Postpartum "Blues" transient period of mild depression, mood instability, anxiety, decreased concentration, increased concern...
Postpartum "Blues"
- transient period of mild depression, mood instability, anxiety, decreased concentration, increased concern over own health and health of baby – considered to be normal emotional changes related to the puerperium
- occurs in 50-80% of mothers; begins 2-4 days postpartum, usually lasts 48 hours, can last up to 10 days
- does not require psychotropic medication
- patient at increased risk of developing postpartum depression
Postpartum Depression (PPD)
- diagnosis: MDE, onset within 4 weeks postpartum
- clinical presentation:
- typically lasts 2 to 6 months; residual symptoms can last up to 1 year
- may present with psychosis - rare (0.2%), usually associated with mania, but can be MDE
- severe symptoms include extreme disinterest in baby, suicidal and infanticidal ideation
- epidemiology: occurs in 10% of mothers, risk of recurrence 50%
- risk factors
- previous history of a mood disorder (postpartum or otherwise)
- psychosocial factors: stressful life events, unemployment, marital conflict, lack of social support, unwanted pregnancy, colicky or sick infant
- treatment
- psychotherapy
- short-term safety of maternal SSRIs for breastfeeding infants established; long-term effects unknown
- supportive, non-directive counselling by trained home visitors
- if depression severe, consider ECT
- prognosis: impact on child development - increased risk of cognitive delay, insecure attachment, behavioural disorders; treatment of mother improves outcome for child at 8 months through increased mother-child interaction
