Postpartum mood disorders
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Postpartum Mood Disorders. Dr:Eman Elsheshtawy Ass. Prof. Psychiatry. Baby Blues. Postpartum Depression. Postpartum Psychosis. Baby Blues. Transient Heightened emotional reactivity 50-85% women experience baby blues Peaks 3-5 days after delivery Lasts up to 10-14 days.

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Postpartum Mood Disorders

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Postpartum mood disorders

Postpartum Mood Disorders

Dr:Eman Elsheshtawy

Ass. Prof. Psychiatry


Postpartum mood disorders

Baby Blues

Postpartum

Depression

Postpartum

Psychosis


Baby blues

Baby Blues

Transient

Heightened emotional reactivity

50-85% women experience baby blues

Peaks 3-5 days after delivery

Lasts up to 10-14 days


Baby blues1

Baby Blues

Considered normal experience of childbirth

Symptoms can be distressing

Usually don’t affect mother’s ability to function and care for child


Baby blues2

baby blues

Characteristics:

Mild mood swings

Irritability

Anxiety

Decreased concentration

Insomnia

Tearfulness

Crying spells


What causes baby blues

What Causes Baby Blues?

Two leading hypothesis:

Abrupt hormone withdrawal

Ovarian steroid receptors in CNS are heavily concentrated in the limbic system

The magnitude of the postpartum drop in estrogens and progesterone correlates with presence of “blues”; absolute levels don’t

Neuroactive steroids (pregnanolone, allopregnanolone) decrease postpartum, affecting GABA


Biological attachment hypothesis

biological attachment hypothesis

  • Neurobiological systems foster attachment between mammalian mothers & infants

  • Oxytocin activates limbic structures (e.g. the ACG) that mediate the interface between attention & emotion

  • Postpartum reactivity may stem from this

  • With stressors, depression may result


Postpartum mood disorders

Baby Blues

Postpartum

Depression


Postpartum depression

Postpartum Depression

About 10% of women after delivery

Average duration 7 months

¼ still affected at child’s first birthday

Overlooked and under diagnosed


Postpartum mood disorders

Female is a 27 year old mother brought into my office as an urgent care appointment. She just had a baby 4 weeks ago after much anticipation. Her husband is an only child and her in-laws filled the nursery with toys and clothes for the baby and are very excited.

She is unable to sleep and eat, extremely doubtful of her ability to do anything.

She is preoccupied with the fear that she will harm the baby and intense guilt of her inability to meet the expectations of the family.

She has been thinking that how easy it is kill herself than to be this worthless


Postpartum depression effects

Postpartum Depression: Effects

Depression negatively effects:

  • Mother’s ability to mother

  • Mother—infant relationship

  • Emotional and cognitive development of the child


Postpartum depression maternal attitudes

Postpartum Depression:Maternal Attitudes

  • Infants perceived to be more bothersome

  • Make harsh judgments of their infants

  • Feelings of guilt, resentment, and ambivalence toward child

  • Loss of affection toward child


Postpartum depression maternal behaviors

Postpartum Depression:Maternal Behaviors

  • Gaze less at their infants

  • Take longer to respond to infant’s utterances

  • Show fewer positive facial expressions

  • Lack awareness of their infants


Familial implications

Familial Implications

Negative interactive patterns with infant

Children exposed to maternal psychiatric illness have:

  • Higher incidence of conduct disorders

  • Inappropriate aggression

  • Cognitive and attention deficits


Intellectual effects

Intellectual Effects

  • London study 2001 demonstrated lower IQ’s in 11 year olds whose mothers were depressed at 3 months age

  • Increased behavior concerns and ADHD (sp. in boys)

  • Shorter duration of breastfeeding in PPD

  • Continued breastfeeding in PPD was protective


Ppd why do we miss it

PPD: Why do we miss it?

  • Patient, society, and physicians dismiss or minimize patients experiences as “normal”

  • Patient without a primary care physician don’t know who to turn to

  • Women’s fear and shame about not being a “good mother”

  • Patients don’t present with CC of depression


Dsm iv major depression postpartum onset

DSM-IV: Major Depression, Postpartum Onset

  • Noted in medical history since Hippo crates Recognized in DSM-IV in 1994

  • Major depression that occurs within 4 weeks of delivery

    • Definition used by researchers usually allows up to 6 months

  • 5 symptoms, every day, at least 2 weeks

    AND functional impairment


Dsm iv major depression symptoms

DSM-IV Major Depression Symptoms

Depressed mood

Lack of pleasure or interest

Appetite disturbance or weight loss*

Sleep disturbance*

Physical agitation or psychomotor slowing

Fatigue, loss of energy*

Feelings of worthlessness or excessive guilt

Diminished concentration, or indecisiveness*

Thoughts of death or suicidal ideation ,Thoughts of harming infant


Mild severe

Mild Severe

Severe Symptoms:

  • Thoughts of dying

  • Thoughts of suicide

  • Wanting to flee or get away

  • Being unable to feel love for the baby

  • Thoughts of harming the baby

  • Thoughts of not being able to protect the infant

  • Hopelessnes


Causes of ppd

Causes of PPD

  • Cause unclear

  • Rapid decline in reproductive hormones

  • Several factors increase risk


Predictors of ppd

Predictors of PPD

  • Prior episodes depression, anxiety, OCD, bipolar d/o, eating d/o

    • Prior depression = 25% risk PPD

    • Prior PPD = 50% risk recurrent PPD

  • Stressful life events

  • FHx mood disorders

  • Hx of PMDD

  • Inadequate social support


Unrelated factors of ppd

Unrelated Factors of PPD

  • Education level

  • Sex of infant

  • Breastfeeding

  • Mode of delivery

  • Planned or unplanned pregnancy


Risk factors for development of post partum depression

Risk Factors for Development of Post Partum Depression

During Pregnancy

A young and single mother

H/O Mental illness or substance abuse

Financial or relationship difficulties

Previous Pregnancy or postpartum depression

After Birth

Labor/Birth Complications

Low confidence as a parent

Problems with Baby’s Health

Lack of supports

Major Life change at the same time as birth of the baby


Postpartum mood disorders

Baby Blues

Postpartum

Depression

Postpartum

Psychosis


Postpartum psychosis

Postpartum Psychosis

2:1,000 births

Psychiatric emergency

Usually within 3 weeks

Usually manifestation of bipolar d/o

70% women experience recurrence in PPP


Ppp symptoms

PPP Symptoms

  • Severe disturbances

  • Rapidly evolving manic episodes

  • Dramatic presentation

  • Initial signs are restlessness, irritability, insomnia

  • Infanticide: 4% of untreated PPP

  • Suicide: 5% of untreated PPP


Postpartum psychosis symptoms

Postpartum Psychosis Symptoms

Confusion/disorientation

Extreme disorganization of thought

Bizarre behavior

Unusual hallucinations

Visual, olfactory, or tactile

Delusions (often centered on the infant)

Hyperactivity

Not feeling need to sleep

Rapid speech

Loss of touch with reality


Public health roles

Public Health Roles

Inform the public

Depression screening in public health settings

Provide appropriate referrals

Partnership with mental health, social service agencies

Follow up care (home visits, support services


Resources

Resources:

“Behind the Smile: My Journey Out of Postpartum Depression”, Marie Osmond

“Down Came the Rain”, Brooke Shields

Anne Lamott, “Operating Instructions: A Journal of My Son’s First Year”

Depression After Delivery 1-800-944-4PPD (http://www.depressionafterdelivery.com)

National Women’s Health Information Center (www.4woman.gov)

Postpartum Support International 1-805-967-7636


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