BEST  TREATMENT   PRACTICES  FOR   PERINATAL  MOOD   AND  ANXIETY   DISORDERS   Heidi  Koss,  MA,  LMHC   Postpartum  Support  International  of  WA     www.ppmdsupport.com   www.postpartum.net  (International)   [email protected]   https://www.facebook.com/HeidiKossLMHC PMADs  are  the  #1   complication  of   Pregnancy Etiology   • Biological   • Psychological   • Social/Environmental   • Spiritual/Existential  Crisis   • Cultural  Myths  of  Motherhood Biology   Genetics   • Mood  disorders  run  in  families   • At  higher  risk  if  mother,  siblings  or  other  family   members  had  PMADs  or  other  mental  health   disorder   • At  higher  risk  if  already  have  an  existing  mental   health  disorder     • At  higher  risk  if  have  History  of  PMS  or  PMDD Spectrum  of  PMADs   • Depression     • Anxiety/panic   • OCD  (Obsessive/Compulsive   Disorder)   • Bipolar  Disorder   • PTSD  (Post  Traumatic  Stress   Disorder)   • PP  psychosis Biological  contributions   • PMADs  may  be  psycho-­‐neuro-­‐immunological   disorders  that  come  from  an  exaggerated   inflammatory  response  to  labor  and  delivery.   • The  body  attempts  to  limit  damage  from  stress,   injury,  or  infection  by  releasing  both  pro-­‐ inflammatory  and  anti-­‐inflammatory  cytokines.   • Pro-­‐inflammatory  cytokines  are  linked  to  fatigue,   hypersomnia,  fever,  decreased  appetite,  and   depression. Biological  contributions   • Early  postpartum  is  a  state  of  serotonin  deficiency   (Bailara,  2006).   • Studies  show  that  women  with  postpartum   depression  have  decreased  tryptophan  levels,   decreased  platelet  serotonin  (Maurer-­‐Spurej,  2007)   and  altered  binding  of  platelet  serotonin  transporter   sites  (Newport  et  al,  2004).   • Cortisol,  estradiol,  and  progesterone  all  have  an   impact  on  the  serotonin  system,  and  the  latter  two   decrease  precipitously  after  birth. Biological  contribu.ons   • Ilona  Yim  at  UC-­‐Irvine  has  found  a  correlation   between  the  rapid  release  of  cortico-­‐releasing   hormone  at  25  weeks  and  the  development  of   postpartum  depression.   (Yim,  Glynn,  Dunkel-­‐Schetter,  Hobel,   Chicz-­‐DeMet,  Sandman,  Archives  of  General  Psychiatry.  2009)     • This  hormone  is  typically  produced  by  both  the   placenta  and  the  hypothalamus. Incidence  of  Clinical  PMADs   • Approximately  15  -­‐  20%  of  all  pregnant  and   postpartum  women  may  experience  some  form  of   PMAD     • Anxiety  may  now  be  more  prevalent  that   depression   (2013,  Paul,  Downs,Schaefer,  Beiler,  Weisman,   Pediatrics)   • Up  to  51%  in  low  SES  populations   (Bennett,  et  al,  2004)   • 10%  of  Men  in  US  experience  PPD   (2006,  Paulson,  Dauber,   and  Leiferman,  Pediatrics) • PMADs  onset  peaks  at  3   months  postpartum  but  can   onset  during  pregnancy  and  at   anytime  during  the  first  year   • May  last  well  into  the  2nd  year   or  longer  if  untreated/ mistreated.   • Maternal  depression  is  more   common  at  4  years  following   childbirth  than  at  any  other   time  in  the  first  12  months  after   childbirth   (Woolhouse,  Mensah,  and   Brown;  British  Journal  of  Obstetrics  and   Gynecology;  2014)