IMPACT of UNTREATED POSTPARTUM DEPRESSION

Dr Violet Okech- HeluDepartment of Mental Health, KNH

Email:violet.okech@gmail.com

Postpartum Depression: The Facts

• Depression is one of the commonest, treatable yet undiagnosed mental health disorders with a HUGE impact on bio-psycho-social functioning.

• Approximately 10% of mothers experience postpartum depression.• Numbers could be higher due to under-diagnosis.• Left untreated can severely affect the

mother,baby,father, siblings and wider society.

Baby blues or Postpartum depression?

• Many women experience the "baby blues" after childbirth.

• Symptoms• Mood swings• Crying easily,• Poor concentration• Irritability• Sadness• Resolve within 1-2 weeks• Due to hormonal changes & physiological changes

• Postpartum Depression• More severe symptoms Last longer than 2 weeks• Interfere with Mom’s

ability to care for:• Baby• Herself• Family• Daily tasks• In postpartum psychosis hallucinations may pose

harm to the baby or Mom

Postpartum depression(PPD)

• Loss of appetite• Insomnia• Intense irritability and

anger• Overwhelming fatigue• Loss of interest in sex• Lack of joy in life• Feelings of shame, guilt

or inadequacy

• Severe mood swings• Difficulty bonding with

your baby• Withdrawal from family

and friends• Thoughts of harming

yourself or your baby• NB:PPD is not a sign of

weakness nor mom’s fault. It’s a disease.

Postpartum psychosis

• Symptoms• Confusion and

disorientation• Hallucinations and

delusions• Paranoia• Attempts to harm

yourself or your baby• An EMERGENCY!

Mom’s should seek help if.. • Symptoms last more than

two weeks• Are getting worse• Difficulty in baby care• Difficulty in completing

everyday tasks• Have thoughts of harming

self or your baby

Risks for postpartum depression

• Previous depression, either during pregnancy or at other times

• Previous postpartum depression

• Recent stressful events.. complicated pregnancy

illness, job loss.• Bipolar mood disorder

• Unplanned or unwanted pregnancy

• Financial difficulties• Young, unwed mother• Problems with spouse

or baby’s dad/family• Weak social support

system • Please Screen for these

risks actively…

Edinburgh Postnatal Depression Scale• The Edinburgh Postnatal Depression Scale (EDPS) was

developed in 1987 to help doctors determine whether a mother may be suffering from postpartum depression.

• The scale has since been validated and confirmed to be both reliable and sensitive in detecting depression.

• During the postpartum period, 10 to 15% of women develop significant symptoms of depression or anxiety.

• Unfortunately, many moms are never treated, and although they may be coping, their enjoyment of life and family dynamics may be seriously affected.

Edinburgh Postnatal Depression Scale• In the past 7 days:• 1. I have been able to laugh and see the funny side of things -• a. As much as I always could

b. Not quite so much nowc. Definitely not so much nowd. Not at all

• 2. I have looked forward with enjoyment to things -• a. As much as I ever did

b. Rather less than I used toc. Definitely less than I used tod. Hardly at all

• 3. I have blamed myself unnecessarily when things went wrong -• a. Yes, most of the time

b. Yes, some of the timec. Not very oftend. No, never

• 4. I have been anxious or worried for no good reason -• a. No, not at all

b. Hardly everc. Yes, sometimesd. Yes, very often

Edinburgh Postnatal Depression Scale• 5. I have felt scared or panicky for no good reason -• a. Yes, quite a lot

b. Yes, sometimes• c. No, not much

d. No, not at all• 6. Things have been getting on top of me -• a. Yes, most of the time I haven’t been able to cope at all

b. Yes, sometimes I haven’t been coping as well as usualc. No, most of the time I have coped quite welld. No, I have been coping as well as ever

• 7. I have been so unhappy that I have had difficulty sleeping -• a. Yes, most of the time

b. Yes, some of the timec. Not very oftend. No, not at all

• 8. I have felt sad or miserable -• a. Yes, most of the time

b. Yes, some of the timec. Not very oftend. No, not at all

• 9. I have been so unhappy that I have been crying -• a. Yes, most of the time

b. Yes, quite oftenc. Only occasionallyd. No, never

• 10. The thought of harming myself has occurred to me -• a. Yes, quite often

b. Sometimesc. Hardly everd. Never

Impact on baby

• Difficulty in attachment and breastfeeding• Difficulty in regulating emotion• Reduced cognitive ability• Poor social skills and the ability to from

successful relationships• Increased fussiness and irritability• Increased risk of mental illness in later life-

elevated cortisol, reduced dopamine and serotonin

Impact on baby

• Difficulty in matching facial expression to emotion

• Reduced ability to show empathy-conduct disorder, later development of psychopathic behaviour?...

• Increased impulsivity• Increased social withdrawal• Decreased access to healthcare options,

immunization etc..

Impact on mother/father/family• Decreased use of postpartum care for Mum and

child• Reduced chances or time for breastfeeding• Inconsistent parenting leading to reduced ability

of children to listen to and obey instructions• Increased likelihood of marital conflict over sex

and family roles• Maternal withdrawal or over-intrusiveness• Possible harm to baby in psychotic episodes

Managing Postpartum depression

• Early detection• Medication• Psychotherapy-personal and couple• Destigmatization of PPD• Increasing social support• Mom “me” time/selfcare• Promoting adherence to treatment