Postpartum Depression?
Q.What Is Postpartum Depression? For most people the birth of a baby is a special time of joy and excitement, but it can also be a time when women are susceptible to a clinical depression. This presents a whole new set of challenges that a new mother has to contend with in addition to caring for her newborn and herself. A depression that occurs after the birth of a baby is called a "postpartum" depression (PPD).
A.Moline and colleagues describe 2 main kinds of PPD: (1) postpartum or maternity "blues," a mild mood problem of short duration and (2) postpartum major depression, a severe and potentially life-threatening illness. Nonacs adds a third category to postpartum disorders -- postpartum psychosis. The Diagnostic and Statistical Manual (DSMIV-TR) delineates "postpartum" as a "modifier" or addition to other diagnoses. For example, a postpartum diagnosis could be described as major depression with postpartum onset, or bipolar I disorder with postpartum onset, or brief psychotic disorder with postpartum onset. Postpartum "blues" is not an official diagnostic entity but it is commonly seen by practitioners. Postpartum Blues Postpartum blues, also known as "baby blues," affect approximately 50% to 80% of new mothers. Symptoms may include mood swings with times of feeling anxious, irritable, or tearful interspersed with times of feeling well. Sleeping difficulties may also occur. The symptoms usually begin 3-4 days after delivery, worsen by days 5-7, and tend to resolve by day 12. For symptoms that last longer than 2 weeks, it is important for the individual to seek medical attention, since approximately 1 in 5 women with postpartum blues develop postpartum major depression. Postpartum Depression According to a Medscape Treatment Update on reproductive psychiatry by Misri and Kostaras, "during pregnancy, depressive symptoms such as changes in sleep and appetite are often difficult to distinguish from the normal experiences of pregnancy." Although up to 70% of women report experiencing negative mood symptoms during pregnancy, the prevalence of pregnant women who actually fulfill the diagnostic criteria for major depression is between 10% and 16%. The course of depression varies throughout pregnancy; most studies report a symptom peak during the first trimester, improvement during the second trimester, and an increase again during the third trimester. Several controlled studies have reported that between 12% and 16% of women experience a postpartum depressive episode, and this rate is as high as 26% in adolescent mothers. However, there is some disagreement over the defined time frame of the postpartum period. Although the DSMIV-TR defines PPD as a major depressive episode occurring within 4 weeks of childbirth, other studies of PPD report that symptoms manifest themselves most often in the 6-12 weeks following delivery, and several researchers have defined the postpartum period as extending from 6-12 months after the birth. PPD can also be precipitated by a miscarriage. Postpartum Psychosis Postpartum psychosis is a rare condition that occurs in approximately 1-2 per 1000 women after childbirth.The presentation can be dramatic, with onset as early as the first 48-72 hours postpartum. For the majority of women with postpartum psychosis, symptoms develop within the first 2 weeks after delivery. The earliest symptoms are typically restlessness, irritability, and sleep disturbance. In general, postpartum psychosis evolves rapidly and is characterized by depressed or elated mood, disorganized behavior, mood lability, and delusions and hallucinations. Postpartum psychosis of the bipolar type is characterized by elated mood, disorganized behavior, mood lability, and the presence of hallucinations or delusions. In extreme cases, the risks of suicide and/or infanticide are high, thus these women often require hospitalization.
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