Post-traumatic stress disorder (PTSD) occurs in approximately 10% of all women at some point in their lifetime. PTSD tends to occur more commonly in women during their childbearing years, yet we have only recently begun to look more closely at the incidence of PTSD associated with childbirth.Â
The American Psychiatric Association is now considering the possibility of including premenstrual dysphoric disorder (PMDD) in the DSM-V as a new category, rather than listing a set of criteria for PMDD in the appendix (as in DSM-IV). The diagnostic criteria remain relatively unchanged. Many feel that the Inclusion of PMDD as a distinct diagnostic category will lead to greater legitimacy for the disorder and will encourage the growth of evidence-based research in this area.
More than half of all women initiating treatment with hormone therapy will stop within the first year of treatment, most often because of side effects. Mood disturbance is a relatively common side effect that occurs with hormone therapy, and previous studies have suggested that progestins in the combined hormone preparations are responsible for these negative mood effects.
Menstrual problems are common among premenopausal women and become more frequent with increasing reproductive age, especially just before and during perimenopause. In the Study of Women's Health Across the Nation, a multisite study of menopause and aging, information regarding menstrual history was collected in a total of 934 premenopausal and early perimenopausal women between the ages of 42 and 52. History of major depression was associated with an increased likelihood of heavy bleeding (odds ratio, 1.89), adjusting for recent major depression, menopause status, and other confounding factors. History of depression was not associated with other abnormal bleeding or premenstrual symptoms. Future longitudinal studies are needed to explore why past depression increases the likelihood of subsequent heavy menstrual bleeding in midlife women. One possibility is that irregular fluctuations in estrogen levels may be responsible for both abnormal menstrual bleeding, as well as the dysregulation of neurotransmitter systems that mediate depressive symptoms.
A few weeks after the FDA called into question the association between SSRI exposure and persistent pulmonary hypertension of the newborn or PPHN, BMJ published another article supporting an increased risk of PPHN among infants exposed to SSRIs in utero.
Sources of vitamin D include sunlight (ultraviolet B, or UVB, rays), dietary intake, and supplements. Sunlight is the main source of human vitamin D. Vitamin D refers to different forms of a steroid hormone.   Vitamin D3 (also called 1, 25-dihydroxycholecalciferol or calcitriol) is produced by the body when ultraviolet light (in the form of UV B) interacts with 7-dehydrocholesterol . Vitamin D3 is thought to be more potent than vitamin D2, with D3 and D2 being the two forms of vitamin D contained in supplements.
Ms. P is a 32-year-old married woman who presented for consultation regarding the use of medication during pregnancy. She had been taking fluoxetine (Prozac) 20 mg for many years for the treatment of recurrent major depression and generalized anxiety. In addition, she was prescribed gabapentin (Neurontin) for sleep.
Both citalopram and escitalopram are antidepressants belonging to the SSRI class.  While escitalopram (marketed in the U.S. as Lexapro) contains only the S-stereoisomer (or enantiomer) of the drug citalopram, Celexa or generic citalopram is a racemic mixture of the S-citalopram and its mirror image, R-citalopram, which is less effective as an antidepressant.
Depression during pregnancy is common and has major health implications for the mother, the fetus and the family. On this website, we have reviewed numerous treatments for affective disorders in pregnancy, including psychotropic medications and several forms of psychotherapy. We have not had much data to support the use of light therapy for antepartum depression, yet I often discuss light therapy as a potential adjunctive treatment for patients with a seasonal component to their depression. A recent study, published by Wirz-Justice and colleagues in the Journal of Clinical Psychiatry, provides evidence that light therapy may be a useful non-pharmacologic treatment for women who suffer from depression during pregnancy(1).
Part 4:Â The Postpartum Period
