1|Page
PERINATAL MENTAL HEALTH EXAM WITH ACCURATE AND VERIFIED
QUESTIONS COVERING MOOD AND ANXIETY DISORDERS DURING
PREGNANCY AND POSTPARTUM, SCREENING TOOLS, RISK FACTORS,
TREATMENT MODALITIES, INTERDISCIPLINARY CARE, AND ETHICAL
CONSIDERATIONS.
Methods to treat Depression in Pregnancy - ANSWER-Counseling with Medication therapy
Don't let them self medicate- over/under eating, abusing exercise, drugs, or alcohol
Examples of statements made by the Depressed Woman - ANSWER-I'm so irritable
I have been on the couch...
I haven't showered
I am always in my pajamas
Other maternal effects of untreated depression - ANSWER-Psychosis
Suicidal ideation/suicide
Impaired maternal- infant bonding
Postpartum depression
Screening for Depression in Pregnancy - ANSWER-Optional time for screening as women have
early, frequent contact with healthcare providers
Research shows that women want to have their care provider ask how they were emotionally at
every prenatal visit
Questions to ask when screening for depression in pregnancy - ANSWER-How have you been
feeling
What's been your general mood
,2|Page
How are you feeling about becoming a mom
How are you eating and sleeping
Are you able to enjoy your usual activities
Why are depressive symptoms often missed during pregnancy? - ANSWER-They are difficult to
distinguish from normal pregnancy related discomforts or are misattributed to normal
pregnancy related changes in maternal temperament
Treatment of Depression in Pregnancy - ANSWER-Recognition that it exists in pregnancy
Cognitive therapy, support groups
Antidepressant medications
Barriers to recognition - ANSWER-Not thinking clearly
Shame at not being excited about the baby, baby showers, the nursery...
Tough it out until delivery
Medications are bad --> could hurt the baby --> get addicted
Medications for Depression during Pregnancy - ANSWER-SSRIs
Paroxetine (Paxil)
Multidrug management via psychiatrist
SSRIs - ANSWER-Selective Serotonin Re-Uptake Inhibitors
Very low risk of birth defects
Creates a high pitched cry in the newborn
Paroxetine (Paxil) - ANSWER-Risk of congenital heart defects
May require more ultrasounds during pregnancy
,3|Page
Multidrug management via psychiatrist - ANSWER-Taper off if desired, many medications later
in pregnancy
Don't switch medications if working well
Most important goals of treatment - ANSWER-Maintaining euthymic mood in the mother and
preventing postpartum depression
Poor Neonatal Adaptation Syndrome - ANSWER-Happens with SSRI use in pregnancy
-Hypotonicity, poor feeding
-Transient, mild respiratory distress
-Jitteriness, mild tremors
-Hypothermia
-Weak cry or increased crying
-Rare, persistent pulmonary hypertension
*More likely at higher doses; usually resolve by 24-48hrs*
Postpartum Psychiatric Disorders: 3 Sub-classes - ANSWER-Baby Blues
-Adjustment reaction with depressed mood
Postpartum Major Mood Disorders
-Depression and anxiety
Postpartum Psychosis
-Most severe of the 3 sub-classes
-Hallucinations, delusions, irrational thoughts and behaviors
, 4|Page
Baby Blues - ANSWER-Experienced by 50-80% of new mothers
Defined as an "adjustment reaction with depressed mood"
Mild and short-lived
Lasts a few days to 3 weeks
May be more pronounced in primiparous women
Baby Blues: Etiology - ANSWER-Psychological adjustment to the rapid role changes of parenting
Hormones (Drop in estrogen and progesterone)
Fatigue
Worse with sleep deprivation, pain, feeding problems, sick newborn, multiples, over stimulation
Pathophysiology of amenorrhea with breastfeeding - ANSWER-Oxytocin --> Progesterone --> NO
Estrogen --> NO Ovulation
When breastfeeding you don't get a regular period
In order for this tow or the baby has to be solely breastfeeding and still waking up during the
night to feed
This lack of estrogen will also affect the mom's mood and they will not feel themselves
Baby Blues- S/S - ANSWER-Mood swings
Irritability
Weepiness
Appetite change
Overwhelmed
Difficulty sleeping
Feeling let down
Anxiety
PERINATAL MENTAL HEALTH EXAM WITH ACCURATE AND VERIFIED
QUESTIONS COVERING MOOD AND ANXIETY DISORDERS DURING
PREGNANCY AND POSTPARTUM, SCREENING TOOLS, RISK FACTORS,
TREATMENT MODALITIES, INTERDISCIPLINARY CARE, AND ETHICAL
CONSIDERATIONS.
Methods to treat Depression in Pregnancy - ANSWER-Counseling with Medication therapy
Don't let them self medicate- over/under eating, abusing exercise, drugs, or alcohol
Examples of statements made by the Depressed Woman - ANSWER-I'm so irritable
I have been on the couch...
I haven't showered
I am always in my pajamas
Other maternal effects of untreated depression - ANSWER-Psychosis
Suicidal ideation/suicide
Impaired maternal- infant bonding
Postpartum depression
Screening for Depression in Pregnancy - ANSWER-Optional time for screening as women have
early, frequent contact with healthcare providers
Research shows that women want to have their care provider ask how they were emotionally at
every prenatal visit
Questions to ask when screening for depression in pregnancy - ANSWER-How have you been
feeling
What's been your general mood
,2|Page
How are you feeling about becoming a mom
How are you eating and sleeping
Are you able to enjoy your usual activities
Why are depressive symptoms often missed during pregnancy? - ANSWER-They are difficult to
distinguish from normal pregnancy related discomforts or are misattributed to normal
pregnancy related changes in maternal temperament
Treatment of Depression in Pregnancy - ANSWER-Recognition that it exists in pregnancy
Cognitive therapy, support groups
Antidepressant medications
Barriers to recognition - ANSWER-Not thinking clearly
Shame at not being excited about the baby, baby showers, the nursery...
Tough it out until delivery
Medications are bad --> could hurt the baby --> get addicted
Medications for Depression during Pregnancy - ANSWER-SSRIs
Paroxetine (Paxil)
Multidrug management via psychiatrist
SSRIs - ANSWER-Selective Serotonin Re-Uptake Inhibitors
Very low risk of birth defects
Creates a high pitched cry in the newborn
Paroxetine (Paxil) - ANSWER-Risk of congenital heart defects
May require more ultrasounds during pregnancy
,3|Page
Multidrug management via psychiatrist - ANSWER-Taper off if desired, many medications later
in pregnancy
Don't switch medications if working well
Most important goals of treatment - ANSWER-Maintaining euthymic mood in the mother and
preventing postpartum depression
Poor Neonatal Adaptation Syndrome - ANSWER-Happens with SSRI use in pregnancy
-Hypotonicity, poor feeding
-Transient, mild respiratory distress
-Jitteriness, mild tremors
-Hypothermia
-Weak cry or increased crying
-Rare, persistent pulmonary hypertension
*More likely at higher doses; usually resolve by 24-48hrs*
Postpartum Psychiatric Disorders: 3 Sub-classes - ANSWER-Baby Blues
-Adjustment reaction with depressed mood
Postpartum Major Mood Disorders
-Depression and anxiety
Postpartum Psychosis
-Most severe of the 3 sub-classes
-Hallucinations, delusions, irrational thoughts and behaviors
, 4|Page
Baby Blues - ANSWER-Experienced by 50-80% of new mothers
Defined as an "adjustment reaction with depressed mood"
Mild and short-lived
Lasts a few days to 3 weeks
May be more pronounced in primiparous women
Baby Blues: Etiology - ANSWER-Psychological adjustment to the rapid role changes of parenting
Hormones (Drop in estrogen and progesterone)
Fatigue
Worse with sleep deprivation, pain, feeding problems, sick newborn, multiples, over stimulation
Pathophysiology of amenorrhea with breastfeeding - ANSWER-Oxytocin --> Progesterone --> NO
Estrogen --> NO Ovulation
When breastfeeding you don't get a regular period
In order for this tow or the baby has to be solely breastfeeding and still waking up during the
night to feed
This lack of estrogen will also affect the mom's mood and they will not feel themselves
Baby Blues- S/S - ANSWER-Mood swings
Irritability
Weepiness
Appetite change
Overwhelmed
Difficulty sleeping
Feeling let down
Anxiety
