Support and Training to Enhance Primary Care for Postpartum Depression

Follow-Up in Primary Care Settings

Regardless of the treatment option chosen, it is important for the provider to follow up on the patient’s progress. Depending on the type of treatment, follow-up visits to monitor the patient’s progress should occur at least every 4-8 weeks. Intermittent follow-up may be done through regular follow-up visits with the patient, contacting conferring providers (once the necessary releases of information are obtained), or telephone contact with the woman. Be sure to assess the patient’s safety, ability to care for herself and her baby, and her overall mood.

If a woman is being treated with medication(s), assess for side effects and the effectiveness of the chosen medication. Initially, it may be necessary to offer reassurance if the medication has not yet begun working, and to assist the patient in using other coping mechanisms until the medications become effective. Data show that when patients are given information on a continual basis about what to expect during treatment, informed that antidepressants are not addictive, and reminded about the importance of continuing medication, they have a lower discontinuation rate. 96 Follow-up ensures the patient is compliant with the treatment plan, the treatment is having a therapeutic effect, and reassures her that additional support is available if needed. Taking time to effectively treat PPD is critical, as the consequences of untreated or mistreated PPD are serious and may be irreversible.

TOP

Assessing Treatment Effectiveness

There are a number of ways to assess whether a treatment modality is having an effect:

  • Re-administer the same PPD screening tool and monitor changes in the score
  • Ask the woman to rate her mood, energy level, and cognitive functioning
  • Observe the woman’s affect, mood, and psychomotor functioning
  • Obtain family reports of the woman’s functioning to assess whether she is improving

A judgment should also be made about whether the treatment benefits the woman; that is, is it leading to sufficient improvement or response? In every case, the goal of treatment is complete response and remission of depression.

The effectiveness of the treatment must also be weighed against any side effects to determine if the benefits of treatment continuation outweigh the negative consequences of treatment, or the risk of relapse.

Managing Relapse

Even the most well executed treatment plan may result in relapse, despite a high level of engagement in treatment. Just as the causes of PPD are unknown, the causes of relapse remain an enigma. The same risk factors for becoming depressed make a woman vulnerable to relapse, as well as new stressors, biochemical changes, and a myriad of other factors. If relapse occurs, offer reassurance that you remain dedicated to helping the patient recover and that she needs to remain engaged in treatment. If treatment was discontinued, consider re-initiating the same treatment; if treatment was ongoing, reassess to see if another form of treatment is necessary. Reassurance is particularly important at this point to encourage the woman to continue to take medications as prescribed and follow through with treatment recommendations.

Impact of untreated PPD 7 11 27 31 54

TOP

Conclusion

By now, you should be familiar with the basic research findings on PPD treatments and treatments used for depression in general, and you can apply this knowledge when making clinical decisions on how to best address PPD with your patients. You should also be familiar with non-pharmacologic treatment options and how to make referrals when indicated. Finally, you should be able to provide effective follow-up treatment for your patients, including assessing treatment effectiveness and determining whether a change of course is indicated.

By now, you should be familiar with the basic research findings on PPD treatments and treatments used for depression in general. You should also be familiar with nonpharmacologic treatment options and how to make referrals when indicated. Finally, you should be able to provide effective follow-up treatment for your patients, including assessing treatment effectiveness and determining whether a change of course is indicated.

The following assessment will measure your knowledge of these and other principles covered in the previous STEP-PPD modules. Upon successful completion, you will receive a certificate of completion, which can be saved or printed for Continuing Education or other use.

TOP