Postpartum depression may be distinguished from the “baby blues” by which one of the following characteristics?
Correct Answer E:
Crying, sadness, and confusion are common to both postpartum depression and “baby blues”. “Baby blues” usually lasts for 1-2 weeks post partum, not long enough for antidepressants to work. Postpartum depression lasts for months, and may not be evident for up to a month after delivery.
A 34-year-old woman presents to her obstetrician’s office accompanied by her spouse three weeks after delivering a healthy infant son. Her husband relates that soon after leaving the hospital his wife has become increasingly irritable, tearful, and is having trouble sleeping. The past week she has become extremely indecisive and expresses concerns that she is not capable of caring for her newborn even though this is her third child.
Which one of the following is the likely diagnosis?
Correct Answer C:
The postpartum period is a time of increased risk for development of mood disturbances in women. Postpartum depressive disorders are divided into three classifications: postpartum blues, postpartum depression, and puerperal psychosis.
Her mood disturbance warrants psychiatric consultation and likely will require pharmacologic treatment.
Risk factors associated with the development of postpartum affective disorders include each of the following, except:
Correct Answer B:
Higher socioeconomic status. Actually, a lower socioeconomic status with antecedent chronic stress, inadequate social supports, limited funds for basic needs such as food, formula, shelter, etc. is a risk factor for postpartum mood disorders. Women with a history of postpartum affective disturbances have a recurrence rate as high as 50% in some studies. For this population, medical and psychologic prevention prior to delivery is very important. In some cases, prophylactic antidepressants or mood stabilizing agents are warranted. Thyroid dysfunction itself can cause a mood disorder, and certainly a complicated delivery can be traumatic psychologically.
Which one of the following is true concerning postpartum depression?
Correct Answer D:
Thyroid function must be evaluated in women with postpartum depression since both hyperthyroidism and hypothyroidism are more common post partum. Postpartum depression may impair cognitive and behavioral development in the child. It is not related to the desired gender of the child, breastfeeding, or education level of the mother. It should be differentiated from the short-term “baby blues” that resolve within about 10 days. Sertraline is considered first-line treatment for postpartum depression in women who are breastfeeding.
Which one of the following is considered both an effective and safe treatment for seasonal affective disorder?
Seasonal affective disorder is defined as recurrent depressive episodes that occur during the autumn and winter, with cessation of symptoms during spring and summer. Typical symptoms include sleep disturbance, loss of interest in daily activities, and decreased libido. It is more common in North America than in Europe. Both SSRIs and tricyclic antidepressants are effective; however, phototherapy, with exposure of the eyes, not the skin, it is also effective and has less potential for side effects. Melatonin may induce symptoms of winter depression in patients successfully treated with phototherapy. Lithium is primarily used in the treatment of bipolar disorder, and has the potential for significant side effects. Electroconvulsant therapy is used to treat major depression, often with psychotic features. Fluticasone is used in the treatment of seasonal allergic rhinitis.
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