Depression in Women: From

PMS to Post-partum Blues

Kimberley Guida, MD
Pullman Family Medicine
@ase Presentation
Julie is a 25 year old female who just delivered
her second child 3 weeks ago. She breaks down
in tears for no reason and is irritable with her 3
year old. She is having trouble sleeping, and has
no appetite. She admits that she feels guilty for
not feeling happy about the new infant in her life.
She feels she is not an effective parent to either
child. She is returning to work next week and
wonders how she will be able to cope.
Statistics
° Depression is twice as common in women as in
men
° 20% of women will experience depression at
some point during their life
° One out of 10 childbearing women will
experience post-partum depression
° 40% of women have premenstrual symptoms, 5%
of these experience premenstrual dysphoric
disorder (PMDD)
=isk Factors For Depression
° Family history of mood disorder
° Loss of a parent before age 10
° History of sexual or physical abuse
° Use of hormones
(contraception/H= /fertility treatments)
° Persistent life stressors (i.e. loss of job)
° Loss of social support system
What Is Depression?
° Psychological ° Physical symptoms
° Depressed mood ° Sleep disturbance
° Decreased interest in ° Appetite/weight
activities changes
° Feelings of guilt, ° Difficulty
hopelessness concentrating
° Suicidal thoughts ° Fatigue
° Decreased energy
Gender Differences
° Women have earlier
onset of depression
° Episodes may last longer
and recur more often
° More atypical symptoms
° Suicide attempts more
frequent but less
successful
° Less substance abuse
than men
° More anxiety symptoms
than men
° More associated eating
disorders
° More associated migraine
headaches
° More feelings of guilt
° More seasonal depression
 reatment For Depression
° Psychosocial (counseling)- cognitive behavioral
therapy
° Medications- used with counseling in cases of
moderate to severe depression
° Alter chemical balance in the body to enhance mood
(norepinephrine, serotonin levels)
° Many different types- SS=I¶s, tricyclics, others
° St. John¶s wort- some studies suggest a benefit
° Need a minimum of 2 weeks to see an effect
° reatment for minimum of 6 months
SS=I¶s- Often the First @hoice
° Selective serotonin reuptake inhibitors- allow
more serotonin to be available in the body,
enhancing mood
° Examples: Prozac, Paxil, Zoloft, Luvox, @elexa
° Once daily dosing
° Side effects: nausea, headaches, nervousness,
insomnia/fatigue, sexual dysfunction, weight gain
with prolonged use
What¶s hat About Sexual
Dysfunction?
° Up to 70% of depressed patients experience a loss
of sexual interest
° If we treat the underlying depression, the libido
often improves
° SS=I¶s may cause problems with libido and
difficulty attaining orgasm
° Other medications may enhance libido- ie
Wellbutrin, Effexor
Premenstrual Dysphoric Disorder
° Mood and anxiety symptoms that occur only
during the premenstrual period, or worsen
significantly during that time
° @an be very debilitating, with a negative impact
on the quality of life and relationships
° Symptoms usually disappear within a few days
after the period starts
° here are 11 identified symptoms, of which 5
must be present
Symptoms of PMDD
° Depressed mood ° Anxiety- feeling ³on
° Feelings of personal edge´
rejection ° Irritability, anger
° Decreased interest in ° Feeling overwhelmed
usual activities ° Difficulty concentrating
° Fatigue, no energy ° Physical symptoms-
° Marked appetite breast tenderness,
changes/cravings headaches, ³bloated´,
° Insomnia or increased muscle pain
sleep
@ause of PMDD?
° Unknown, but felt by many researchers to
result from an abnormal response to normal
cycle of hormonal changes in the body
° Likely a combination of genetic,
environmental, and behavioral factors
° Women with PMDD have greater risk of
future depression during pregnancy, post-
partum period, and perimenopause
 reatment For PMDD
° @hoice of treatment is aimed at the most
troubling symptoms
° Lifestyle modification
° Dietary approach
° Vitamin supplementation
° Medications
° @ognitive/behavioral approach
Lifestyle/diet Modification
° Women who engage in moderate aerobic exercise
3 times weekly have fewer premenstrual
symptoms than sedentary women
° Low-fat, vegetarian diet has been shown to
decrease duration and intensity of menstrual pain
° Women with a high caffeine intake have more
premenstrual irritability symptoms
° Excess of simple carbohydrates (sugar) is
associated with mood disturbances
Vitamin Supplementation
° @ontroversial- data is conflicting
° Vitamin B6 100mg/day
° Magnesium 400 mg/day
° Manganese 6 mg/day
° Vitamin E 400 iu/day
° @alcium 1000 mg/day
Medications for PMDD
° Anti-inflammatories- effective for pain
relief
° Oral contraceptives- suppress ovulation
° Diuretics± when salt restriction not helpful
in reducing significant fluid retention
° SS=I¶s are often first choice- daily versus
premenstrual week only
@ognitive Behavioral herapy
° Attempts to reduce negative feelings in the
premenstrual period
° Improve feelings of self-esteem and
problem solving skills
° =elaxation therapy may also be helpful
Post-partum Depression
° 1 of 10 women experience post-partum
depression, but the condition is under-
diagnosed
° May have significant impact on both
mother and child
° Societal pressures to be ³good mother´
may prevent woman from admitting
symptoms
³Baby Blues´
° Occurs in 70-85% of women
° Onset within the first few days after
delivery
° =esolves by 2 weeks
° Symptoms include: mild depression,
irritability, tearfulness, fatigue, anxiety
° May have increased risk of post-partum
major depression later on
Post-partum Major Depression
° Symptoms of depression that last longer
than 2 weeks
° Usually begins 2-3 weeks after delivery
° May last up to one year
° High risk of recurrence in future
pregnancies
Post Partum Psychosis
° =are disorder (Andrea Yates?)- 0.2% women
° Onset within the first month after delivery
° Symptoms include mania, agitation, expansive or
irritable mood, avoidance of the infant
° May have delusions or hallucinations that involve
the infant- possessed by demon, etc.
° his is a medical emergency- needs
hospitalization
 reatment for Post Partum
Depression
° Same as for major depression
° SS=I¶s work well
° All antidepressants are to some degree,
excreted in the breast milk, but usually
undetectable levels in the infant¶s blood
° Avoid Prozac due to long half life- may
accumulate in the infant
 o Summarize«.
° Depression is very common in women
° May be more likely around times of
hormonal flux- premenstrual, post-partum,
perimenopause
° here is effective treatment available
° Don¶t hesitate to discuss symptoms with
your doctor
 his Presentation Is Available
Online At:

www.pullmanfamilymed.com
hank You