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