Transcript Postpartum Depression

Postpartum mothers are at significant
risk of developing a psychiatric illness
severe enough to require hospitalization
as the next slide demonstrates.
This increased risk lasts for about two years
after childbirth.
Admissions to a Psychiatric Hospital:
2 Years Pre and Post Delivery
70
Admissions/Month
60
50
40
30
20
Pregnancy
10
0
–2 Years
– 1 Year
Childbirth
+1 Year
+2 Years
First, let us discuss the proper
terminology for these disorders.
“Postpartum Depression” is a general term used in
our society to describe any psychiatric illness
occurring after childbirth.
In reality,
Postpartum Depression describes only one of
four syndromes that can occur after childbirth.
4 Postpartum syndromes are:
1. Maternity or Postpartum Blues
2. Postpartum Psychosis
3. Adjustment Disorder of the Postpartum Period
4. Major Depression in the Postpartum
(Postpartum Depression)
Unfortunately, common reference to all four
conditions as “Postpartum Depression” creates
confusion and fear.
Postpartum Psychosis,
most severe and dangerous condition, is
relatively rare
quite different from Postpartum Depression, as the
next slide demonstrates.
Spectrum of Postpartum
Mood Changes
Transient,
nonpathologic
100%
90%
Incidence
80%
70%
60%
50%
40%
30%
20%
10%
0%
Medical
emergency
Serious,
disabling
Postpartum Blues
risk for Postpartum
 Depression
Postpartum Depression
50% to 70%
2/3 have onset by
6 wks postpartum
Postpartum Psychosis
10%
70% are affective
(Bipolar, Major
Depression)
0.01%
Maternity or Postpartum Blues
• Is not considered a psychiatric illness and is
unrelated to psychiatric history .
• Occurs in 26 to 85% of birthing mothers. The
exact incidence is unclear.
• Present in all cultures studied
• Appears unrelated to environmental stressors
• BABY BLUES
• You’ve just had a baby. You expected to be basking in new mom
bliss. You expected to be celebrating the arrival of your little
one with your friends and family. But instead of celebrating, you
feel like crying. You were prepared for joy and excitement—not
exhaustion, anxiety, and weepiness.
You may not have been expecting it, but mild depression
and mood swings are common in new mothers.
In fact, this post-delivery depression is so common that it
has its own name: the baby blues.
Up to 85% of new mothers experience the
baby blues.
Maternity or Postpartum Blues
Many new moms feel happy one minute and sad
the next. If you feel better after a week or so, you
probably just had the "baby blues."
If it takes you longer to feel better, you may have
postpartum depression.
“Blues” = heightened reactivity, not clinical depression
• Mood swings from weepiness to extreme happiness and
heightened reactivity
Occurs 3 to 5 days after childbirth.
It is self limiting, resolving in about a week.
If occurs, increases risk for Postpartum Depression.
• In addition to moodiness and sadness, the baby blues can include
difficulty sleeping, irritability, appetite changes, and concentration
problems.
Symptoms typically show up within a few days of giving birth and
last from several days to a couple of weeks.
The baby blues are considered to be a normal part of new
motherhood—probably caused by the hormonal changes that occur
following birth.
If you have them, there is no cause for undue worry. The baby blues
usually don’t last very long and will go away on their own once your
hormones level out.
Aside from the support of your loved ones and plenty of rest, no
treatment is necessary. However, if your symptoms don’t go away within
two to three weeks, or they are severe (such as suicidal thoughts or an
inability to care for your newborn), you may be suffering from a more
serious condition known as postpartum depression.
The rest of the syndromes to
be described are all considered
psychiatric illnesses and
benefit from clinical treatment.
1. Postpartum Psychosis
• Is relatively rare, occurring one to three cases per
1000 births
Is a severe and life threatening condition for both
mother and infant
Develops soon after birth, often within two weeks,
usually within a month
Requires intense treatment and hospitalization: A
medical emergency
Is usually followed by Postpartum Depression
1. Symptoms of Postpartum Psychosis
Very rarely, new moms may stop eating, have trouble
sleeping and become frantic or paranoid.
Women with this condition usually need to be hospitalized.
• Delusions: False beliefs, often of a religious
nature and very frequently involving the
infant
• Perceptual distortions: Seeing or hearing
things which are not present
• Often, feelings of excessive well being or
importance
2. Adjustment Disorder of the
Postpartum Period
• Occurs in about 20% of birthing mothers but
incidence is unclear as many women with this
problem do not seek treatment.
• Manifests as excessive difficulties adjusting to
motherhood.
• If emotional symptoms exist, they are not as severe
as those seen in Postpartum Depression
Bright. Am Fam Physician. 1994; 50: 595.
Suri and Burt. J Pract Psychiatry Behav Health. 1997; 3: 67.
2. Adjustment Disorder of the
Postpartum Period
• Can resolve without treatment over time
• but can cause ongoing difficulties for the
mother.
• Can develop into Postpartum Depression if
more severe and untreated.
• Responds well to short term psychotherapy.
Bright. Am Fam Physician. 1994; 50: 595.
Suri and Burt. J Pract Psychiatry Behav Health. 1997; 3: 67.
3. POSTPARTUM DEPRESSION
• Occurs in 10% of birthing mothers
– 20% if the mother has had Maternity Blues
Occurs usually within 6 weeks of birth but
can occur up to a year after birth
Unlike the "baby blues," postpartum
away quickly.
depression does not go
3. Onset of Symptoms in Postpartum Depression
Time of Onset of Postpartum Depression in 413 Patients
The more severe, the earlier the onset.
Percentage of Patients
60
Severe, needed hospital admission
Mild, treated by general practitioner
40
20
0
Within Two Weeks
Six Weeks
Six Months
3. Postpartum Depression: Symptom Onset
• 40%: After first postnatal visit
– At 6 weeks
• 20%: Coincided with weaning
• 16%: At return of menstruation
– At 2 to 3 months if not breast feeding
• 14%: Initiation of oral contraceptives
3. POSTPARTUM DEPRESSION
Postpartum depression manifests as symptoms of depression
can make you feel restless, anxious, fatigued and worthless.
Some new moms worry they will hurt themselves or their babies.
Can develop gradually or suddenly/abruptly after birth
usually sets in soon after childbirth and develops gradually
over a period of several months.
• in some women, the first signs don’t appear until months after
they’ve given birth. Because of the possibility of delayed onset,
if you have a depressive episode within six months of having a
baby, postpartum depression should be considered.
3. POSTPARTUM DEPRESSION
symptoms are either longer• lasting or more severe.
• Anxiety is also more prominent in postpartum depression. If you
have postpartum depression, you may worry to excess over your
baby’s health and well-being.
• In addition to obsessing over the safety of your newborn, you
may be troubled by intrusive thoughts about harming your baby.
SIGNS AND SYMPTOMS OF POSTPARTUM DEPRESSION
Lack of interest in your baby
Negative feelings towards your baby
Worrying about hurting your baby
Lack of concern for yourself
Loss of pleasure
Lack of energy and motivation
Feelings of worthlessness and guilt
Changes in appetite or weight
Sleeping more or less than usual
Recurrent thoughts of death or suicide
What are the symptoms of
Depression?
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–
–
–
–
Sadness of mood most of the day, nearly every day
Diminished interest or pleasure in usual activities
Major change in appetite or weight
Not able to sleep or sleeping too much
Agitation or feeling slowed down
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate
guilt
– Diminished ability to think or concentrate, or
indecisiveness
– Recurrent thoughts of death, dying, or suicide
APA Diagnostic and Statistical Manual. 1994
3. Symptoms
Frequently Seen in
Postpartum Depression
• Marked agitation and anxiety
• Mother can not sleep even when the baby
is sleeping
• Obsessions and compulsions about the
baby
What are obsessions and
compulsions?
• An obsession is a repetitive, intrusive and disturbing
thought that enters the mind and is out of the
individual's control.
• A compulsion is a repetitive act that is done in an
attempt to be rid of the obsessional thought.
• Both cause great anxiety and discomfort in the
individual.
Postpartum obsessions
• Commonly focused on infant
• Thoughts(obsessions) of hurting the infant
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Dropping infant
Drowning infant
Stabbing infant
Putting infant in oven or microwave
Sexually abusing infant
Thoughts that someone will steal or harm the infant
Postpartum compulsions
• Commonly follow the obsessions as an attempt to
alleviate the thought
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–
–
–
–
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Avoid holding baby by staircases, etc
Avoid bathing infant
Hide knives
Avoid kitchen area
Avoid changing diapers or bathing infant
Avoid leaving the house
Although the presence of obsessions and
compulsions indicates need for treatment,
these mothers are rarely dangerous to the
infants.
They are actually at higher risk to hurt
themselves as a result of their fear of possibly
hurting the infant.
The Impact of Postpartum Depression on Children
Behavioral problems Children of depressed mothers are more likely to develop
behavioral problems down the line, including sleep
problems, temper tantrums, aggression, and hyperactivity.
Delays in cognitive
Development is often delayed in babies and children who
development
have depressed mothers. They may learn to walk and talk
later than other children. They may also have many other
learning difficulties, including problems with school.
Social problems
Children of depressed mothers have difficulty establishing
secure relationships. They may find it hard to make friends
in school. They may be socially withdrawn, or they may act
out in destructive ways.
Emotional problems Studies have show that children of depressed mothers
have lower self-esteem, are more anxious and fearful, are
more passive, and are less independent.
Depression
The risk of developing major depression early in life is
particularly high for the children of mothers with
postpartum depression.
Causes
The rapid hormonal changes that accompany pregnancy and
delivery may trigger depression.
After childbirth, women experience a big drop in estrogen and
progesterone hormone levels.
Thyroid levels can also drop, which leads to fatigue and
depression.
These hormone dips—along with the changes in blood
pressure, immune system functioning, and metabolism that
new mothers experience—can all play a part in postpartum
depression.
Causes
Women who have just given birth are also dealing with
numerous changes, both physical and emotional.
They may still be coping with physical pain from the
pregnancy and delivery.
They may also have difficulties losing the baby weight, leading
to insecurities about their physical and sexual attractiveness.
In addition to changes to their body, they are also dealing with
lifestyle changes. The lifestyle adjustment can be particularly
difficult for first time moms, who must get used to an entirely
new identity. The stress of caring for a newborn can also take
a toll. New mothers are often sleep deprived. In addition, they
may feel overwhelmed and anxious about their ability to
properly care for their baby. All of these factors can contribute
to and trigger postpartum depression.
Risk Factors that predispose women to
postpartum disorders.
•
•
•
•
•
•
•
•
First pregnancy
Young age
Psychiatric illness during pregnancy
Prior history of postpartum illness
Prior history of mental illness
Family history of mental illness
Recent stressful life events
Problems in the marriage
In addition, there are many SOCIETAL AND
CULTURAL factors that may predispose women to
postpartum problems including...
Isolation…
…Diminished extended family Involvement.
Unrealistic expectations of the
postpartum mother
Distorted and glamorized perceptions
of pregnancy…
…and of
recovery
in the
postpartum...
…frequently
promoted
in the
media.
How is Postpartum Depression
treated?
• Psychiatric medication
– Antidepressants:
• In particular, those that increase release of serotonin
in the brain
– Medicines for anxiety and to help with sleep
• Individual, couples and family psychotherapy
In summary, postpartum psychiatric
illness exists.
It can be debilitating and dangerous to
both mother and child.
Effective treatments are available.
Support groups of mothers in recovery
are also available in many areas of the
country.
Postpartum Depression Action Plan
Patient __________________________
Physician/NP/PA __________________nic ____________________________
Phone Number ____________________
Choose one area and add other areas as you begin to feel better.
1. Stay active.
Make time every day to do some physical activity, such as walking for 10 to 20 minutes or dancing to a
favorite song.
Every day during the next week I will spend at least ______ minutes doing
___________________________ .
2. Do something that you think is fun each day.
Even though you may need to work a little more at having fun, try doing something that has always
been fun such as a hobby, listening to music or watching a favorite TV show.
Every day during the next week I will spend at least ______ minutes doing
___________________________ .
3. Spend time with people who help or support you.
When you are feeling down it is easy to avoid people, but you
should not be alone all the time. Choose people who you can
talk to or who can do your activities with you. Try to talk to
them about how you feel. But it's okay if you can’t talk about
it your feelings at first, too.
During the week I will make contact for at least
______ minutes with ______________________
(name), doing or talking about
______________________ .
4. Relaxing.
For many people with depression, it is hard to stop feeling sad or having
unhappy thoughts. Learning to relax can help. Try taking slow deep breaths,
saying comforting things quietly to yourself or taking a warm bath.
Every day during the next week I will practice relaxing at least ____
times for at least ____ minutes each time.
5. Set simple goals.
Do not expect too much too soon. Do simple things such as reading a few pages
of a magazine or fixing a cup of tea or cocoa. Delay big decisions until you are
feeling better. Give yourself credit for each thing you do. Break work into small
steps.
What I want to do is
_______________________________________
___________________________________________________
______
Step 1
______________________________________
___________________
Step 2
______________________________________
____________________
How likely are you to do the above things during the
next week?
Very likely
Maybe
Unsure
Not very likely