Postpartum Major Depression
Postpartum major depression is not:
Baby blues - usually 4-5 days postpartum and consist of a mild mood disturbance without the pervasive dysphonia characteristic of major depression. Resolves usually in 10 days. 70% of new mothers will experience this.
Postpartum psychosis - mood disorders (most commonly bipolar disorder), symptoms include disorganization, bizarre behavior, elation, and rapid mood changes. Treat with antipsychotics. These mothers are high at risk for infantcide and suicide. Occur in 0.1% of mothers.
"Normal Obsessional Thoughts" - Distinguish between psychotic and normal "obsessional thoughts" (50% of mothers); e.g., it is normal to think about weird thoughts like strangling the baby (however this is abnormal if a voice is telling her to do so)
10-15% of new mothers, depression in postpartum period, same symptoms as depression
Must meet depression criteria in DSM IV:
Specifies "with postpartum onset" if onset of episode is within 4 weeks postpartum.
Edinburgh Postnatal Depression Scale - can fill out questionnaire; self-assess whether they are depressed or not
previous episode(s) of depression
history of/current difficult life events ("stress")
family history of psychiatric disorder
diminished psychosocial support
"Sensitivity to hormonal fluctuations"; hormonal treatment - not proven to work, more than just hormonal fluctuations, maybe her body is more sensitive to hormonal fluctuation.
Thyroid dysfunction, especially hypothyroidism
Bipolar disorder - depressed; may influence treatment of antidepressants
Co-morbid psychiatric diagnoses: substance abuse, anxiety disorder, eating disorders, personality disorders
- ONE of either:
- depressed mood (often with severe anxiety)
- markedly diminished interest or pleasure in activities (anhydonia)
- AND 4 of the following:
- sleep disturbance (can you go to sleep after you nurse)
- appetite/weight disturbance (food taste funny- not normal)
- physical agitation or retardation
- fatigue/decreased energy (excessive)
- worthlessness or excessive guilt (panic disorders)
- decreased concentration/indecisiveness
- thoughts of death or suicidal ideation
- AND the symptoms must be present for most of the day, nearly everyday, for two weeks.
Psychotherapy if moderate depression, but also consider medication and ECT.
Support groups (national network: Depression after Delivery)
Studies currently conducted at Women’s Mental HealthCARE
- Tricyclic antidepressants (e.g. nortriptyline) and some SSRIs (setraline, paroxetine, fluvoxamine) are compatible with breast feeding, at or below level of detection (5 ng/mL), does not cause birth defect, abnormal loss, behavioral problems
- Fetal exposure to depression itself?
- Fluoxetine (Prozac) considered not compatible with breastfeeding
- Follow treatment guidelines for treatment of major depressive episode:
- Acute treatment to symptom remission
- Continuation treatment for 9-12 months
- Maintenance treatment as indicated
- Treatment of PPMD
- Prevention of PPMD
- Prevention of postpartum bipolar episodes
- Antidepressant use during pregnancy