By Kristina R. Anderson
SAN DIEGO, CA -- May 21, 2007 -- Major depression and anxiety disorders in pregnancy and during postpartum are conditions that are routinely under-diagnosed and often go untreated or under-treated. That's according to findings presented here at the annual meeting of the American Psychiatric Association (APA).
The researchers say women at risk of developing major depression during pregnancy need to be correctly screened and identified because the depression can carry over to the even more vulnerable postpartum period and can put the bonding process at risk.
"We've always known about the link between depression and the postpartum period but depression in pregnancy itself is being diagnosed more routinely," said Deidre Ryan, FRCPC (Fellow of the Royal College of Physicians of Canada) and associate professor of psychiatry, University of British Columbia, Canada, Women's Hospital. "But the symptoms such as sleep, appetite and energy changes can overlap, especially in the first trimester of pregnancy, making diagnosis difficult."
Dr. Ryan also noted there is a spectrum of mood changes from the "blues," which are experienced by 50% to 70% of women and usually resolve spontaneously and rarely require treatment, all the way to postpartum psychosis where suicide is a risk.
The risks of untreated depression during pregnancy, she said, are lack of good prenatal care; risk of medical/obstetrical complication, such as intrauterine growth retardation; self-medication and substance abuse; lack of bonding, which generally begins in pregnancy; and although very uncommon, the risk of suicide exists. "Although suicide rates are lower for women when they're pregnant than at any other time in their lives, those with untreated depression will go on to develop postpartum depression," said Dr. Ryan.
Then there is the "Andrea Yates" syndrome, which had "huge repercussions throughout the world," Dr. Ryan said. "Forty percent of women with postpartum depression report obsessional thoughts, for instance, images of harm occurring to the baby." Yates killed her five young children in 2001 by drowning them in the bathtub. The DSM IV postpartum psychosis occurs not only, as commonly thought, within the four weeks after birth, but actually within the first year of the birth. There can be mood swings, insomnia, hallucinations, and symptoms that require admission to a hospital. This is the time that women are at the highest risk for suicide, Dr. Ryan noted.
There are also comorbid issues that require screening, such as eating disorders. "Many women are preoccupied with weight and shape," Dr. Ryan said, suggesting that all pregnant women be screened between 28 and 32 weeks of pregnancy and also postpartum, between one and four months.
Some of the biological risk factors for perinatal depression include a prior history of depression, family history of psychiatric illness, discontinuation of medications, significant medical/obstetrical problems, hypothyroidism, and cessation of lactation. "The time of weaning or cessation of lactation is a risk time for developing perinatal depression and, at this time, we do not know if breast feeding offers protection from depression or not," said Dr. Ryan. "Chronic maternal depression results in higher rates of anxiety, depressive and behavioural disorders in toddlerhood, preadolescence, and adulthood."
The psychosocial risk reactions that put women at high risk for perinatal depression include:
• Lack of a partner, family, and social support
• Stressful life events
• Death of a family member
• Breastfeeding difficulties
• Colicky babies and infant health problems
• Unplanned pregnancy
• Socioeconomic status
• Abuse issues
• Cultural issues and disappointment over the sex of the child
"Depression not only affects the woman, but the entire family is at risk if the woman is not treated," said Dr. Ryan, "especially the child who exhibits internalizing behaviour."
The Edinburgh Postnatal Depression Scale is now the gold standard for identifying women who are suffering from postpartum depression but Dr. Ryan said that the future goal was a screening tool for all anxiety disorders that put women at risk during and after pregnancy.
[Presentation title: "Management of Psychiatric Disorders in Pregnant and Postpartum Women"]
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