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Premenstrual dysphoric disorder (PMDD) is a cyclical illness characterized by mood, behavioral, and physical symptoms that occur exclusively in the luteal phase of the menstrual cycle and remit with the [...]

The article examines areas of concern involved in psychiatric consultation with mothers suffering from postpartum medical conditions. Topics discussed include practical approach to differential diagnosis and treatment, most common reasons for inpatient psychiatric consultation, and the importance of observation of the mother's behavior with her child.

Background: Depression during pregnancy affects 5%-8% of women. While the percentage of women in the US taking serotonin reuptake inhibitors during pregnancy has risen over the last decade, pregnant women continue to report that they prefer non-pharmacologic interventions. Objective: We review the literature regarding neuromodulation techniques for major depressive disorder during pregnancy. The rationale for their use in this population, new developments, and future directions are discussed. Methods: A literature search was conducted in PubMed Plus, Ovid Medline, and Embase to collect all articles on neuromodulation for the treatment of depression during pregnancy. Key search words included electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation, transcranial direct current stimulation, neuromodulation, depression, and pregnancy. Given the sparse literature, all articles from 1960 to 2014 that addressed the use of neuromodulation in pregnancy were included. Conclusion: The data support the use of electroconvulsive therapy in all trimesters of pregnancy for major depressive disorder. New data are emerging for the use of transcranial magnetic stimulation in pregnancy, which is likely safe, but more data are needed before it can be recommended as a primary treatment modality during pregnancy. Other neuromodulation techniques have not been well studied in this population. [ABSTRACT FROM AUTHOR]

Objective: Brain derived neurotrophic factor (BDNF) is a neuroprotective peptide crucial to the development and function of the nervous system that is important for both a healthy mood and pregnancy. The aim of this study was to definitively characterize serum BDNF levels in 3rd trimester pregnant women as compared to follicular phase, non-pregnant women who had been carefully screened for the absence of psychiatric illness. Method: Twenty healthy pregnant women ≥ 28 weeks gestational age with a healthy, singleton pregnancy and 20 non-pregnant, healthy women in the follicular phase of their menstrual cycle were consecutively recruited from a general obstetrics clinic at the University of Pennsylvania from March 2010 through October 2010. Peripheral serum BDNF levels were evaluated in 20 pregnant women and 20 non-pregnant women in the follicular phase of their menstrual cycle. Results: Median serum BDNF in the pregnant group was 11781.1 pg/ml (IQR 9435.2, 15936.4) and in the non- pregnant group was 23212.5 pg/ml (IQR 14644.0, 26287.9). Serum BDNF was significantly lower in the pregnant group compared to the non-pregnant group (p = .0029). Conclusions: This study confirms that serum BDNF is significantly lower in pregnant women compared to non- pregnant, follicular phase women even in the absence of psychiatric illness. In a subset of vulnerable women, low BDNF levels may precipitate an environment that puts women and their babies at increased risk for affective or neurodevelopmental disturbances. [ABSTRACT FROM AUTHOR]

Summary Premenstrual dysphoric disorder (PMDD) can occur co-morbidly with other axis I disorders, particularly mood and anxiety disorders. The data supporting this diagnostic dilemma are reviewed in terms of methodological comparisons between studies. The point prevalence of the co-occurrence of PMDD and other psychiatric disorders is discussed as well as implications for treatment and further study. [ABSTRACT FROM AUTHOR]