the quality of life and relationships Symptoms usually disappear within a few days after the period starts There are 11 identified symptoms. of which 5 must be present .Premenstrual Dysphoric Disorder     Mood and anxiety symptoms that occur only during the premenstrual period. or worsen significantly during that time Can be very debilitating.

no energy Marked appetite changes/cravings Insomnia or increased sleep      Anxiety. anger Feeling overwhelmed Difficulty concentrating Physical symptomsbreast tenderness.feeling “on edge” Irritability.Symptoms of PMDD       Depressed mood Feelings of personal rejection Decreased interest in usual activities Fatigue. headaches. “bloated”. muscle pain .

Cause of PMDD?    Unknown. but felt by many researchers to result from an abnormal response to normal cycle of hormonal changes in the body Likely a combination of genetic. and perimenopause . postpartum period. environmental. and behavioral factors Women with PMDD have greater risk of future depression during pregnancy.

Treatment For PMDD       Choice of treatment is aimed at the most troubling symptoms Lifestyle modification Dietary approach Vitamin supplementation Medications Cognitive/behavioral approach .

Lifestyle/diet Modification     Women who engage in moderate aerobic exercise 3 times weekly have fewer premenstrual symptoms than sedentary women Low-fat. vegetarian diet has been shown to decrease duration and intensity of menstrual pain Women with a high caffeine intake have more premenstrual irritability symptoms Excess of simple carbohydrates (sugar) is associated with mood disturbances .

data is conflicting Vitamin B6 100mg/day Magnesium 400 mg/day Manganese 6 mg/day Vitamin E 400 iu/day Calcium 1000 mg/day .Vitamin Supplementation       Controversial.

effective for pain relief Oral contraceptives.suppress ovulation Diuretics– when salt restriction not helpful in reducing significant fluid retention SSRI’s are often first choice.daily versus premenstrual week only .Medications for PMDD     Anti-inflammatories.

Cognitive Behavioral Therapy    Attempts to reduce negative feelings in the premenstrual period Improve feelings of self-esteem and problem solving skills Relaxation therapy may also be helpful .

but the condition is underdiagnosed May have significant impact on both mother and child Societal pressures to be “good mother” may prevent woman from admitting symptoms .Post-partum Depression    1 of 10 women experience post-partum depression.

fatigue. tearfulness. irritability. anxiety May have increased risk of post-partum major depression later on .“Baby Blues”      Occurs in 70-85% of women Onset within the first few days after delivery Resolves by 2 weeks Symptoms include: mild depression.

Post-partum Major Depression     Symptoms of depression that last longer than 2 weeks Usually begins 2-3 weeks after delivery May last up to one year High risk of recurrence in future pregnancies .

This is a medical emergency. avoidance of the infant May have delusions or hallucinations that involve the infant.needs hospitalization . etc.0. agitation.Post Partum Psychosis      Rare disorder (Andrea Yates?).possessed by demon. expansive or irritable mood.2% women Onset within the first month after delivery Symptoms include mania.

excreted in the breast milk.Treatment for Post Partum Depression     Same as for major depression SSRI’s work well All antidepressants are to some degree.may accumulate in the infant . but usually undetectable levels in the infant’s blood Avoid Prozac due to long half life.

premenstrual.     Depression is very common in women May be more likely around times of hormonal flux. post-partum. perimenopause There is effective treatment available Don’t hesitate to discuss symptoms with your doctor .To Summarize…. Thank You .My lady Are you depressed Come to me and I shall give you Rest.

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