Mood & Anx Disorders During Pregnancy Pt2, Treatment , Postpartum Depression Case Study
Q.When dealing with peripartum mood and anxiety disorders, most clinics use a multidisciplinary approach based on a biopsychosocial model of treatment. For mild to moderate symptoms, or for cases in which the pregnant or lactating mother refuses pharmacotherapy, psychotherapies, such as interpersonal psychotherapy (IPT) and cognitive-behavioral therapy (CBT) should be tried first. Bright light therapy is a biological (nonpharmacologic) treatment that is currently being investigated and has shown promise. For women with moderate to severe symptoms, or for those who are at an increased risk of relapse, antidepressant medications should be considered. For women who are acutely suicidal or psychotic, as well as for those who are nonresponsive or cannot tolerate pharmacotherapy, electroconvulsive therapy may be indicated.
A.IPT is a short-term interpersonally oriented psychotherapy that has been used successfully to treat depression. Preliminary studies of IPT in pregnant and postpartum women have produced encouraging results.[52-53] The focus of IPT in this population is on role transitions and the acquisition of new skills applicable to motherhood. CBT is an approach that focuses on the interrelationships between thoughts, affect, behavior, physical reactions, and the environment and teaches strategies for positive change in each of these domains. A recent pilot study in which 6 sessions of CBT were administered to women with postpartum depression demonstrated that CBT is as effective as fluoxetine in the treatment of mild to moderate postpartum depression.[54] Bright light therapy. The use of light therapy as an alternative biological treatment in depressed pregnant and postpartum women has only been minimally studied or reported in the literature. The use of light therapy for major depression has been shown to be an effective form of treatment with a favorable side-effect profile.[55] Light therapy is widely used to treat seasonal affective disorder (SAD), nonseasonal depression, and premenstrual dysphoric disorder (PMDD). One report on pregnant depressed women and another on postpartum depressed women who were all treated with morning bright light therapy provide preliminary support for the hypothesis that light therapy may have an antidepressant effect in these special populations.[56-57] All psychotropic medications cross the placenta and cause in utero exposure to the developing fetus. In addition, these medications are found in breast milk in varying amounts, and thus are passed on to the nursing infant. When pharmacotherapy is indicated for a woman who is pregnant or breast-feeding, the risk of potential harmful effects on the developing fetus or nursing infant must be weighed against the risks of untreated depression in the mother, and this decision must be made on an individual basis. There is a growing body of literature on the use of antidepressant medications during pregnancy and lactation. As there is no evidence to suggest that mental illness during pregnancy or the postpartum period is any different than at any other time, women with puerperal mood disorders should be treated for similar durations and with comparable doses as indicated for patients with nonpuerperal mood disorders.[58]
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