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Providing appropriate perinatal mental health treatment for mild/moderate anxiety/depression in our communities

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Date & Location
Thursday, July 18, 2024, 7:00 AM - Sunday, July 18, 2027, 7:30 AM

Credits
AMA PRA Category 1 Credits™ (0.50 hours), ANCC Nursing Contact Hours (0.50 hours), CME-Designated Participation Credit (0.50 hours)

Overview

Becca Casey, MSN, PMHNP-BC will discuss why we need midwives and obstetricians caring for the mental health of birthing people. She will also provide a brief review of screening for depression/anxiety and evidenced-based treatments for mild/moderate depression/anxiety. She will convey common side effects with antidepressant treatment and strategies to mitigate those side effects and share resources for non-psychiatric providers to utilize.

Presenter

Becca Casey, MSN, PMHNP-BC
Psychiatric Nurse Practitioner, Department of Psychiatry
DHMC, Lebanon, NH 

About our Presenter

Becca has a BA from Simmons College (2005) and MSN from Yale School of Nursing (2011).  In 2012, she completed a behavioral health fellowship at Harvard Vanguard Medical Associates in Chelmsford, MA. She has spent 13 years providing psychiatric care directly and as a consultant at various community health organizations in New England. She is currently a psychiatric nurse practitioner at Dartmouth Hitchcock Medical Center and faculty member at Dartmouth Geisel Medical School since 2018. She has spent six years working embedded in our obstetrics and gynecology department supporting the mental health of the perinatal population with director, Julie Frew MD. She also provides proactive inpatient consult service on DHMC’s medical floors. She contributes as an educator to psychiatric nurse practitioners and medical residents. She is a member of the International Marcé Society for Perinatal Mental Health. She has pursued advanced perinatal mental health training with Postpartum Support International (PSI), MGH women’s mental health and the National Curriculum of Reproductive Psychiatry (NCRP). She is currently pursuing certification in reproductive psychiatry with NCRP’s year-long training program.


Learning Objectives
At the conclusion of this learning activity, participants will be able to:

  1. Describe one new prescribing approach for managing anxiety or depression in perinatal individuals with mental health conditions.
  2. Discuss approaches that can make the treatment of PMHC more strengths-based and collaborative.

Accreditation

In support of improving patient care, Dartmouth Health is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

American Medical Association (AMA)
Dartmouth Health designates this Enduring Material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

American Nurses Credentialing Center (ANCC)
Dartmouth Health designates this Enduring Material for a maximum of 0.50 ANCC contact hours.

All other learners may claim CME-designated participation credit. Consult your professional licensing board regarding the applicability and acceptance of CME-designated participation credit for programs certified for credit by organizations accredited by Joint Accreditation for Interprofessional Education.

Registration/Requirements for Successful Completion
You may claim credit for successful completion of this online course. In order to claim credit, you must follow these steps:

  1. Click the Register tab above. If you are not logged into your account, you will need to log in. Use the Forgot Your Password? button if you need to reset your password.
  2. Register for the activity.
  3. Click the Content/Tests tab and then View Content to view the recording. View the entire presentation.
  4. Complete the Post-Test (attestation - return to the Content/Tests tab to find it).
  5. Click the Complete Evaluation button, or click My Account in the menu bar; then click Evaluations.
  6. Complete and Submit the Evaluation.

Bibliographic Sources

  • Anxiety-in-Pregnancy-the-Postpartum. (n.d.). Parlab.med.ubc.ca. Retrieved April 22, 2024, from https://parlab.med.ubc.ca/infographic-on-anxiety-in-pregnancy-the-postpartum/anxiety-in-pregnancy-the-postpartum/

  • Breslau N. Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Can J Psychiatry. 2002 Dec;47(10):923-9. https://doi.org/10.1177/070674370204701003. PMID: 125531

  • CIDI-based Screening Scale for Bipolar Spectrum Disorders - Overview. (n.d.). https://www.ohsu.edu/sites/default/files/2021-10/%28CIDI%29%20Screening%20Scale%20for%20Bipolar%20Spectrum%20Disorders.pdf

  • Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P. T., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P. A., & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet, 391(10128), 1357–1366. https://doi.org/10.1016/s0140-6736(17)32802-7

  • Contributor, S., & Nagle-Yang. (n.d.). SSRIs and Pregnancy Risk-Risk Conversation Trainee Guide. Retrieved April 28, 2024, from https://ncrptraining.org/wp-content/uploads/2019/10/Depression_Risk-Risk_Classroom_Trainee-Guide_Final_V1.pdf

  • Francisca, Veringa-Skiba, I. K., Sauer, A., Esther, & Bögels, S. M. (2023). Cost-Effectiveness of the Mindfulness-Based Childbirth and Parenting Program for Pregnant Women With Fear of Childbirth. Journal of Obstetric, Gynecologic & Neonatal Nursing. https://doi.org/10.1016/j.jogn.2023.10.004

  • Frew, J. (2024, April 18). Management of Anxiety and Depression in the OB/Gyn Clinic Setting [Power point Management of Anxiety and Depression in the OB/Gyn Clinic Setting].

  • Frew, J., Thorsness, K., Hutner, L., & Saadatmand, J. (n.d.). Perinatal Anxiety Disorders Self-Study Contributors Updated in 2022 by. Retrieved April 28, 2024, from https://ncrptraining.org/wp-content/uploads/2022/03/Perinatal-Anxiety_Self-Study_v2.pdf

  • Generalized Anxiety Disorder 7-item (GAD-7) scale. (n.d.). https://www.dartmouth-hitchcock.org/sites/default/files/2021-02/gad-7-anxiety-scale.pdf

  • Genovez M, Vanderkruik R, Lemon E, Dimidjian S. Psychotherapeutic Treatments for Depression During Pregnancy. Clin Obstet Gynecol. 2018 Sep;61(3):562-572. https://doi.org/10.1097/GRF.0000000000000388. PMID: 29965823

  • Goldfinger, C., Green, S. M., Furtado, M., & McCabe, R. E. (2019). Characterizing the nature of worry in a sample of perinatal women with generalized anxiety disorder. Clinical Psychology & Psychotherapy, 27(2). https://doi.org/10.1002/cpp.2413

  • Grace SL, Evindar A, Stewart DE. The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Arch Womens Ment Health. 2003 Nov;6(4):263-74. https://doi.org/10.1007/s00737-003-0024-6. PMID: 14628179

  • Health, M. C. for W. M. (2023, December 28). New Oral Drug Zuranolone (Zurzuvae) for Postpartum Depression is Now Available - MGH Center for Women’s Mental Health. https://womensmentalhealth.org/posts/new-oral-postpartum-drug-zuranolone-available/

  • Hutner, L. A., Catapano, L. A., Nagle-Yang, S. M., Williams, K. E., Osborne, L. M., & American Psychiatric Association Publishing (2022). Textbook of women’s reproductive mental health. American Psychiatric Association Publishing.

  • Huybrechts KF, Bateman BT, Palmsten K, Desai RJ, Patorno E, Gopalakrishnan C, Levin R, Mogun H, Hernandez-Diaz S. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA. 2015 Jun 2;313(21):2142-51. https://doi.org/10.1001/jama.2015.5605. PMID: 26034955; PMCID: PMC4761452

  • Jain, A., & Mitra, P. (2023). Bipolar Disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558998/

  • Katon, W., & Reed, S. (2014). Improving Depression Care in OB-GYN Settings. Psychiatric News, 49(15), 1–1. https://doi.org/10.1176/appi.pn.2014.8a15

  • Leistikow, N., Baller, E. B., Bradshaw, P. J., Riddle, J. N., Ross, D. A., & Osborne, L. M. (2022). Prescribing Sleep: An Overlooked Treatment for Postpartum Depression. Biological Psychiatry. https://doi.org/10.1016/j.biopsych.2022.03.006

  • Mazzoni S, Brewer S, Durfee J, Pyrzanowski J, Barnard J, Dempsey AF, O'Leary ST. Patient Perspectives of Obstetrician-Gynecologists as Primary Care Providers. J Reprod Med. 2017 Jan-Feb;62(1-2):3-8. PMID: 29999273

  • Montejo AL, Prieto N, de Alarcón R, Casado-Espada N, de la Iglesia J, Montejo L. Management Strategies for Antidepressant-Related Sexual Dysfunction: A Clinical Approach. J Clin Med. 2019 Oct 7;8(10):1640. https://doi.org/10.3390/jcm8101640. PMID: 31591339; PMCID: PMC6832699

  • Montejo AL, Prieto N, de Alarcón R, Casado-Espada N, de la Iglesia J, Montejo L. Management Strategies for Antidepressant-Related Sexual Dysfunction: A Clinical Approach. J Clin Med. 2019 Oct 7;8(10):1640. https://doi.org/10.3390/jcm8101640. PMID: 31591339; PMCID: PMC6832699

  • Pan, WL., Chang, CW., Chen, SM. et al. Assessing the effectiveness of mindfulness-based programs on mental health during pregnancy and early motherhood - a randomized control trial. BMC Pregnancy Childbirth 19, 346 (2019). https://doi.org/10.1186/s12884-019-2503-4

  • Pearlstein T. Perinatal depression: treatment options and dilemmas. J Psychiatry Neurosci. 2008 Jul;33(4):302-18. PMID: 18592032; PMCID: PMC2440793

  • Pfizer (1999). The Patient Health Questionnaire (PHQ-9) -overview. https://coepes.nih.gov/sites/default/files/2020-12/PHQ-9%20depression%20scale.pdf

  • Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) - PTSD: National Center for PTSD. (2014). Va.gov. https://www.ptsd.va.gov/professional/assessment/screens/pc-ptsd.asp

  • Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) (n.d.) https://www.ptsd.va.gov/professional/assessment/documents/pc-ptsd5-screen.pdf

  • Psychiatric Medications: Perinatal and Lactation Considerations Approaching Risk/Risk Discussions around Lithium and Anticonvulsants, SGAs, and Benzos. (n.d.). Retrieved May 5, 2024, from https://ncrptraining.org/wp-content/uploads/2019/12/Risk-Risk_Medications-in-Pregnancy-Self-Study_Trainee.pdf

  • Reza N, Deligiannidis KM, Eustis EH, Battle CL. Complementary Health Practices for Treating Perinatal Depression. Obstet Gynecol Clin North Am. 2018 Sep;45(3):441-454. https://doi.org/10.1016/j.ogc.2018.04.002. PMID: 30092920.

  • Simas, M. (n.d.). Retrieved April 18, 2024, from https://www.umassmed.edu/globalassets/lifeline4moms/implementation-guide/lifeline-for-moms-toolkit-obstetric-care-clinician-algorithms.pdf

  • Sockol, L. E. (2018). A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women. Journal of Affective Disorders, 232, 316–328. https://doi.org/10.1016/j.jad.2018.01.018

  • UpToDate. (n.d.) https://www.uptodate.com/contents/switching-antidepressant-medications-in-adults#H4

  • Whitton A, Warner R, Appleby L. The pathway to care in post-natal depression: women's attitudes to post-natal depression and its treatment. Br J Gen Pract. 1996 Jul;46(408):427-8. PMID: 8776916; PMCID: PMC1239697.

  • Zimmermann M, Julce C, Sarkar P, McNicholas E, Xu L, Carr C, Boudreaux ED, Lemon SC, Byatt N. Can psychological interventions prevent or reduce risk for perinatal anxiety disorders? A systematic review and meta-analysis. Gen Hosp Psychiatry. 2023 Sep-Oct;84:203-214. https://doi.org/10.1016/j.genhosppsych.2023.08.005. Epub 2023 Aug 16. PMID: 37619299; PMCID: PMC10569160.

Provider Contact Information
Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
CE Office
Dartmouth Health
[email protected]



Mitigation of Relevant Financial Relationships


Dartmouth Health adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education.  Any individuals in a position to control the content of a CE activity, including planners, faculty, authors, or others are required to disclose all financial relationships with ineligible companies^.  All relevant financial relationships have been mitigated prior to the commencement of the activity.

^Ineligible Company is any entity whose primary business purpose is producing, marketing, selling, re-selling or distributing healthcare products used by or on patients.



Member Information
Role in activity
Nature of Relationship(s) / Name of Ineligible Company(s)
Karen G Lee, C-TAGME
Educational Conference Coordinator
Dartmouth Hitchcock Medical Center
Activity Coordinator
Nothing to disclose
Emily Baker, MD
MFM Physician
Dartmouth Hitchcock Medical Center
Course Director
Nothing to disclose
Rebecca A Casey, APRN
APRN
Dartmouth Hitchcock Medical Center
Faculty
Nothing to disclose
Julie S Bosak, DrPH, APRN, CNM
Executive Director NNEPQIN and NHPQC
Dartmouth Hitchcock Medical Center
Other Planning Committee Member
Nothing to disclose
Victoria A Flanagan, RN, MS
Perinatal Outreach Educator
Dartmouth Hitchcock Medical Center
Other Planning Committee Member
Nothing to disclose

Providing appropriate perinatal mental health treatment for mild/moderate anxiety/depression in our communities
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