Postpartum Depression Disease

DESCRIPTION

Postpartum depression, postpartum blues and postpartum psychosis are the three main behavioral conditions that may take place in women following the delivery.

System(s) affected: Nervous
Genetics: N/A
Incidence/Prevalence in USA: 10-15% of new mothers develop postpartum depression.
Predominant age: Women of reproductive age. It has been described in mothers adopting a baby.
Predominant sex: Female

SIGNS AND SYMPTOMS

Most women will have some of these symptoms, not all

Depressed mood
Sadness
Crying spells
Fatigue
Sleep disturbances (insomnia or hypersomnia)
Appetite disturbances (poor appetite or excessive eating)
Poor concentration
Feelings of helplessness
Feelings of hopelessness
Fears of harming the baby
Lack of interest in the baby
Feelings of guilt and inadequacy
Feelings of worthlessness and low self-esteem
Fears of harming oneself
Sudden mood swings
Lability of affect
Excessive concern with the baby's health
Poor libido, no interest in sex
Anxiety symptoms
Feelings of gloom and doom
Dizziness and rapid breathing
Heart palpitations
Obsessive and intrusive thoughts

CAUSES

Unknown. Perhaps multifactorial, including: biological-genetic predisposition in terms of brain chemistry, sudden drop in estrogen and progesterone levels at delivery, socioeconomic stress

RISK FACTORS

Previous episodes of postpartum depression
Previous episodes of depression
History of depression during pregnancy
Family history of depression
Early childhood losses
Growing up with alcoholic dysfunctional parents
Unwanted pregnancy
Presence of socioeconomic stress
Lack of social and family support system

LABORATORY

TSH
Estrogen and progesterone levels may be helpful (often low)

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

Polysomnograms for sleep apnea and/or daytime sleepiness. Sleep EEG to confirm short REM latency prognosticating a better response to antidepressants.
Psychological testing for personality/character disorders and provide clues for the best choice of nonpharmacological therapies

IMAGING

Head CT/MRI rarely needed

DIAGNOSTIC PROCEDURES

Neuropsychological testing
Projective psychological testing
Beck, Hamilton and Zung depression inventories may provide information on the severity of the depression and suicidal risks

APPROPRIATE HEALTH CARE

Most patients respond to outpatient individual psychotherapy in combination with pharmacotherapy
Support/therapy groups helpful
Assess for homicidal and suicidal ideations
Visiting nurse services can provide direct observations of the mother regarding safety issues and bonding
Assess (consider psychiatrist consultation) patients for psychotic symptoms - if psychotic delusions or hallucinations present, immediate hospitalization needed. The psychotic mother should not be left alone with the baby.

GENERAL MEASURES

Proper sleep and rest for the new mother are very important for stable mood.
Patient education and bibliotherapy for the patient and her family are helpful and valuable
ECT: Some patients who cannot tolerate the antidepressant medication, or who are actively engaged in suicidal self-destructive behaviors or who have a previous history of responding favorably to ECT should be seriously considered for treatment with ECT

SURGICAL MEASURES

N/A

ACTIVITY

Based on patients physical condition

DIET

Good nutrition and hydration
The addition of a multivitamin with minerals may be helpful

PATIENT EDUCATION

Patient and family education helpful
Encourage the patient to read, for example:
- "That Isn't What I Expected: Overcoming Postpartum Depression" by Karen R. Kleinman and Valerie Davis Radkin, 1994
- "Sleepless Days: One Woman's Journey Through Postpartum Depression" by Susan Kushner Resnick, 2000
- "A Mother's Tears: Understanding the Mood Swings that Follow Childbirth", by Arlene M. Huysman, 1998
- "Overcoming Postpartum Depression and Anxiety", by Linda Sebastian, 1998.

PREVENTION/AVOIDANCE

Routinely assess women in the third trimester for depression, to identify depression and begin treatment before or immediately after delivery.
Self-rating depression scales (e.g., Zung depression scale or the Beck depression scale) helpful

POSSIBLE COMPLICATIONS

Self inflicted violence and suicide attempts
Psychotic delusions
Neglect of baby
Harm to the baby

EXPECTED COURSE AND PROGNOSIS

Generally good. Improvement expected within a few months to a year. Some patients, particularly those with personality disorders, develop chronic depression requiring long term treatment.

ASSOCIATED CONDITIONS

Bipolar mood disorder
Depressive disorder not otherwise specified
Dysthymic disorder
Cyclothymic disorder

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: Teenage mothers are more susceptible.

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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