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产后抑郁
Postpartum Depression


Donna E. Stewart ... 妇产科和儿科 • 2016.12.01

本刊这一特别栏目以一个简短病历开始,它强调一个常见的临床问题。随后文章陈述支持各种不同策略的证据,并对已有的正式指南进行综述。文章最后作者给出临床建议。

 

一名28岁的单身母亲,有一3月龄子。她报告持续2个月重度疲劳、对很多事物失去兴趣、易激惹、难以集中注意力、失眠、精力不足和悲伤哭泣。她在18岁时,类似症状出现过周时间,在妊娠中期也出现过,但是那两次其症状均自发消退。她没有自杀或精神病倾向,但自感无力应对。您会给她怎样的建议?

 

临床问题


产后抑郁是一种可使人失能但可治疗的精神障碍,是生育最常见的并发症之一1。美国精神病学会《精神障碍诊断和统计手册》(American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders)第五版(DSM-5)中将产后抑郁作为一种“围产期发病(如果在妊娠期间或分娩后4周内出现心境症状)”的重性抑郁发作纳入2(表1)。然而,分娩4周后开始出现或不满足重性抑郁发作全部标准的抑郁仍可能造成伤害并需要治疗3。在临床实践和临床研究中,根据不同的定义,产后抑郁(即非精神病型产褥期抑郁)是分娩后4周内、3个月内、6个月内或至12个月2-4内出现的抑郁。





作者信息

Donna E. Stewart, C.M., M.D., and Simone Vigod, M.D.
From the University Health Network Centre for Mental Health (D.E.S.), the Toronto General Hospital Research Institute (D.E.S.), the Reproductive Life Stages Program, Women’s Mental Health Program, and Women’s College Hospital and Research Institute (S.V.), and the University of Toronto (D.E.S., S.V.) — all in Toronto. Address reprint requests to Dr. Stewart at the University Health Network Centre for Mental Health, Toronto General Hospital Research Institute, University of Toronto, 200 Elizabeth St., EN-7-229, Toronto, ON M5G 2C4, Canada, or at donna.stewart@uhn.ca.

 

参考文献

1. Howard LM, Molyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet 2014;384:1775-1788

2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed.: DSM-5. Arlington, VA: American Psychiatric Publishing, 2013.

3. Wisner KL, Moses-Kolko EL, Sit DKY. Postpartum depression: a disorder in search of a definition. Arch Womens Ment Health 2010;13:37-40

4. Gaynes BN, Gavin N, Meltzer-Brody S, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ)2005:1-8

5. Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, Mortensen PB. New parents and mental disorders: a population-based register study. JAMA 2006;296:2582-2589

6. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA 2010;303:1961-1969

7. Wisner KL, Sit DKY, McShea MC, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013;70:490-498

8. Bloch M, Schmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR. Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry 2000;157:924-930

9. Mehta D, Newport DJ, Frishman G, et al. Early predictive biomarkers for postpartum depression point to a role for estrogen receptor signaling. Psychol Med 2014;44:2309-2322

10. Couto TCE, Brancaglion MYM, Alvim-Soares A, et al. Postpartum depression: a systematic review of the genetics involved. World J Psychiatry 2015;5:103-111

11. Guintivano J, Arad M, Gould TD, Payne JL, Kaminsky ZA. Antenatal prediction of postpartum depression with blood DNA methylation biomarkers. Mol Psychiatry 2014;19:560-567

12. Norhayati MN, Hazlina NHN, Asrenee AR, Wan Emilin WMA. Magnitude and risk factors for postpartum symptoms: a literature review. J Affect Disord 2015;175:34-52

13. Goodman JH. Postpartum depression beyond the early postpartum period. J Obstet Gynecol Neonatal Nurs 2004;33:410-420

14. Stein A, Pearson RM, Goodman SH, et al. Effects of perinatal mental disorders on the fetus and child. Lancet 2014;384:1800-1819

15. Esscher A, Essén B, Innala E, et al. Suicides during pregnancy and 1 year postpartum in Sweden, 1980-2007. Br J Psychiatry 2016;208:462-469

16. Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health 2005;8:77-87

17. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987;150:782-786

18. Committee on Obstetric Practice. The American College of Obstetricians and Gynecologists committee opinion no. 630: screening for perinatal depression. Obstet Gynecol 2015;125:1268-1271

19. Earls MF, Committee on Psychosocial Aspects of Child and Family Health American Academy of Pediatrics. . Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics 2010;126:1032-1039

20. Myers E, Aubuchon-Endsley N, Bastian L, et al. Efficacy and safety of screening for postpartum depression: AHRQ publication no. 13-EHC064-EF. Rockville, MD: Agency for Healthcare Research and Quality, 2013.

21. Antenatal and postnatal mental health: clinical management and service guidance. London: National Institute for Health and Care Excellence, 2014 (http://www.nice.org.uk/guidance/cg192).

22. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-613

23. Bosanquet K, Bailey D, Gilbody S, et al. Diagnostic accuracy of the Whooley questions for the identification of depression: a diagnostic meta-analysis. BMJ Open 2015;5:e008913-e008913

24. Wisner KL, Parry BL, Piontek CM. Postpartum depression. N Engl J Med 2002;347:194-199

25. Milgrom J, Gemmill AW, Bilszta JL, et al. Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 2008;108:147-157

26. Yazici E, Kirkan TS, Aslan PA, Aydin N, Yazici AB. Untreated depression in the first trimester of pregnancy leads to postpartum depression: high rates from a natural follow-up study. Neuropsychiatr Dis Treat 2015;11:405-411

27. Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database Syst Rev2013:CD001134-CD001134

28. Dennis C-L, Chung-Lee L. Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth 2006;33:323-331

29. Byatt N, Levin LL, Ziedonis D, Moore Simas TA, Allison J. Enhancing participation in depression care in outpatient perinatal care settings: a systematic review. Obstet Gynecol 2015;126:1048-1058

30. Dennis CL, Hodnett E. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Syst Rev2007:CD006116-CD006116

31. Ashford MT, Olander EK, Ayers S. Computer- or Web-based interventions for perinatal mental health: a systematic review. J Affect Disord 2016;197:134-146

32. Molyneaux E, Howard LM, McGeown HR, Karia AM, Trevillion K. Antidepressant treatment for postnatal depression. Cochrane Database Syst Rev2014:CD002018-CD002018

33. Lam RW, Parikh SV, Ramasubbu R, et al. Effects of combined pharmacotherapy and psychotherapy for improving work functioning in major depressive disorder. Br J Psychiatry 2013;203:358-365

34. Orsolini L, Bellantuono C. Serotonin reuptake inhibitors and breastfeeding: a systematic review. Hum Psychopharmacol 2015;30:4-20

35. Gentile S. Use of contemporary antidepressants during breastfeeding: a proposal for a specific safety index. Drug Saf 2007;30:107-121

36. Hempel G. Drug monitoring and clinical chemistry. Vol. 5. Philadelphia: Elsevier, 2004.

37. Food and Drug Administration. Review of three pharmacokinetic studies in adolescent children 12-17 years for Lexapro. May 22, 2008 (http://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DevelopmentResources/UCM226545.pdf).

38. Sigurdsson HP, Hefner G, Ben-Omar N, et al. Steady-state serum concentrations of venlafaxine in patients with late-life depression: impact of age, sex and BMI. J Neural Transm (Vienna) 2015;122:721-729

39. Waldschmitt C, Vogel F, Pfuhlmann B, Hiemke C. Duloxetine serum concentrations and clinical effects: data from a therapeutic drug monitoring (TDM) survey. Pharmacopsychiatry 2009;42:189-193

40. Smit M, Dolman KM, Honig A. Mirtazapine in pregnancy and lactation — a systematic review. Eur Neuropsychopharmacol 2016;26:126-135

41. Jaquenoud Sirot E, Harenberg S, Vandel P, et al. Multicenter study on the clinical effectiveness, pharmacokinetics, and pharmacogenetics of mirtazapine in depression. J Clin Psychopharmacol 2012;32:622-629

42. Sriraman NK, Melvin K, Meltzer-Brody S. ABM clinical protocol #18: use of antidepressants in breastfeeding mothers. Breastfeed Med 2015;10:290-299

43. Gentile S. Tricyclic antidepressants in pregnancy and puerperium. Expert Opin Drug Saf 2014;13:207-225

44. Lam RW, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: introduction and methods. Can J Psychiatry 2016;61:506-509

45. Dennis CL, Ross LE, Herxheimer A. Oestrogens and progestins for preventing and treating postpartum depression. Cochrane Database Syst Rev2008:CD001690-CD001690

46. Myczkowski ML, Dias AM, Luvisotto T, et al. Effects of repetitive transcranial magnetic stimulation on clinical, social, and cognitive performance in postpartum depression. Neuropsychiatr Dis Treat 2012;8:491-500

47. Deligiannidis KM, Freeman MP. Complementary and alternative medicine therapies for perinatal depression. Best Pract Res Clin Obstet Gynaecol 2014;28:85-95

48. Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium. Heterogeneity of postpartum depression: a latent class analysis. Lancet Psychiatry 2015;2:59-67

49. Clinical practice guidelines: depression and related disorders — anxiety, bipolar disorder and puerperal psychosis — in the perinatal period: a guideline for primary care health professionals. Melbourne, VIC, Australia: Beyond Blue, February 2011 (http://resources.beyondblue.org.au/prism/file?token=BL/0891).

50. Scottish Intercollegiate Guidelines Network (SIGN). SIGN 127: management of perinatal mood disorders: a national clinical guideline. Edinburgh: Healthcare Improvement Scotland, March 2012 (http://www.sign.ac.uk/pdf/sign127.pdf).

51. American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. 2010 (http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf).

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