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Old 06-02-2012
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Psyche A 22-year-old woman cannot sleep

A 22-year-old woman is evaluated in the office for feelings of sadness and guilt 6 weeks after an uncomplicated delivery of twins. Her symptoms have been present for 3 weeks but have worsened over the past week, and she cannot sleep, is preoccupied about the babiesí health, and has discontinued all social activities. She says that her husband is supportive and that they have no marital problems. She is willing to start treatment for her disorder, but she is concerned about the potential impact of medication because she is breastfeeding, and is interested in alternative treatments. Which of the following is the best treatment option for this patient?

A Fluoxetine
B Psychotherapy
C Reassurance with follow-up in 2 weeks
D St. Johnís wort
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Old 06-02-2012
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Originally Posted by Novobiocin View Post
A 22-year-old woman is evaluated in the office for feelings of sadness and guilt 6 weeks after an uncomplicated delivery of twins. Her symptoms have been present for 3 weeks but have worsened over the past week, and she cannot sleep, is preoccupied about the babiesí health, and has discontinued all social activities. She says that her husband is supportive and that they have no marital problems. She is willing to start treatment for her disorder, but she is concerned about the potential impact of medication because she is breastfeeding, and is interested in alternative treatments. Which of the following is the best treatment option for this patient?

A Fluoxetine
B Psychotherapy
C Reassurance with follow-up in 2 weeks
D St. Johnís wort
B......postpartum depression ?????
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Old 06-03-2012
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Originally Posted by Novobiocin View Post
A 22-year-old woman is evaluated in the office for feelings of sadness and guilt 6 weeks after an uncomplicated delivery of twins. Her symptoms have been present for 3 weeks but have worsened over the past week, and she cannot sleep, is preoccupied about the babiesí health, and has discontinued all social activities. She says that her husband is supportive and that they have no marital problems. She is willing to start treatment for her disorder, but she is concerned about the potential impact of medication because she is breastfeeding, and is interested in alternative treatments. Which of the following is the best treatment option for this patient?

A Fluoxetine
B Psychotherapy
C Reassurance with follow-up in 2 weeks
D St. Johnís wort
-post partum blues=self-limited=C.
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Old 06-04-2012
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Originally Posted by Novobiocin View Post
A 22-year-old woman is evaluated in the office for feelings of sadness and guilt 6 weeks after an uncomplicated delivery of twins. Her symptoms have been present for 3 weeks but have worsened over the past week, and she cannot sleep, is preoccupied about the babiesí health, and has discontinued all social activities. She says that her husband is supportive and that they have no marital problems. She is willing to start treatment for her disorder, but she is concerned about the potential impact of medication because she is breastfeeding, and is interested in alternative treatments. Which of the following is the best treatment option for this patient?

A Fluoxetine
B Psychotherapy
C Reassurance with follow-up in 2 weeks
D St. Johnís wort
Symptoms peak on the fourth or fifth day after delivery and last for several days, but they are generally time-limited and spontaneously remit within the first 2 postpartum weeks. this is postpartum dep
pt is not wishing to be treated with med ???? so may be B
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Old 06-04-2012
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This patient has postpartum depression, and psychotherapy alone is an effective nonpharmacologic treatment. Prevalence studies estimate that up to 20% of women have a nonpsychotic major depression within the first 6 months after parturition.

In addition to meeting criteria for major depressive disorder according to the American Psychiatric Association Diagnostic and Statistical Manual-IV (DSM-IV) guidelines, women with postpartum depression may have predominant symptoms of anxiety and upsetting and unwanted thoughts of harming their infant. Because of the risks associated with untreated postpartum depression, reassurance with follow-up is not an adequate treatment approach. For breastfeeding women who do not wish to take antidepressant medication because of concerns about exposure of the infant, nondrug treatments, such as psychotherapy, are a first-line choice.

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that is secreted in significant concentrations in breast milk and has a very long half-life, so it is not a desirable choice for this patient. Sertraline and paroxetine are SSRIs that do not reach as high levels in breast milk and have shorter half-lives, making them the preferred pharmacologic agents for moderate to severe postpartum depression in breastfeeding mothers who require drug therapy.

St. John’s wort (Hypericum perforatum) is an herbal remedy for which numerous controlled trials have shown some efficacy in mild to moderate depression. However, more recent trials of larger size and stronger methodology, as well as meta-analyses, have found either no effect or a significantly diminished effect. In addition, there is no good evidence regarding whether it is secreted in breast milk or what effect it might have on children, so it is not recommended for women who are nursing.
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