Case Study 1 Depression – Perinatal depression
Mrs Wazowski, a 32 year old female is a regular customer of yours, who presents to your pharmacy requesting advice about the Nuk brand of dummy and suitable infant formula for her baby. She explains that she has become quite concerned about her baby not sleeping and more recently is worried about how her baby has been feeding and is now concerned that her breast milk is not sufficient. It has become very distressing to Mrs Wazowski. She claims that she has tried the controlled crying techniques many times for her baby but ends up all night walking the floors trying to calm her baby down and finds that it is all becoming just too hard. She is worried that her child is not putting on weight and she is doing everything that she can think of to help but nothing is working. As she is talking to you she starts to become a bit teary and you notice that she is very anxious about her circumstances.

On examination: Social history: Nonsmoker; Moderate alcohol Past medical history: Asthmatic Current Medications: Seretide® 250/25 Salbutamol inhaler prn

Questions
1. What is perinatal depression? How can it be identified and discuss what are considered associated risk factors and correlations for such a presentation?

2. What is the management of perinatal depression and when would antidepressants be considered?

3. What consideration needs to be given to any therapeutic intervention for this patient?

4. Discuss how the interaction between the mother and infant can have a role in monitoring patients and how the “circle of security” may assist with Mrs Wazowski?

5. Six years later Mrs Wazowski presents again with symptoms of depression and her doctor has tried several agents to help with her symptoms and now she is taking the maximum dose of venlafaxine that she can tolerate. Discuss what options exist to improve a patient’s mood further or to augment treatment in patients who only partial respond to antidepressant therapy