Postpartum Depression 5/21/2018

Transcription

1 BREASTFEEDING AND POSTPARTUM DEPRESSION: MILK, TEARS, AND HOPE GINI BAKER, RN, PMH, IBCLC, FILCA UC SAN DIEGO EXTENSION LACTATION PROGRAMS DISCLOSURES CONFLICTS OF INTEREST PROGRAM COORDINATOR OBJECTIVES: Fatigue Anhedoniais defined as the inability to experience pleasure from activities usually found enjoyable, e.g. exercise, hobbies, music, sexual activities or social interactions. STATISTICS ON RATES OF PPD 70%- 80% of women between 10%-20% 1 in 7 women STATISTICS ON RATES OF PPD annually around 900,000 individuals 65% or greater Copyrighted Materials 1

2 STATISTICS ON RATES OF PPD 10% of new fathers Half of men 8% of adoptive parents IDENTIFYING THE MOM WITH PPD/ANXIETY ASSESSMENT PROCESS LISTEN TO THE WOMENS STORY, her story is unique to HER YOU RISK FACTORS FOR PPD/ANXIETY History of Depression/current depression History of PMS History of PPD 10%-50% more likely Inadequate Support Negative Life events Teen mother Premature baby Multiple birth High stress life Sick or colicky baby Compromised Infant Financial troubles Family problems Physical Limitations BREASTFEEDING DIFFICULTIES BREASTFEEDING FAILURE CRITICAL THINKING ASSESSING MOM MOM S HISTORY BIRTH HISTORY BABY SUPPORT BREASTFEEDING likely of 25% 11 times more MATERNAL HISTORY MEDICAL HISTORY PSYCH HISTORY BIRTH HISTORY PRENATAL INTRAPARTUM DELIVERY POSTPARTUM SOCIAL HISTORY PREGNANCY HISTORY PARENTING CURRENT PREGNANCY PRENATAL LABOR AND DELIVERY POSTPARTUM BREASTFEEDING Copyrighted Materials 2

3 BABY S HISTORY SUPPORTING THE DYAD... PREVIOUS BABY(S) TEMPERAMENT BREASTFEEDING PRENATAL INTRAPARTUM DELIVERY POSTPARTUM Family Visitors (2 Week growth spurt) Help at home Who Relationship Mom s expectation of the role of the helper Helpers expectation of their role HEALTH CARE SUPPORT LACTATION PEDIATRICIAN OBSTETRICIAN FAMILY PRACTICE PSYCH COUNSELOR(S) SUPPORT GROUPS REGULAR VS SPECIALTY BREASTFEEDING... Various scenarios Breastfeeding becoming well established Mom issues Baby issues Feeding issues Family Issues Need to be very careful/sensitive to your approach and words you use Mom s plans & goals vs what is currently happening Mom vs FOB vs Family Mom vs Pediatrician Mom vs Lactation consultant TRIAGE TOOLS AND RESOURCES Beck s Depression Scale item, self-report rating inventory that measures characteristic attitudes and symptoms of depression (Beck, et al., 1961). Also a13-item short form and the more recent BDI-11 by Beck, Steer & Brown, Takes approximately 10 minutes to complete, clients require a fifth sixth grade reading level to adequately understand the questions. Full curriculum for staff training Available at: Copyrighted Materials 3

4 PHQ-9... The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as 0 (not at all) to 3 (nearly every day). WHAT CAN BE DONE... WITH LITTLE TO NO RESOURCES? Yoga Exercise depression Massage depression Relaxation training depression yoga postpartum BREATHING WHICH HAVEN T BEEN SHOWN TO WORK?... dietary supplements depression Acupuncture placebo Light therapy pregnancy NON-DRUG TREATMENTS FOR DEPRESSION IN PREGNANT AND BREASTFEEDING WOMEN KATHLEEN KENDALL-TACKETT, PH.D., IBCLC Omega-3 Fatty Acids Copyrighted Materials 4

5 NON-DRUG TREATMENTS FOR DEPRESSION IN PREGNANT AND BREASTFEEDING WOMEN KATHLEEN KENDALL-TACKETT, PH.D., IBCLC ANTIDEPRESSANTS... Newer antidepressants include: Zyban Escitalopram Prozac Sarafem Pexeva Sertraline Zoloft Older antidepressants include: Elavil Desipramine Norpramin Doxepin Sinequan Tranylcypromine Parnate Trimipramine Surmontil It can take several weeks for antidepressants to be fully effective RESOURCES ILCA... International Lactation Consultants Association Reference Guide POSTPARTUM MOOD AND ANXIETY DISORDERS, A CLINICIANS GUIDE. CHERYL TATANO BECK, JEANNE WATSON DRISCOLL, JONES AND BARTLETT PUBLISHERS, 2006 A MOTHER S CLIMB OUT OF DARKNESS, A STORY ABOUT OVERCOMING POSTPARTUM, JENNIFER HENTZ MOYER, PARECLARUS PRESS, LLC, 2014 FROM THE HEART, ON BEING THE MOTHER OF A CHILD WITH SPECIAL NEEDS, WOODBINE HOUSE 1995 POSTPARTUM HEALTH ALLIANCE POSTPARTUM SUPPORT INTERNATIONAL (PSI) WW.POSTPARTUM.NET THE BLUE DOT PROJECT... RESOURCES INFORMATION/HANDOUTS FOR MOM ; Author Kathleen Kendall-Tackett, Ph.D, IBCLC Why Breastfeeding and Omega-3s Hep Prevent Depression in Pregnant and Postpartum Women Making Peace with your Birth Experience Medication Use for Trauma Symptoms and PTSD in Pregnant and Breastfeeding Women Should Mothers Avoid Nighttime Breastfeeding to Decrease Their Risk of Depression Non-Drug Treatments for Depression in Pregnant and Breastfeeding Women Antidepressant Use in Pregnant and Breastfeeding Women RESOURCES PSIPR@POSTPARTUM.NET TRAINING@POSTPARTUM.NET WDAVIS@POSTPARTUM.NET WDAVIS@POSTPARTUM.NET PSIOFFICE@POSTPARTUM.NET SUPPORT@POSTPARTUM.NET Copyrighted Materials 5

6 RESOURCES TPARTUM_DEPRESSION_UNCOVERED_BY_JOHNS_HOPKINS_RESEARCHERS Copyrighted Materials 6