Major depression is multifactorial and prompted by genetic and environmental factors. Families of afected individuals often also have members sufering with alcohol abuse and anxiety disorders. Provocative conditions leading to depression include life events that prompt grief reactions, substance abuse, use of certain medications, and other medical disorders. Although life events can trigger depression, genes influence the response to these events and render the distinction between genetic and environmental factors diicult. One genome-wide linkage analysis of more than 1200 mothers suggests that variation in chromosomes 1 and 9 raises susceptibility to postpartum mood symptoms (Mahon, 2009).
It is unquestionable that pregnancy is a major life stressor that can precipitate or exacerbate depressive tendencies. In
TABLE 61-2. Symptoms of Depressive IIlnessa
Persistent sad, anxious, or "empty" feelings worthlessness, and/or helplessness
Irritabi Iity, restlessness
Loss of interest in activities once pleasurable, including sex Fatigue and decreased energy
Difficulty concentrating, remembering details, and making decisions Insomnia, early-morning wakefulness, or excessive sleeping Overeating or appetite loss
Thoughts of suicide, suicide attempts
Persistent aches or pains, headaches, cramps or digestive problems that do not ease with treatment aNot all patients experience the same symptoms.
Modified with permission from National Institute of Mental Health, 2010.
addition, various pregnancy-induced efects are implicated. Hormones certainly afect mood, as evidenced by premenstrual Major or minor depression develops postpartum in 10 to 20 syndrome and menopausal depression. Estrogen has been percent of women (Mental Health America, 2016). Available linked to increased serotonin synthesis, decreased serotonin data indicate that unipolar major depression may be slightly breakdown, and serotonin-receptor modulation (Deecher, more prevalent during the puerperium than among women in 2008). Concordantly, women who experience postpartum the general population (Yonkers, 2011). Postpartum depressive depression often have higher predelivery serum estrogen and symptoms are associated with young maternal age, antenatal progesterone levels and experience a greater decline postpardepression, unmarried status, smoking, newborns requiring tum (Ahokas, 1999). intensive care, and those with a history of stressors during preg
Dennis and associates (2007) queried the Cochrane Datanancy (Ko, 2017; Silverman, 2017). Speciically, physical or base and reported that the prevalence of antenatal depression verbal abuse during pregnancy is a potent risk for postpartum averaged 11 percent. Melville and coworkers (2010) found it depression (McFarlane, 2014). Finally, serious adverse obstetriin nearly 10 percent of more than 1800 women enrolled for cal events, especially those involving the neonate, are strongly prenatal care at a single university clinic. Others have reported linked to postpartum depression (Nelson, 2013, 2015). the incidence to be much higher depending on the population Depression is frequently recurrent. Up to 70 percent of studied (Gavin, 2005; Hayes, 2012; Lee, 2007). women with previous postpartum depression have a subsequent aChapter 12 (p. 245). bChapter 60 (p. 11r60).
SSRI = Selective serotonin-reuptake inhibitor.
Data from Briggs, 2015; Huybrechts, 2015; Koren, 2012.
Immediate referral to psychiatrist if no response, consider antidepressant Rx; antidepressant psychotherapy beneficial for pregnant women with mood disorders.