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Clinical Review Quiz

Psychopharmacologic Management of Depression in Pregnant Women and Breastfeeding Mothers

William R. Marchand, MD,
and John W. Thatcher, MD

Dr. Marchand is acting associate director, Department of Veterans Affairs VISN 19 MIRECC, and an assistant professor of psychiatry, University of Utah, Salt Lake City, UT. Dr. Thatcher is a clinical instructor in psychiatry; University of Utah, Salt Lake City, UT.



The questions below are based on the article
“Psychopharmacologic Management of Depression in Pregnant Women and Breastfeeding Mothers”.


Choose the single best answer for each question.


1. A 24-year-old woman presents to her primary care physician at 1 week postpartum with symptoms of depression. She describes feeling “blue” every day since she delivered. She reports that instead of feeling joy at the birth of her child as she had expected, her mood is gloomy and she is not able to enjoy being a new mother. The patient is concerned about her mood and does not know “what is wrong with her.” Which of the following is the most appropriate intervention?
  1. Immediately initiate treatment with sertraline
  2. Psychiatric hospitalization
  3. Reassurance and close monitoring
  4. Refer for psychotherapy
  5. Refer to a psychiatrist
Click here to compare your answer.


Questions 2 to 4 refer to the following case.

A 30-year-old breastfeeding woman presents to her primary care physician at 5 weeks postpartum. She reports 3 weeks of daily sadness and fatigue. Her husband states that she does not seem to enjoy life anymore and is frequently tearful. Sleep and appetite have increased, and she reports feeling hopeless. Physical examination and routine laboratory tests are unremarkable.


2. Which of the following is the most important step in the evaluation of this patient’s symptoms?

  1. Beck Depression Inventory
  2. Evaluation for delirium
  3. Evaluation for suicidal ideation
  4. Psychologic testing
  5. Thorough neurologic examination
Click here to compare your answer.


3. Which of the following is most important to rule out?
  1. Alcohol-induced mood disorder
  2. Bipolar depression
  3. Panic disorder
  4. Schizophrenia
  5. Somatization disorder
Click here to compare your answer.


4. Further evaluation reveals that the patient has severe major depression. She has no prior history of depression or any other psychiatric illness or treatment. What is the most appropriate intervention?

  1. Initiate treatment with sertraline
  2. Initiate treatment with venlafaxine
  3. Reassurance and close monitoring
  4. Refer for psychotherapy
  5. Refer to a psychiatrist
Click here to compare your answer.


5. A 27-year-old woman who is 5 months pregnant presents to her primary care physician with moderate depressive symptoms. She reports multiple episodes of depression starting around age 15 years. She has tried 4 different antidepressants in the past but does not feel that they were very helpful. What is the most appropriate intervention?

  1. Initiate a trial with the antidepressant that previously worked best
  2. Psychologic testing
  3. Refer for psychotherapy
  4. Refer to a psychiatrist
  5. Start citalopram
Click here to compare your answer.


 

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