38679301 postpartum depression

8/12/2019 38679301 Postpartum Depression

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D. Wolocko, Daily News

By

Ricardo J. Fernandez, M.D., DFAPACouncilor, NJ Psychiatric Association


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Post!artu" De!ression#

Psychiatric Syndromesof the

Postpartum Period


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$his !resentation is %or

the e&clusi'e use o% theNew Jersey Psychiatric

Association we(site

and %or the !ur!oses o% consu"erin%or"ation and education.

)t "ay not (e otherwise

re!roduced or !resented withoutthe knowled*e and consent o%

Ricardo J. Fernandez, M.D.


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Wo"en are at serious risk

%or de'elo!in* a!sychiatric illness a%ter

child(irth.

D. Wolocko, Daily News


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Post!artu" "others are at

si*ni%icant risk o% de'elo!in* a!sychiatric illness se'ere

enou*h to re+uire

hos!italization as the ne&t

slide de"onstrates.

$his increased risk lasts %ora(out two years a%ter

child(irth.


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Ad"issions to a Psychiatric os!ital-

/ears Pre and Post Deli'ery

Kendell RE et al.Br J Psychiatry.1987;150:662; presented at WMH, Berlin 2001.

0

10

0

20

30

40

50

60

Ad

"issions7Month

Pregnancy

2 Years 1 Year Childbirth +1 Year +2 Years


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First, let us discuss the

!ro!er ter"inolo*y %orthese disorders.


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Post!artu" De!ression#is a *eneral ter" used in

our society to descri(eany!sychiatric illness

occurrin* a%ter child(irth.


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)n reality,

Post!artu" De!ression

descri(es only oneo%%our syndro"es that can

occur a%ter child(irth.


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$he %our syndro"es are-

Maternity or Post!artu" Blues

Post!artu" Psychosis

Ad8ust"ent Disorder o% the

Post!artu" Period

Ma8or De!ression in the Post!artu"

9Post!artu" De!ression:


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;n%ortunately, co""on re%erence

to all %our conditions as

Post!artu" De!ression# createscon%usion and %ear.

)t is i"!ortant to understand that

Post!artu" Psychosis, the "ostse'ere and dan*erous condition,

is relati'ely rare and +uite

di%%erent %ro" Post!artu"De!ression, as the ne&t slide

de"onstrates.


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Cohen >?-1-1?@5.

0A

10A

.0A

20A

30A

40A

50A

60A

?0A

>0A

100A

$ransient,$ransient,non!atholo*icnon!atholo*ic

MedicalMedicale"er*encye"er*ency

=erious,=erious,disa(lin*disa(lin*

Post!artu" Blues



40 to 60

100.01

2/3 have onset by

6 wks postpartum

risk for Postpartum

Depression

!" are affective#$ipo%ar& 'a(or

Depression)

=!ectru" o% Post!artu"

Mood Chan*es

Incidence

Incidence


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is o%ten "isla(eledin the "edia as

Post!artu" De!ression,creatin* "uch an&iety

and %ear in wo"en with

the less se'ere

!ost!artu" disorders.


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Now, lets discuss thes!eci%ic syndro"es.


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Maternity or Post!artu"

Blues )s notconsidered a !sychiatric illness and is

unrelated to !sychiatric history .

ccurs in 5 to ?4 o% (irthin* "others. $he

e&act incidence is unclear. Present in all cultures studied

A!!ears unrelated to en'iron"ental stressors


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Maternity or Post!artu"

BluesBlues# hei*htened reacti'ity,

not clinical

de!ression Mood swin*s %ro" wee!iness to e&tre"e

ha!!iness and hei*htened reacti'ity

ccurs 2 to 4 days a%ter child(irth. )t is sel%

li"itin*, resol'in* in a(out a week.

)% occurs, increases risk %or

Post!artu" De!ression.


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$he rest o%

the syndro"es to(e descri(ed are

all considered!sychiatric illnesses

and (ene%it %ro" clinicaltreat"ent.


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)s relati'ely rare, occurrin* one to three cases!er 1000 (irths

)s a se'ere and li%e threatenin* condition %or(oth "other and in%ant

De'elo!s soon a%ter (irth, o%ten within twoweeks, usually within a "onth

Re+uires intense treat"ent andhos!italization- A "edical e"er*ency

)s usually %ollowed (y Post!artu" De!ression


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=y"!to"s o% Post!artu"

Psychosis Delusions- False (elie%s, o%ten o% a

reli*ious nature and 'ery %re+uently

in'ol'in* the in%ant Perce!tual distortions- =eein* or

hearin* thin*s which are not !resent

%ten, %eelin*s o% e&cessi'e well(ein* or i"!ortance


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Ad8ust"ent Disorder o%

the Post!artu" Period ccurs in a(out 0 o% (irthin* "others

(ut incidence is unclear as "any wo"en

with this !ro(le" do not seek treat"ent. Mani%ests as excessivedi%%iculties ad8ustin*

to "otherhood.

)% e"otional sy"!to"s e&ist, they are not

as se'ere as those seen in Post!artu"De!ression

Bri*ht.Am *am Physician. 1>>3 40- 4>4.=uri and Burt. + Pract Psychiatry $ehav ,ea%th. 1>>6 2- 56.


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Ad8ust"ent Disorder o%

the Post!artu" Period Can resol'e without treat"ent o'er

ti"e (ut can cause on*oin*

di%%iculties %or the "other. Can de'elo! into

Post!artu" De!ression i% "orese'ere and untreated.

Res!onds well toshort ter" !sychothera!y.



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ccurs in 10 o% (irthin* "others

0 i% the "other has had Maternity

Blues.

ccurs usually within 5 weeks o%

(irth (ut can occur u! to a year a%ter

(irth



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nset o% =y"!to"s in

Post!artu" De!ression$wo =tudies

2. Time of Onset of Postpartum epression in !1" Patients

$he "ore severe, the ear%ierthe onset.

#

2#

!#

$#

%ithin T&o %ee's (i) %ee's (i) *onths

Percentage

ofPatients

(eere, needed hospital admission

*ild, treated by general practitioner

1. Time of Onset of Postpartum epression in "1- %omenWithin 13 Days

35

Within 5 Weeks

13

Within 2 Months

Within 5 Months

1?


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Post!artu" De!ression-

=y"!to" nset

30- A%ter %irst !ostnatal 'isit

At 5 weeks

0- Coincided with weanin*

15- At return o% "enstruation At to 2 "onths i% not (reast %eedin*

13- )nitiation o% oral contrace!ti'es


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Mani%ests as sy"!to"s o%

de!ression, o%ten with "arked

an&iety7a*itation and o(sessionsa(out har" co"in* to the child.

Can de'elo! *radually or

a(ru!tly a%ter (irth



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What are the sy"!to"s

o% De!ressionE =adness o% "ood "ost o% the day, nearly e'ery day

Di"inished interest or !leasure in usual acti'ities

Ma8or chan*e in a!!etite or wei*ht

Not a(le to slee! or slee!in* too "uch

A*itation or %eelin* slowed down

Fati*ue or loss o% ener*y Feelin*s o% worthlessness or e&cessi'e or ina!!ro!riate *uilt

Di"inished a(ility to think or concentrate, or indecisi'eness

Recurrent thou*hts o% death, dyin*, or suicide

APA Dia*nostic and =tatistical Manual. 1>>3


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=y"!to"s

Fre+uently =een in


Marked a*itation and an&iety

Mother can not slee! e'en when the

(a(y is slee!in*

(sessions and co"!ulsionsa(out the (a(y


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What are o(sessions and

co"!ulsionsE An o(session is a re!etiti'e, intrusi'e and

distur(in* thou*ht that enters the "ind

and is out o% the indi'iduals control. A co"!ulsion is a re!etiti'e act that is

done in an atte"!t to (e rid o% the

o(sessional thou*ht.

Both cause *reat an&iety and disco"%ort

in the indi'idual.


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Post!artu" o(sessions

Co""only %ocused on in%ant

$hou*hts9o(sessions: o% hurtin* the in%ant

Dro!!in* in%ant

Drownin* in%ant

=ta((in* in%ant

Puttin* in%ant in o'en or "icrowa'e

=e&ually a(usin* in%ant

$hou*hts that so"eone will steal or har"the in%ant


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Post!artu" co"!ulsions

Co""only %ollow the o(sessions as an

atte"!t to alle'iate the thou*ht

A'oid holdin* (a(y (y staircases, etc A'oid (athin* in%ant

ide kni'es

A'oid kitchen area

A'oid chan*in* dia!ers or (athin* in%ant A'oid lea'in* the house


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Althou*h the !resence o%o(sessions and co"!ulsions

indicates need %or treat"ent,

these "others are rarelydan*erous to the in%ants. $hey are

actually at hi*her risk to hurt

the"sel'es as a result o% their %earo% !ossi(ly hurtin* the in%ant.


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ow is Post!artu"

De!ression treatedE Psychiatric "edication

Antide!ressants-

)n !articular, those that increase releaseo% serotonin in the (rain

Medicines %or an&iety and to

hel! with slee!

)ndi'idual, cou!les and %a"ily

!sychothera!y


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What a(out

(reast %eedin*E

$he incidence o% (reast

%eedin* in (irthin* "othersis increasin* as the ne&t

slide shows.

) id % B t F di


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)ncidence o% Breast Feedin*

1>5@001

80%

49%

28%

20%

37%

52%

5661%

1926-

1930

1951-

1955

1966-

1970

1972 1975 1998 2000 2001

Briggs, Freeman, Yafee,Drugs in Pregnancy and Lactation, 1998

Maternity Surey,Parents Express, !"i#$,!$, 4&01, 4&02


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GGa reasona(lea reasona(le

o!tiono!tionin Post!artu"in Post!artu"

De!ression EDe!ression E

Breast %eedin*GBreast %eedin*G


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Althou*h all "edications

cross into (reast "ilk,there are a %ew

antide!ressants thata!!ear to cross less than

others and "ay (e sa%er

in (reast %eedin*.

Consult your doctor.


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$here are risk %actors that

!redis!ose wo"en to!ost!artu" disorders.


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Risk Factors

First !re*nancy

/oun* a*e

Psychiatric illness durin* !re*nancy Prior history o% !ost!artu" illness

Prior history o% "ental illness

Fa"ily history o% "ental illness Recent stress%ul li%e e'ents

Pro(le"s in the "arria*e


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)n addition, there are"any societal and

cultural %actors that "ay!redis!ose wo"en to

!ost!artu" !ro(le"sincludin*...


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IsolationIsolation

Diminishedextended family

Involvement.


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Distorted and glamorized perceptions

of pregnancy


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and ofrecovery

in thepostpartum...


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frequentlypromoted

in themedia.


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As well as unrealistic

expectations of the postpartum mother


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)n su""ary, !ost!artu"

!sychiatric illness e&ists.

)t can (e de(ilitatin* and

dan*erous to (oth "other

and child.H%%ecti'e treat"ents are

a'aila(le. =u!!ort *rou!s o%

"others in reco'ery are alsoa'aila(le in "any areas

o% the country.


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For "ore in%or"ation-

Consult with your doctor

Contact-

De!ression@A%ter@Deli'ery 9DAD: www.De!ressionA%terDeli'ery.co"

De!ression and Bi!olar =u!!ort Alliance 9DB=A:

Phone- ?00@?5@252

We(-www.DB=Alliance.or* New Jersey Psychiatric Association

Phone- ?00@234@0132


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38679301 postpartum depression

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