There are also attitudinal barriers to seeking treatment, including stigma. Interpersonal relationships with friends and family, as well as institutional and financial obstacles serve as help-seeking barriers. The history of mistrust within the United States healthcare system or negative health experiences can influence ones willingness and adherence to seek postpartum depression treatment. Cultural responses must be adequate in PPD healthcare and resources. Representation and cultural competency are crucial in equitable healthcare for PPD. Different ethic groups may believe that healthcare providers will not respect their cultural values or religious practices, which influences their willingness to use mental health services or be prescribed antidepressant medications. Additionally, resources for PPD are limited and often dont incorporate what mothers would prefer. The use of technology can be a beneficial way to deliver mothers with resources because it is accessible and convenient. Epidemiology
North America
United States
Within the United States, the prevalence of postpartum depression was lower than the global approximation at 11.5% but varied between states from as low as 8% to as high as 20.1%. The highest prevalence in the US is found among women who are American Indian/Alaska Natives or Asian/Pacific Islanders, possess less than 12 years of education, are unmarried, smoke during pregnancy, experience over two stressful life events, or whos full term infant is low-birthweight or was admitted to a Newborn Intensive Care Unit.
Nafarelin is not available for use by any other routes than intranasal administration. Side effects
Side effects of nafarelin are related to sex hormone deficiency and include hot flashes, vaginal dryness, headaches, mood changes, and sexual dysfunction. Nafarelin causes erectile dysfunction in more than half of men with benign prostatic hyperplasia treated with it. Some people may experience acne, muscle pain, reduced breast size, and nasal irritation. These side effects are reversible and should resolve after stopping the medication. There is a case report of severe hyperkalemia during nafarelin therapy in a woman with uterine fibroids. The mechanism is unknown. Pharmacology
Pharmacodynamics
Nafarelin is a GnRH agonist, or an agonist of the GnRH receptor, the biological target of GnRH. It works by continuously activating the GnRH receptor, which results in profound desensitization of the receptor such that it becomes non-functional. As a result, nafarelin suppresses the GnRH-induced secretion of the gonadotropins, luteinizing hormone and follicle-stimulating hormone, from the pituitary gland. This, in turn, results in profound suppression of gonadal sex hormone production, as well as reversible suppression of fertility. Pharmacokinetics
The bioavailability of nafarelin with intranasal administration is 2.8% on average, with a range of 1.2 to 5.6%. The plasma protein binding of nafarelin is 80%. It is metabolized primarily by peptidases and not by cytochrome P450 enzymes. The elimination half-life of nafarelin is 2.5 to 3.0 hours by intranasal administration, whereas the half-life of nafarelin and its metabolites by subcutaneous injection is 85.5 hours. Nafarelin is eliminated 44 to 55% in urine and 18.5 to 44.2% in feces.