Svangerskaps- og barselsdepresjon
Sist oppdatert: Sist revidert:
Sist revidert av:Silje Folven BarlindhaugDefinisjon:
Depresjon som inntreffer i svangerskapet eller etter fødselen.
Forekomst:
I USA er forekomsten rundt 10-15% etter fødsel (en av åtte kvinner). Rundt 1/3 starter under graviditeten
Symptomer:
Nedstemthet, gråt, mangel på evne til å glede seg, søvnløshet, slapphet, spiseforstyrrelser, selvmordstanker, tilbakevendende tanker om død
Funn:
Varierende grader av depressivt klinisk preg
Diagnostikk:
Labprøver og andre undersøkelser har ingen verdi utover differensialdiagnostisk
Behandling:
Avlastning og støtte fra familien, kognitiv terapi, ev. SSRI i tillegg ved moderat til alvorlig depresjon, ev. innleggelse ved alvorlig depresjon.
- Brook Steen T, Eberhard-Gran M, Nordeng H, et al. Mental helse i svangerskapet. Veileder i fødselshjelp. Norsk gynekologisk forening. 2020. www.legeforeningen.no
- O'Connor E, Senger CA, Henninger ML. Interventions to Prevent Perinatal Depression Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 321: 588-601. pmid:30747970 PubMed
- Langan RC, Goodbred AJ. Identification and management of peripartum depression. Am Fam Physician. 2016 May 15;93(10):852-858. PMID: 27175720 PubMed
- Eberhard-Gran M, Tambs K, Opjordsmoen S, Skrondal A, Eskild A. Depression during pregnancy and after delivery: A repeated measurement study. J Psychosom Obstet Gynecol 2004; 25: 15-21. pmid:15376401 PubMed
- Engeland A, Bjorge T, Klungsoyr K, Hjellvik V, Skurtveit S, Furu K. Trends in prescription drug use during pregnancy and postpartum in Norway, 2005 to 2015. Pharmacoepidemiol Drug Saf. 2018 Sep;27(9):995-1004. PubMed
- Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017 Sep;219:86-92. PubMed
- Ko JY, Rockhill KM, Tong VT et al. Trends in Postpartum Depressive Symptoms - 27 States, 2004, 2008, and 2012. MMWR Morb Mortal Wkly Rep 2017; 66: 153-58. pmid:28207685 PubMed
- Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD001134. DOI: 10.1002/14651858.CD001134.pub3. The Cochrane Library
- Viktorin A, Meltzer-Brody S, Kuja-Halkola R et al. Heritability of Perinatal Depression and Genetic Overlap With Nonperinatal Depression. Am J Psychiatry 2016; 173: 158-65. pmid:26337037 PubMed
- Räisänen S, Lehto SM, Nielsen HS, Gissler M, Kramer MR, Heinonen S. Risk factors for and perinatal outcomes of major depression during pregnancy. BMJ Open. 2014;4(11):e004883. PMID: 25398675 PubMed
- Bjørk MH, Veiby G, Reiter SC, et al. Depression and anxiety in women with epilepsy during pregnancy and after delivery: A prospective population-based cohort study on frequency, risk factors, medication, and prognosis. Epilepsia 2015; 56: 28-39. PMID: 25524160 PubMed
- Ludermir AB, Lewis G, Valongueiro SA et al. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet 2010; 376: 903-10. PMID: 20822809 PubMed
- Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol. 2010;202(1):5–14. PMID: 20096252 PubMed
- Palladino CL, Singh V, Campbell J, Flynn H, Gold KJ. Homicide and suicide during the perinatal period: findings from the National Violent Death Reporting System. Obstet Gynecol. 2011;118(5):1056–1063. PMID: 22015873 PubMed
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
- Jones I, Shakespeare J. Postnatal depression. BMJ. 2014;349:g4500. PMID: 25125284 PubMed
- Eberhard-Gran M, Slinning K, Rognerud M. Screening for barseldepresjon – en kunnskapsoppsummering. Tidsskr Nor Legeforen 2014; 134: 297-301. pmid:24518477 PubMed
- Helsedirektoratet. Nasjonal faglig retningslinje for svangerskapsomsorgen. Oslo, 2018. Sist faglig oppdatert des 2019. Siden besøkt 09.03.2020 www.helsedirektoratet.no
- Nasjonal retningslinje for diagnostisering og behandling av voksne med depresjon i primær- og spesialisthelsetjenesten. IS-1561. Helsedirektoratet, des. 2009. helsedirektoratet.no
- Cooney GM, Dwan K, Greig CA, et al. Exercise for depression. Cochrane Database Syst Rev. 2013 Sep 12;9:CD004366. doi: 10.1002/14651858.CD004366.pub6. DOI
- McCurdy AP, Boulé NG, Sivak A, Davenport MH. Effects of Exercise on Mild-to-Moderate Depressive Symptoms in the Postpartum Period: A Meta-analysis. Obstet Gynecol 2017; 129: 1087-1097. pmid:28486363 PubMed
- Karyotaki E, Riper H, Twisk J, et al. Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms: A Meta-analysis of Individual Participant Data. JAMA Psychiatry 2017; 74(4): 351-359. pmid:28241179 PubMed
- Yonkers KA, Vigod S, Ross LE. Diagnosis, pathophysiology, and management of mood disorders in pregnant and postpartum women. Obstet Gynecol. 2011;117(4):961–977. PMID: 21860306 PubMed
- Scope A, Leaviss J, Kaltenthaler E, et al. Is group cognitive behaviour therapy for postnatal depression evidence-based practice? A systematic review. BMC Psychiatry. 2013;13:321. PMID: 24283266 PubMed
- Stephens S, Ford E, Paudyal P, Smith H. Effectiveness of psychological interventions for postnatal depression in primary care: a meta-analysis. Ann Fam Med 2016; 14:463. PMID: 27621164 PubMed
- Ashford MT, Olander EK, Ayers S. Computer- or web-based interventions for perinatal mental health: A systematic review. J Affect Disord 2016; 197:134. PubMed
- Van Lieshout RJ, Layton H, Savoy CD, et al. Effect of Online 1-Day Cognitive Behavioral Therapy–Based Workshops Plus Usual Care vs Usual Care Alone for Postpartum Depression A Randomized Clinical Trial. JAMA Psychiatry 2021. pmid:34495285 PubMed
- Miniati M, Callari A, Calugi S, et al. Interpersonal psychotherapy for postpartum depression: a systematic review. Arch Womens Ment Health 2014; 17:257. PubMed
- Molyneaux E, Howard LM, McGeown HR, Karia AM, Trevillion K. Antidepressant treatment for postnatal depression. Cochrane Database of Systematic Reviews 2014, Issue 9. Art. No.: CD002018. DOI: 10.1002/14651858.CD002018.pub2. DOI
- Koren G., Nordeng H.. Antidepressant use during pregnancy: the benefit-risk ratio. Am J Obstet Gynecol 2012; 207: 157-63. pmid:22425404 PubMed
- Huybrechts KF, Palmsten K, Avorn J, et al. Antidepressant Use in Pregnancy and the Risk of Cardiac Defects. N Engl J Med 2014; 370: 2397-407. PMID: 25229934 PubMed
- Furu K, Kieler H, Haglund B, et al. Selective serotonin reuptake inhibitors and venlafaxine in early pregnancy and risk of birth defects: population based cohort study and sibling design. BMJ 2015. PMID: 25888213 PubMed
- Lund N, Pedersen LH, Henriksen TB. Selective serotonin reuptake inhibitor exposure in utero and pregnancy outcomes. Arch Pediatr Adolesc Med 2009; 163: 949-54. PubMed
- Huybrechts KF, Bateman BT, Pawar A, Bessette LG, Mogun H, Levin R, Li H, Motsko S, Scantamburlo Fernandes MF, Upadhyaya HP, Hernandez-Diaz S. Maternal and fetal outcomes following exposure to duloxetine in pregnancy: cohort study. BMJ. 2020 Feb 19;368:m237. pmid: 32075794 PubMed
- Dennis C-L, Ross LE, Herxheimer A. Oestrogens and progestins for preventing and treating postpartum depression. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD001690. DOI: 10.1002/14651858.CD001690.pub2 DOI
- Stewart DE, Vigod S. Postpartum Depression. N Engl J Med. 2016 Dec;375(22):2177-2186. PMID: 27959754. PubMed
- Orsolini L, Bellantuono C. Serotonin reuptake inhibitors and breastfeeding: a systematic review. Hum Psychopharmacol. 2015 ;30:4-20. PMID: 25572308 PubMed
- Eberhard-Gran M, Eskild A, Opjordsmoen S. Use of psychotropic medications in treating mood disorders during lactation : practical recommendations. CNS Drugs. 2006;20(3):187-98. PMID: 16529525. PubMed
- Berle JO, Spigset O. Antidepressant use during breastfeeding. Curr Womens Health Rev 2011; 7: 28-34. pmid:22299006 PubMed
- Leiknes KA, Cooke MJ, Jarosch-von Schweder L, Harboe I, Høie B. Electroconvulsive therapy during pregnancy: a systematic review of case studies. Arch Womens Ment Health. 2015 Feb;18(1):1-39. PMID: 24271084 PubMed
- Molyneaux E, Telesia LA, Henshaw C, Boath E, Bradley E, Howard LM. Antidepressants for preventing postnatal depression. Cochrane Database of Systematic Reviews 2018, Issue 4. Art. No.: CD004363. DOI: 10.1002/14651858.CD004363.pub3 DOI
- Dennis C-L, Hodnett E, Reisman HM, et al. Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. BMJ 2009; 338: a3064. PMID: 19147637 PubMed
- Miller BJ, Murray L, Beckmann MM et al. Dietary supplements for preventing postnatal depression. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD009104. DOI: 10.1002/14651858.CD009104.pub2. The Cochrane Library
- Silje Folven Barlindhaug, spesialist i allmennmedisin, redaktør NEL
Tidligere fagmedarbeidere
- Randolf Terje Vågen, medisinsk fagsjef, Divisjon psykisk helsevern, St. Olavs hospital
- Olav Thorsen, spesialist allmennmedisin, Klubbgaten legesenter, Stavanger
- Gunnar Morken, spesialist i psykiatri, førsteamanuensis, Psykiatrisk Institutt, Norges teknisk-naturvitenskapelige universitet, Trondheim