For a diagnosis of major depressive disorder: five symptoms

are required.

symptoms must be present for most of the day,

occurring more days than not, for a 2-week period.

For minor depressive disorder 2,3,or 4 symptoms must be present.  Must include depressed mood or lack of pleasure.

symptoms must be present for most of the day,

occurring more days than not, for a 2-week period.

1. Depressed mood

2. Lack of pleasure (anhedonia)

3. Psychomotor slowing or agitation

4. Sleep disturbance (sleeping too much or not enough)

5. Fatigue or loss of energy

6. Eating too much or not enough

7. Concentration difficulties

8. Diminished self-esteem or guilt

9. Suicidal thoughts or recurrent thoughts of death

• Studies have shown that screening all pregnant women will identify a significant number of women with depression that otherwise may not have been identified
  
  
• About 15-30% of women will screen positive

1. I have been able to laugh and see the funny side of things. 

2. I have looked forward with enjoyment to things. 

3. * I have blamed myself unnecessarily when things went 

4. I have been anxious or worried for no good reason. 

5. * I have felt scared or panicky for not very good reason. 

6. * Things have been getting on top of me. Yes, most of the time I haven't been able to cope at all 

7. * I have been so unhappy that I have had difficulty sleeping. 

8. * I have felt sad or miserable. 

9. * I have been so unhappy that I have been crying. 

10. The thought of harming myself has occurred to me. 

Response categories are scored 0, 1, 2, and 3 according to increased severity of the 

symptoms. Items marked with an asterisk are reverse scored (i.e. 3, 2, 1, and 0). The total 

score is calculated by adding together the scores for each of the ten items. 

• In the past two weeks have you felt down, depressed, or hopeless?”, and
• In the past 2 weeks have you had little interest or pleasure in doing things?”

Cognitive behavioral therapy (CBT)

Interpersonal therapy (IPT)

Electroconvulsive therapy (ECT)

Light Therapy

• Most widely used medications for treatment of mood disorders in pregnancy
• Includes citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxitine, (Paxil), and sertraline (Zoloft)
• All SSRIs are FDA Category C except paroxetine (Category D) for risk in pregnancy
• Usually first line treatment for mood disorders in pregnancy, because less side effects than TCAs
• Usually a single daily dose

• TCAs also affect reuptake of nurotransmitters, but because their reuptake is less selective, they often will have more side effects and thus may not be the first option when choosing an antidepressant
• Amyltriptyline, desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Aventil, Pamelor), protriptyline (Vivactil), and timipramine (Surmontil)
• Side effects include: drowsiness, blurred vision, dry mouth, constipation, urinary retention, dizziness, headache, photophobia, sexual dysfunction
• Fetal effects of TCAs: similar to those of SSRIs—does not appear to be overall increased risk of anomalies, but neonatal withdrawal type effects have been noted
• Desiprimine and nortriptyline are preferred in pregnancy because they have fewer sedative and hypotensive maternal side effects