Postpartum Conditions

The Blues, Depression and Psychosis

Postpartum Blues:1,2

Occurs: In 50-80 percent of women
Onset: Day 3 to day 14 postpartum
Symptom Duration: Persists several days to few weeks
Rx: Spontaneously remits 3

Symptoms

    • Mood instability/irritability
    • Weepiness
    • Sadness/feeling vulnerable
    • Lack of confidence/overwhelmed
    • Anxiety/nervousness
    • Poor concentration
    • Difficulty sleeping
    • Loss of appetite

What complicates the diagnosis?: 3

    • New mothers often think it takes time to adjust and so think their depression is normal.
    • Stigma plays a major role. – Less than 20 percent reported their symptoms to a caregiver only 33 percent believed they had a postpartum depression (Whitton, et al 1996).
    • Societal pressure creates a sense of shame or guilt in the mother who says “something’s wrong.”
    • Fear that the physician might declare the mother “unfit” and try to take away the child.
    • Mother fears that she is crazy or will become psychotic.
    • Mother's confusion on where to turn (the pediatrician, the Ob/Gyn).
    • Physicians who try to be supportive delay the diagnosis and treatment.
    • Physicians who spend too little time with the mother exploring the emotional impact of the birth.
    • Similarities between the normal issues of childbirth and symptoms of depression.
    • Depression often seen as “normal” response, stress reaction to childbirth.

Postpartum Depression: 3

Occurs: In 8-15 percent of women
Onset: 3 weeks postpartum; 50 percent by 3 months; 75 percent by 6 months
Symptom Duration: : May last from 3 to 14 months, most recover within 1 year; 30 percent have a recurrence
Rx: Early recognition of the symptoms and the risk factors outlined below 3

Symptoms

    • Depressed mood, tearfulness, despondency
    • Lack of pleasure/interest
    • Sleep disturbance (insomnia or hypersomnia)*
    • Weight loss, loss of appetite*
    • Loss of energy*
    • Psychomotor agitation or retardation*
    • Mood instability/irritability; inability to cope
    • Increased feelings of vulnerability
    • Lack of confidence/feeling overwhelmed1
    • Anxiety/nervousness
    • Poor concentration/indecisiveness memory problems*
    • Frequent thoughts of death/suicide
    • Difficulties with family, infant, husband
    • Marked fear of criticism of mothering skills

*Symptoms that are frequently considered normal sequelae of childbirth

Risk factors:

    • Past history of psychopathology and psychological disturbance during pregnancy (50-80 percent if previous postpartum depression)
    • Low social support
    • Poor marital relationship, single parenthood, irritable infant
    • Recent life events
    • Postpartum Blues sometimes referred to as “Baby Blues”
    • Depression/anxiety during pregnancy
    • Presence of antithyroid antibodies
    • History of abuse, (childhood abuse or domestic violence)
    • Baby with a disability, serious illness or extreme prematurity
    • Low family income

Other factors:

    • Parent's perception of her own upbringing
    • Unplanned pregnancy
    • Unemployment
    • Not breast feeding
    • Poor coping style
    • Longer time to conception
    • Depression in fathers
    • Having two or more children

Postpartum Psychosis: 3

Occurs: In 0.2 percent of women
Onset: First six weeks postpartum (3 to 20 days is the highest risk period)
Symptom Duration: : Lasts a few days to a month. 80 percent recover in one year (30 to 50 percent recurrence v high incidence of future affective diagnosis) 

Symptoms

    • Hyperactivity/mood instability
    • Increased rate of speech
    • Delusions (infant death, denial of birth, need to kill the baby)
    • Paranoia
    • Extreme confusion
    • Hallucinations
    • Extreme depression
    • Suicidal or homicidal feelings
    • Fatigue
    • Tearfulness

Risk Factors:

    • Previous history of affective disorder (especially psychosis or bipolar disorder)
    • Family history of affective disorder Previous postpartum psychosis
    • First pregnancy
    • C-section
    • Perinatal death; advanced maternal age; difficult labor

Treatment Do’s and Don’ts:

Professionals who specialize in the treatment of pre and postpartum depression, suggest the following: 

    • Do not assume that if she looks good she is fine
    • Do not tell her that it’s normal to feel this way after a baby
    • Do not assume that she will get better on her own
    • Do encourage her to get a comprehensive evaluation
    • Do take her concerns seriously
    • Do let her know that you are there if she needs you


A Patient’s History: Professionals who specialize in the treatment of pre and postpartum depression, suggest the importance of knowing the following information about your patient. 

    • Do you have a history of depression?
    • Are you worried about how you feel now?
    • Are you sleeping ok when the baby sleeps?
    • Do you feel you could lose control?
    • Has your appetite changed?
    • Do you worry that you are a bad mother?
    • Are you feeling particularly anxious?
    • Do you find it hard to make decisions?
    • Are you frightened to be alone with the baby?
    • Does your husband know how you feel?
    • Do you feel more irritable than normal?
    • Is there anything else you find it hard to talk about?

footnotes

  1. Pitt, B., "Maternity Blues"; British Journal of Psychiatry 1973; 122: 431-433.
  2. Whiffen, V.E., Gotlib, I.H., Infants of postpartum depressed mother, Infant Behavioral Development 1984; 7: 517 v 522.
  3. Nonacs, R.M., e-Medicine, Post Partum Depression Last Update: August 8, 2004.