8/12/2019 38679301 Postpartum Depression
1/47
D. Wolocko, Daily News
By
Ricardo J. Fernandez, M.D., DFAPACouncilor, NJ Psychiatric Association
8/12/2019 38679301 Postpartum Depression
2/47
Post!artu" De!ression#
Psychiatric Syndromesof the
Postpartum Period
8/12/2019 38679301 Postpartum Depression
3/47
$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.
8/12/2019 38679301 Postpartum Depression
4/47
Wo"en are at serious risk
%or de'elo!in* a!sychiatric illness a%ter
child(irth.
D. Wolocko, Daily News
8/12/2019 38679301 Postpartum Depression
5/47
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.
8/12/2019 38679301 Postpartum Depression
6/47
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
8/12/2019 38679301 Postpartum Depression
7/47
First, let us discuss the
!ro!er ter"inolo*y %orthese disorders.
8/12/2019 38679301 Postpartum Depression
8/47
Post!artu" De!ression#is a *eneral ter" used in
our society to descri(eany!sychiatric illness
occurrin* a%ter child(irth.
8/12/2019 38679301 Postpartum Depression
9/47
)n reality,
Post!artu" De!ression
descri(es only oneo%%our syndro"es that can
occur a%ter child(irth.
8/12/2019 38679301 Postpartum Depression
10/47
$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:
8/12/2019 38679301 Postpartum Depression
11/47
;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.
8/12/2019 38679301 Postpartum Depression
12/47
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
Post!artu" De!ression
Post!artu" Psychosis
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
8/12/2019 38679301 Postpartum Depression
13/47
Post!artu" Psychosis
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.
8/12/2019 38679301 Postpartum Depression
14/47
Now, lets discuss thes!eci%ic syndro"es.
8/12/2019 38679301 Postpartum Depression
15/47
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
8/12/2019 38679301 Postpartum Depression
16/47
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.
8/12/2019 38679301 Postpartum Depression
17/47
$he rest o%
the syndro"es to(e descri(ed are
all considered!sychiatric illnesses
and (ene%it %ro" clinicaltreat"ent.
8/12/2019 38679301 Postpartum Depression
18/47
Post!artu" Psychosis
)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
8/12/2019 38679301 Postpartum Depression
19/47
=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
8/12/2019 38679301 Postpartum Depression
20/47
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.
8/12/2019 38679301 Postpartum Depression
21/47
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.
Bri*ht.Am *am Physician. 1>>3 40- 4>4.=uri and Burt. + Pract Psychiatry $ehav ,ea%th. 1>>6 2- 56.
8/12/2019 38679301 Postpartum Depression
22/47
Post!artu" De!ression
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
Bri*ht.Am *am Physician. 1>>3 40- 4>4.=uri and Burt. + Pract Psychiatry $ehav ,ea%th. 1>>6 2- 56.
8/12/2019 38679301 Postpartum Depression
23/47
nset o% =y"!to"s in
Post!artu" De!ression$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?
8/12/2019 38679301 Postpartum Depression
24/47
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
8/12/2019 38679301 Postpartum Depression
25/47
Post!artu" De!ression
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
Bri*ht.Am *am Physician. 1>>3 40- 4>4.=uri and Burt. + Pract Psychiatry $ehav ,ea%th. 1>>6 2- 56.
8/12/2019 38679301 Postpartum Depression
26/47
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
8/12/2019 38679301 Postpartum Depression
27/47
=y"!to"s
Fre+uently =een in
Post!artu" De!ression
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
8/12/2019 38679301 Postpartum Depression
28/47
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.
8/12/2019 38679301 Postpartum Depression
29/47
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
8/12/2019 38679301 Postpartum Depression
30/47
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
8/12/2019 38679301 Postpartum Depression
31/47
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.
8/12/2019 38679301 Postpartum Depression
32/47
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
8/12/2019 38679301 Postpartum Depression
33/47
What a(out
(reast %eedin*E
$he incidence o% (reast
%eedin* in (irthin* "othersis increasin* as the ne&t
slide shows.
) id % B t F di
8/12/2019 38679301 Postpartum Depression
34/47
)ncidence o% Breast Feedin*
1>5@001
80%
49%
28%
20%
37%
52%
5661%
1926-
1930
1951-
1955
1966-
1970
1972 1975 1998 2000 2001
Briggs, Freeman, Yafee,Drugs in Pregnancy and Lactation, 1998
Maternity Surey,Parents Express, !"i#$,!$, 4&01, 4&02
8/12/2019 38679301 Postpartum Depression
35/47
GGa reasona(lea reasona(le
o!tiono!tionin Post!artu"in Post!artu"
De!ression EDe!ression E
Breast %eedin*GBreast %eedin*G
8/12/2019 38679301 Postpartum Depression
36/47
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.
8/12/2019 38679301 Postpartum Depression
37/47
$here are risk %actors that
!redis!ose wo"en to!ost!artu" disorders.
8/12/2019 38679301 Postpartum Depression
38/47
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
8/12/2019 38679301 Postpartum Depression
39/47
)n addition, there are"any societal and
cultural %actors that "ay!redis!ose wo"en to
!ost!artu" !ro(le"sincludin*...
8/12/2019 38679301 Postpartum Depression
40/47
IsolationIsolation
Diminishedextended family
Involvement.
8/12/2019 38679301 Postpartum Depression
41/47
Distorted and glamorized perceptions
of pregnancy
8/12/2019 38679301 Postpartum Depression
42/47
and ofrecovery
in thepostpartum...
8/12/2019 38679301 Postpartum Depression
43/47
frequentlypromoted
in themedia.
8/12/2019 38679301 Postpartum Depression
44/47
As well as unrealistic
expectations of the postpartum mother
8/12/2019 38679301 Postpartum Depression
45/47
)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.
8/12/2019 38679301 Postpartum Depression
46/47
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
8/12/2019 38679301 Postpartum Depression
47/47
Top Related