Peripartum mood disturbances medical therapy: Difference between revisions
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{{CMG}}; {{AE}}{{Sunita}} | {{CMG}}; {{AE}}{{Sunita}} | ||
==Overview== | ==Overview== | ||
To manage [[peripartum mood disturbances]] efficiently, a multidisciplinary and comprehensive approach is used. | |||
==Medical Therapy== | |||
Reassurance, familial and social support, [[psychoeducation]], and, in certain circumstances, [[psychotherapy]] and/or [[pharmacologic]] [[treatment]] are all used in the [[treatment]] of [[PPD]]s. | |||
[[Medical]] [[therapy]] for [[postpartum depression]] includes:<br>All [[Postpartum Depression]] <ref name="urlPostpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics | Annual Review of Medicine">{{cite web |url=https://doi.org/10.1146/annurev-med-041217-011106 |title=Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics | Annual Review of Medicine |format= |work= |accessdate=}}</ref><br> | |||
[ | |||
*Investigate and manage social stressors, [[psychiatric]] and [[medical]] [[comorbidities]]<br> | |||
*[[Psychosocial]] support strategies.<br> | |||
*[[Self-care]]<br> | |||
*[[Sleep]] protection<br> | |||
*[[Exercise]] | |||
[[Postpartum depression]]: moderate severity or not in [[remission]] from [[self-care]] and [[psychosocial]] strategies<br> | |||
*[[Psychological]] [[treatment]]s, including [[CBT]] and IPT<br> | |||
*Add [[SSRI]] if insuffiecient response (for [[lactation]] safety)<br> | |||
[ | [[Postpartum Depression]]: Severe<br> | ||
*[[SSRI]] alone or with [[psychological]] intervention (for [[lactation]] safety)<br> | |||
*Consider [[antidepressant]] switch and augmentation startegies if no response to [[SSRI]] alone.<br> | |||
*Consider [[ECT]] with severe [[suicidality]], [[psychosis]] or [[treatment]] [[resistance]].<br> | |||
Additional [[therapeutic]] options: bright [[light]] [[therapy]], [[yoga]], [[relaxation]] [[training]], [[massage]] and acupunture.<br> Alternative [[treatment]] options are [[omega-3]] PUFAs, such as [[eicosapentaenoic acid]] (EPA) and [[docosahexaenoic acid]] (DHA), which have fewer [[side effects]]. | |||
Postpartum psychosis is a medical emergency and requires prompt inpatient treatment. Once the organic causes of [[psychosis]] are ruled out the treatment is given according to the symptom profile.<br> [[Antipsychotics]], [[mood stabilizers]] and [[benzodiazepines]] are used in acute therapy. [[Insomnia]] should be treated promptly. [[ECT]] is used when the condition is treatment resistant or a quicker response is required because of symptoms severity or safety concerns. Antimaniac and [[antipsychotic agents]] benefit a patient who has a known history of the [[illness]] or a family member has a history.<ref name="urlPharmacotherapy of postpartum psychosis: Expert Opinion on Pharmacotherapy: Vol 4, No 10">{{cite web |url=https://www.tandfonline.com/doi/abs/10.1517/14656566.4.10.1651 |title=Pharmacotherapy of postpartum psychosis: Expert Opinion on Pharmacotherapy: Vol 4, No 10 |format= |work= |accessdate=}}</ref><br> | [[Postpartum]] [[psychosis]] is a [[medical emergency]] and requires prompt [[inpatient]] [[treatment]]. Once the organic [[causes]] of [[psychosis]] are ruled out the [[treatment]] is given according to the [[symptom]] profile.<br> [[Antipsychotics]], [[mood stabilizers]] and [[benzodiazepines]] are used in [[acute]] [[therapy]]. [[Insomnia]] should be treated promptly. [[ECT]] is used when the condition is [[treatment]] resistant or a quicker response is required because of [[symptoms]] severity or safety concerns. Antimaniac and [[antipsychotic agents]] benefit a [[patient]] who has a known [[history]] of the [[illness]] or a family member has a history.<ref name="urlPharmacotherapy of postpartum psychosis: Expert Opinion on Pharmacotherapy: Vol 4, No 10">{{cite web |url=https://www.tandfonline.com/doi/abs/10.1517/14656566.4.10.1651 |title=Pharmacotherapy of postpartum psychosis: Expert Opinion on Pharmacotherapy: Vol 4, No 10 |format= |work= |accessdate=}}</ref><br>Before being discharged from the [[hospital]], a strategy must be in place that includes close monitoring, appropriate sleep, and [[stress reduction]].<ref name="urlA Review of Postpartum Psychosis | Journal of Womens Health">{{cite web |url=https://www.liebertpub.com/doi/abs/10.1089/jwh.2006.15.352 |title=A Review of Postpartum Psychosis | Journal of Women's Health |format= |work= |accessdate=}}</ref> | ||
Before being discharged from the hospital, a strategy must be in place that includes close monitoring, appropriate sleep, and stress reduction.<ref name="urlA Review of Postpartum Psychosis | Journal of Womens Health">{{cite web |url=https://www.liebertpub.com/doi/abs/10.1089/jwh.2006.15.352 |title=A Review of Postpartum Psychosis | Journal of Women's Health |format= |work= |accessdate=}}</ref> | |||
The majority of cases of Postpartum blues are self-limited and temporary. The mainstay of therapy is supportive care. As a result, it resolves on its own, requiring reassurance, education, validation, and [[psychological]] support.<ref name="pmid15276962">{{cite journal |vauthors=Seyfried LS, Marcus SM |title=Postpartum mood disorders |journal=Int Rev Psychiatry |volume=15 |issue=3 |pages=231–42 |date=August 2003 |pmid=15276962 |doi=10.1080/0954026031000136857 |url=}}</ref> | * The majority of cases of [[Postpartum]] blues are self-limited and temporary. The mainstay of [[therapy]] is supportive care. As a result, it resolves on its own, requiring reassurance, [[education]], validation, and [[psychological]] support.<ref name="pmid15276962">{{cite journal |vauthors=Seyfried LS, Marcus SM |title=Postpartum mood disorders |journal=Int Rev Psychiatry |volume=15 |issue=3 |pages=231–42 |date=August 2003 |pmid=15276962 |doi=10.1080/0954026031000136857 |url=}}</ref> | ||
==References== | ==References== | ||
Latest revision as of 05:12, 5 August 2021
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Peripartum mood disturbances Microchapters |
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Differentiating Peripartum mood disturbances from other Diseases |
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Diagnosis |
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Treatment |
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Peripartum mood disturbances medical therapy On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunita Kumawat, M.B.B.S[2]
Overview
To manage peripartum mood disturbances efficiently, a multidisciplinary and comprehensive approach is used.
Medical Therapy
Reassurance, familial and social support, psychoeducation, and, in certain circumstances, psychotherapy and/or pharmacologic treatment are all used in the treatment of PPDs.
Medical therapy for postpartum depression includes:
All Postpartum Depression [1]
- Investigate and manage social stressors, psychiatric and medical comorbidities
- Psychosocial support strategies.
- Self-care
- Sleep protection
- Exercise
Postpartum depression: moderate severity or not in remission from self-care and psychosocial strategies
- Psychological treatments, including CBT and IPT
- Add SSRI if insuffiecient response (for lactation safety)
Postpartum Depression: Severe
- SSRI alone or with psychological intervention (for lactation safety)
- Consider antidepressant switch and augmentation startegies if no response to SSRI alone.
- Consider ECT with severe suicidality, psychosis or treatment resistance.
Additional therapeutic options: bright light therapy, yoga, relaxation training, massage and acupunture.
Alternative treatment options are omega-3 PUFAs, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have fewer side effects.
Postpartum psychosis is a medical emergency and requires prompt inpatient treatment. Once the organic causes of psychosis are ruled out the treatment is given according to the symptom profile.
Antipsychotics, mood stabilizers and benzodiazepines are used in acute therapy. Insomnia should be treated promptly. ECT is used when the condition is treatment resistant or a quicker response is required because of symptoms severity or safety concerns. Antimaniac and antipsychotic agents benefit a patient who has a known history of the illness or a family member has a history.[2]
Before being discharged from the hospital, a strategy must be in place that includes close monitoring, appropriate sleep, and stress reduction.[3]
- The majority of cases of Postpartum blues are self-limited and temporary. The mainstay of therapy is supportive care. As a result, it resolves on its own, requiring reassurance, education, validation, and psychological support.[4]
References
- ↑ "Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics | Annual Review of Medicine".
- ↑ "Pharmacotherapy of postpartum psychosis: Expert Opinion on Pharmacotherapy: Vol 4, No 10".
- ↑ "A Review of Postpartum Psychosis | Journal of Women's Health".
- ↑ Seyfried LS, Marcus SM (August 2003). "Postpartum mood disorders". Int Rev Psychiatry. 15 (3): 231–42. doi:10.1080/0954026031000136857. PMID 15276962.