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{{CMG}}; {{AE}}{{Sunita}}
{{CMG}}; {{AE}}{{Sunita}}
==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
To manage [[peripartum mood disturbances]] efficiently, a multidisciplinary and comprehensive approach is used.


OR
==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.
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
[[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 &#124; Annual Review of Medicine |format= |work= |accessdate=}}</ref><br>
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR


Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Investigate and manage social stressors, [[psychiatric]] and [[medical]] [[comorbidities]]<br>
*[[Psychosocial]] support strategies.<br>
*[[Self-care]]<br>
*[[Sleep]] protection<br>
*[[Exercise]]


OR
[[Postpartum depression]]: moderate severity or not in [[remission]] from [[self-care]] and [[psychosocial]] strategies<br>


Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*[[Psychological]] [[treatment]]s, including [[CBT]] and IPT<br>
*Add [[SSRI]] if insuffiecient response (for [[lactation]] safety)<br>


OR
[[Postpartum Depression]]: Severe<br>


Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
*[[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>


==Medical Therapy==
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]].
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===


* '''1 Stage 1 - Name of stage'''
[[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 &#124; Journal of Women's Health |format= |work= |accessdate=}}</ref>
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
* 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>
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==
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{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Primary care]]
[[Category:Obstetrics]]
[[Category:Medicine]]
[[Category:Up-To-Date]]
[[Category:Psychiatry]]

Latest revision as of 05:12, 5 August 2021

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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]

Postpartum depression: moderate severity or not in remission from self-care and psychosocial strategies

Postpartum Depression: Severe

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

  1. ↑ "Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics | Annual Review of Medicine".
  2. ↑ "Pharmacotherapy of postpartum psychosis: Expert Opinion on Pharmacotherapy: Vol 4, No 10".
  3. ↑ "A Review of Postpartum Psychosis | Journal of Women's Health".
  4. ↑ Seyfried LS, Marcus SM (August 2003). "Postpartum mood disorders". Int Rev Psychiatry. 15 (3): 231–42. doi:10.1080/0954026031000136857. PMID 15276962.

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