respond to the topic,(Peripartum depression) say I agree with what you said for this and for this. and add information that deals with the same thing but is not mentioned in that work, the answers that have an argument…

at least 3 references

Peripartum Depression

Women who are depressed during pregnancy have higher rates of use of alcohol, illicit substances, and tobacco in pregnancy, with poorer nutrition and weight gain, and lower rates of prenatal care. Untreated depression in pregnancy increases the risk of low birth weight, preterm birth, and neonatal intensive care unit admission (Konstanatinou et al 2020). Peripartum Depression is one of the most common disorders of pregnancy. It has a higher morbidity and mortality risk than any other condition affecting pregnant people. Symptoms of peripartum depression persist for more than two weeks and include anhedonia, decreased energy, reduced appetite, and poor concentration (Justesen & Jourdaine, 2023).

·
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.

SSRIs are the first choice for moderate to severe peripartum depression treatment. In a randomized controlled trial comparing antidepressants with community-based psychosocial intervention for peripartum depression, SSRIs were superior, with a number needed to treat at four weeks.  Postpartum women can be sensitive to medications because of hormone effects on liver enzymes, increased volume of distribution, and increased levels of drug-binding proteins; therefore, some experts recommend starting a medication at one-half of the regular dose and titrating slowly. In contrast, pregnant women often require higher doses of medications because of larger volumes of distribution (Skånland, & Cieślar-Pobuda,2019).

SSRIs are off-label and prescribed for the treatment of bulimia nervosa leading to trials to evaluate their effect on binge eating disorder. Antidepressants that have shown promising results include 
bupropionLinks to an external site., 
duloxetineLinks to an external site., 
escitalopramLinks to an external site., 
fluvoxamineLinks to an external site., fluoxetine, imipramine, 
sertralineLinks to an external site., and 
venlafaxineLinks to an external site..  

lisdexamfetamineLinks to an external site.
, a 
prodrugLinks to an external site. of D-amphetamine, is the only FDA-approved medication for binge eating disorder and should, as a rule, be preferred over antidepressants.

A nonpharmacological intervention for treating peripartum depression is psychotherapy. Nonpharmacologic treatment strategies are similar to prevention strategies, with the U.S. Preventive Services Task Force recommending referral for psychotherapy as the mainstay of treatment. Cognitive behavior therapy and interpersonal psychotherapy are the best studied and have the most robust supporting evidence. Group and individual approaches are effective. The two most common psychotherapies include interpersonal therapy (focus on improving social interactions and coping skills) and cognitive behavioral therapy (focus on adjusting patients' self-detrimental thought processes). Interpersonal therapy has been shown to improve mood during pregnancy, but cognitive behavioral therapy has only been validated for postpartum depression (Spinelly, 2003).

·
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?

Risks of medication use during pregnancy and breastfeeding must be weighed against the risks of untreated or inadequately treated depression. Inadequately treated depression has the potential to progress to active suicidality and can lead to impaired bonding for the birth parent, impaired childhood development, and adverse pregnancy outcomes, including preterm birth, low birth weight, and hypertensive disorders. Paroxetine might be associated with major malformations, especially cardiac defects. Some evidence is available of an association between neonatal behavioral syndrome and exposure to SSRIs in utero during the last trimester. Infants with continuous exposure to mother's depression and continuous exposure to SSRIs throughout gestation were more likely to be born preterm than were infants with partial or no exposure. Guidelines suggest that SSRIs should be used with caution during pregnancy, and that paroxetine be avoided (Kupfer, Frank & Phillps, 2012).

·
Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.

·
Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder.

Consistent with the goals of the new FDA and Pregnancy and Lactation Labeling Rule, clinicians must consider the risks of untreated illness as well as pharmacotherapy-related maternal adverse reactions, infant outcomes, and birth complications when counseling patients about medications in pregnancy and postpartum. Discussion of dosing requirements during gestation and any adverse effects related to breastfeeding must also be addressed (Betcher et al, 2019). Nurse practitioners and others who prescribe these drugs need to be aware of potential adverse effects and counsel depressed pregnant women appropriately. Some of the possible risks are drug perfusion to the fetus, adverse birth outcomes, neonatal withdrawal syndrome, and impaired child development. Before nurses can help to treat depression, they must first be able to recognize it. To screen for depression, it is important to be clear about the definition, risk factors, and comorbidity of depression in pregnant women.

SSRI antidepressant use in the final trimester also has been associated with 

persistent pulmonary hypertensionLinks to an external site.
 in the newborn. Researchers utilizing the Medicaid Database with nearly 3.79 million pregnant women compared outcomes of women taking an SSRI, another class of antidepressant, or no antidepressant in the last 90 days of pregnancy. Pregnant women who discontinued their antidepressants proximal to conception were nearly three times more likely to suffer a recurrence of depressive symptoms during pregnancy than women who continued their medication. Small case series studies show that the concentrations of the SSRI 
fluoxetineLinks to an external site., 
sertralineLinks to an external site., 
citalopramLinks to an external site., and 
escitalopramLinks to an external site. decrease throughout pregnancy. Doses may need to be adjusted for pregnant women taking SSRIs. Monitoring symptoms frequently, especially in the second and 

third trimestersLinks to an external site.
, and 

dose increasesLinks to an external site.
 with early symptoms of relapse is a strategy to avoid symptom recurrence (Ververs et al, 2009).

 

Preparation for writing the Advocacy Letter

1. Choose a topic that interests you.

2. If you are unsure what to advocate for or against, look at professional organizations for inspiration:

a.
APHA

b.
ANA

c.
Maryland Public Health Association

3. Look for advocacy groups that are working on the issue. We don't have to recreate the wheel.  See what strategies the advocacy groups are supporting. For example: Brady and Gifford non-profits focus on gun policy. 

4. Decide if you want to make change within an agency, at the local, state or federal level. Find the decision maker appropriate to that level. Click here to
find your elected official.

5. If you are writing to a legislator, look at that person’s website to see their position on the issue. Please do not ‘preach to the choir’—that is, if they already support the issue, it does no good to throw more facts at them.

6. If you are addressing a national issue, and your legislator aligns with your proposed action, consider looking at the committee that would hear a bill about your issue.

a. If there is a proposed bill that has not been active, you can ask the chair of the committee to bring it back up in committee.

b. Click here to
check for federal bills.

7. If you are addressing a state issue, the Maryland General Assembly meets January- April of each year.

a. You can see if state bill on your issue was unsuccessful in 2018, and ask your legislator to re-introduce it in 2019.

b. Click here to
check for state bills.

8. For evidence to support your proposed action, use the One Search through HS/HSL for the broadest results. If you are still having trouble finding articles, the premier journal for public health research is called The Nation's Health.

9. Reminders from the rubric:

a. Include your ‘Ask’ clearly and concisely in the first paragraph. In busy offices, staff may not read the entire letter.

b. In the same vein, keep the letter one page. References can be on a second page.

c. Include your credentials. All of you are BSN Candidates (and add whatever other credentials you have). This adds a professional weight to your voice.

10. As always, please let me know of any questions.
KGR

 

Using the paradigms of health, discuss the link between health and behavior.  Describes how this relationship affects social determinants of health. 

Instructions: 

  Word limit 500 words.  Please make sure to provide citations and references (in APA, 7th ed. format) for your work.  

Concept Map: Respiratory Process

Top of Form

Bottom of Form

Module 05 Content

1.

Top of Form

Complete the
ATI Systems Disorder template for your assigned respiratory topic. Every box on the template must be completed, a citation is needed for every box, and your reference list must be included (APA). 

due 9-12-23 @10am