POSTPARTUM DEPRESSION

Women are psychologically vulnerable in the period (weeks and months) following child birth. Out of 10 American women 1 suffers from postpartum depression and it causes considerable distress and disruption to the women and their families. It begin 2-3 weeks after delivery and can last up to one year, affecting approximately 15{d1272f9be01bb360d2e08f42defc794b644e1298a474496e050da4509a809c3c} of mothers.

POSTPARTUM MOOD DISORDERS

Postpartum blues (baby blues)

Occur in the first 2 weeks after delivery, affecting 70-80{d1272f9be01bb360d2e08f42defc794b644e1298a474496e050da4509a809c3c} of mothers. Women with postpartum blues experience mild depressive symptoms that are generally self-limited.

Postpartum depression (described in detail)

Postpartum psychosis

Occur in first 3 months after delivery, affecting 1:500 and 1:1000 mothers. The patients experience psychotic episodes.

SIGNS AND SYMPTOMS:

  • excessive guilt,
  • tearfulness
  • appetite disturbance
  • anxiety,
  • anhedonia (loss of pleasure)
  • depressed mood
  • fatigue,
  • sleep disturbance
  • suicidal ideation and recurrent thoughts of death

RISK FACTORS:

  • past history of psychiatric illness
  • depression during pregnancy
  • obstetric factors (caesarean section/ fetal or neonatal)
  • social isolation and deprivation
  • poor relationships
  • recent adverse life events (bereavement/ illness)
  • unintended pregnancy
  • severe postpartum blues

PATHOPHYSIOLOGY:

  • Family history of depression.
  • Neuroendocrine basis: include disturbance in cortisol, oxytocin, endorphins, estrogen, progesterone and thyroxin.
  • One of the theories: sudden fall in estrogen postpartum triggers a hypersensitivity of certain dopamine receptors in a predisposed group of women and may be responsible for severe mood disturbance that follows.

TREATMENT:

Most women recover without treatment within 3-6 months; however, 1 in 10 will remain depressed at one year

  • NON-PHARMACOLOGICAL: counseling, interpersonal psychotherapy and cognitive behavioral therapy are effective in cases of mild to moderate depression. Electroconvulsive therapy is considered in case of severe/refractory symptoms.
  • PHARMACOLOGICAL: tricyclic antidepressants and selective serotonin reuptake inhibitors.

Evidence of estrogen is conflicting.

 

REFERENCES:

Obstetrics by 10 teachers 19th edition

Paul bolin videos on youtube

Out of 10 American women 1 suffers from postpartum depression (American College of Obstetricians and Gynecologists, 2005

Postpartum Depression: Does Early Education Help First-time Mothers …

By Emily Pearson 2008

APA. DSM-IV-TR. The Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

Appleby L, Warner R, Whitton A, Faragher B. A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. BMJ. 1997 Mar 29. 314(7085):932-6

Dimidjian S, O’Hara MW. Pharmacotherapy or untreated antenatal depression: a false dichotomy. J Clin Psychiatry. 2009 Sep. 70(9):1321-2.

O’Hara MW. Postpartum depression: what we know. J Clin Psychol. 2009 Dec. 65(12):1258-69.

O’Hara MW, Neunaber DJ, Zekoski EM. Prospective study of postpartum depression: prevalence, course, and predictive factors. J Abnorm Psychol. 1984 May. 93(2):158-71.

(Kandell, Mc Guire, 1981; O’Hara, Rehm & Campbell, 1982; Hopkina, Marcus & Campbell, 1984; O’Hara, Zikuski, Philip & Wright, 1990;  Adrian I. Rosenfield, 2007).

(American College of Obstetricians and Gynecologists, 2002 ; Emily Pearson, 2008),

O’Hara, 1997).