Baby Blues s

Post Partum Depression and Baby Blues Syndrome

Stefanie Karina

07120110100

dr. Dharmady, spKJ

Introduction

It was recognized that many women go through an It was recognized that many women go through an adjustment period that does not equate to a clinical adjustment period that does not equate to a clinical diagnosis of depression.diagnosis of depression.

There are concerns that women are being There are concerns that women are being inappropriately diagnosed with PPD and have then lived inappropriately diagnosed with PPD and have then lived with a diagnoses that is inaccurate.with a diagnoses that is inaccurate.

This has encouraged a need for more understanding This has encouraged a need for more understanding and awareness around the difference so that PPD is not and awareness around the difference so that PPD is not under, over, or misdiagnosed. under, over, or misdiagnosed.

- Krista M. Beckwith, CDPHE - Krista M. Beckwith, CDPHE

Why is the distinction between “normal

adjustment” and “PPD” important?

Under-diagnosedUnder-diagnosed

Significant distress in early motherhood assumed to Significant distress in early motherhood assumed to be “normal” and women don’t get the support they be “normal” and women don’t get the support they need b/c it is assumed that all new moms suffer.need b/c it is assumed that all new moms suffer.

Further fuels the myth that some women can’t Further fuels the myth that some women can’t tolerate motherhood.tolerate motherhood.

Moms are left feeling as though they struggle Moms are left feeling as though they struggle because they are “bad moms” rather than because of because they are “bad moms” rather than because of a real and legitimate illness a real and legitimate illness

Why is the distinction between “normal

adjustment” and “PPD” important?

Over-diagnosisOver-diagnosis

Unnecessarily medicating moms who struggleUnnecessarily medicating moms who struggle

Further fuels the myth that the new mom should Further fuels the myth that the new mom should always be happyalways be happy

Potential of life-long label (real or perceived) Potential of life-long label (real or perceived)

What we DO know: THE BABY BLUES

2-3 weeks following birth 2-3 weeks following birth

Emotional vulnerability thought to be caused by Emotional vulnerability thought to be caused by hormonal shifts following birth coupled with the hormonal shifts following birth coupled with the stress of returning home for the first timestress of returning home for the first time

Normal and expected part of early postpartum Normal and expected part of early postpartum experience (30-75%) experience (30-75%)

IMPORTANT: When vulnerability lasts longer than 2-IMPORTANT: When vulnerability lasts longer than 2-3 weeks it is no longer considered “the blues” or 3 weeks it is no longer considered “the blues” or “the baby blues” “the baby blues”

What We Do Know: Normal

Postpartum Experience

Includes some anxiety, uncertainty, isolation, Includes some anxiety, uncertainty, isolation, emotional vulnerability for all women emotional vulnerability for all women

(However, when moms feel these symptoms (However, when moms feel these symptoms more often than not, there is usually more often than not, there is usually something else going on. New moms should something else going on. New moms should not suffer)not suffer)

What we DO know: DSM V

A period of at least 2 weeks during which there is A period of at least 2 weeks during which there is either depressed mood or loss of interest or either depressed mood or loss of interest or pleasure in nearly all activities. pleasure in nearly all activities.

The individual must also experience at least four The individual must also experience at least four additional symptoms drawn from a list that additional symptoms drawn from a list that includes: changes in appetite or weight, sleep and includes: changes in appetite or weight, sleep and psychomotor activity, decreased energy, feelings or psychomotor activity, decreased energy, feelings or worthless or guilt, difficulty thinking, concentrating worthless or guilt, difficulty thinking, concentrating or making decisions, or recurrent thoughts of death or making decisions, or recurrent thoughts of death or suicidal ideation, plans or attempts.or suicidal ideation, plans or attempts.


To count toward a Major Depressive Episode To count toward a Major Depressive Episode symptoms must either be newly present or must symptoms must either be newly present or must have clearly worsened compared with the person’s have clearly worsened compared with the person’s pre- episode status. pre- episode status.

The symptoms must persist for most of the day The symptoms must persist for most of the day nearly every day for at least 2 consecutive weeks. nearly every day for at least 2 consecutive weeks. The episode must be accompanied by clinically The episode must be accompanied by clinically significant distress or impairment in social, significant distress or impairment in social, occupational, or other important areas of occupational, or other important areas of functioning. functioning.


Mood and anxiety symptoms during Mood and anxiety symptoms during pregnancy, as well as the “baby blues”, pregnancy, as well as the “baby blues”, increase the risk for a postpartum major increase the risk for a postpartum major depressive disorder.depressive disorder.


In the DSM-5, postpartum depression would be In the DSM-5, postpartum depression would be diagnosed as a "depressive disorder with diagnosed as a "depressive disorder with peripartum onset". peripartum onset".

Peripartum onset is defined as starting anytime Peripartum onset is defined as starting anytime during pregnancy or within the four weeks during pregnancy or within the four weeks following delivery. following delivery.

Experts diagnose postpartum depression as Experts diagnose postpartum depression as depression with onset anytime within the first year depression with onset anytime within the first year after delivery. after delivery.

Etiology

Hormone imbalanceHormone imbalance

Thyroid hormoneThyroid hormone

Profound lifestyle changesProfound lifestyle changes

Risk Factor

• Poor social supportPoor social support..

• Serious life events and multiple (death of parent, Serious life events and multiple (death of parent, husband, etc. ...)husband, etc. ...)

• PMSPMS (premenstrual syndrome) (premenstrual syndrome), menstrual , menstrual disorders, infertilitydisorders, infertility

• History of childhood abuse (physical, emotional, History of childhood abuse (physical, emotional, sexual)sexual)

• Low socioeconomic statusLow socioeconomic status

Risk Factor

• Thyroid disorders / family historyThyroid disorders / family history..

• Chronic fungal infection.Chronic fungal infection.

• Severe morning sickness to malnutritionSevere morning sickness to malnutrition..

• Has inhHas inharmonious relationship with the parentarmonious relationship with the parent..

• History of mothers with postpartum depressionHistory of mothers with postpartum depression..

• Cessation of breastfeeding immediately after birth / Cessation of breastfeeding immediately after birth / not enough milk.not enough milk.

Risk Factor

• Great increase in weight during pregnancy and a Great increase in weight during pregnancy and a slight decrease in weight after giving birthslight decrease in weight after giving birth..

• Trauma of the birth process is not expected (SC, Trauma of the birth process is not expected (SC, VE, FE)VE, FE)..

• Marital DiscordMarital Discord..

• Unwanted pregnancyUnwanted pregnancy..

• Old primigravida (> 35 years)Old primigravida (> 35 years)..

When is Mental Health Support Necessary?

Mom isn’t improving with reassurance Mom isn’t improving with reassurance

Mom knows what she needs to be well but can’t Mom knows what she needs to be well but can’t access these tools access these tools

You (the provider) begin to feel uncomfortable and You (the provider) begin to feel uncomfortable and that your support may no longer be within your that your support may no longer be within your scope of practice scope of practice

Mom is having scary thoughts about harm to Mom is having scary thoughts about harm to herself or her babyherself or her baby

When is Mental Health Support Necessary?

You have concerns about mom-baby You have concerns about mom-baby attachmentattachment

Distress is chronic and is affecting her ability Distress is chronic and is affecting her ability to function as necessary to function as necessary

Mom can not access important basic needs Mom can not access important basic needs because of her severity because of her severity

Watching of early signs of

increased post partum distressMom begins to pull away from communityMom begins to pull away from community

Mom is unable to take breaks from caring for Mom is unable to take breaks from caring for baby although she has a great need to do sobaby although she has a great need to do so

Mom begins to show an increased need for Mom begins to show an increased need for control over situations that are uncontrollablecontrol over situations that are uncontrollable

Mom’s hoe and optimism begins to fadeMom’s hoe and optimism begins to fade

DIAGNOSIS

Screening of Pospartum Blues/Baby Blues Syndrome using EPDS

Screening of Pospartum Blues/Baby Blues Syndrome using EPDS

EPDS Score<10EPDS Score<10 EPDS Score>10EPDS Score>10

Therapy is not needed

Therapy is not needed

1.Theraphy communication approach

2. Family support increasing

1.Theraphy communication approach

2. Family support increasing

Medicinal therapy or interpersonal

psychotherapy

Medicinal therapy or interpersonal

psychotherapy

Need adequate theraphy

Need adequate theraphy

ReferRefer

GynecologGynecolog PsychiaterPsychiater

Providing Support

Providing Support: Brain Health

Sleep: At least 4 hours of uninterrupted sleep for Sleep: At least 4 hours of uninterrupted sleep for reduction of riskreduction of risk

Nutrition: supports serotonin production and Nutrition: supports serotonin production and protects against depression/anxiety protects against depression/anxiety

Water: Dehydration and anxiety have been linkedWater: Dehydration and anxiety have been linked

Exercise: Reduces risk and supports symptomsExercise: Reduces risk and supports symptoms

Breath: Adequate oxygen intake changes body’s Breath: Adequate oxygen intake changes body’s physiological response to stressphysiological response to stress

Providing Support: Biopsychosocial Health

Providing Support: Assessing Community

Helping Mom Understand the Degree of her Distress

Medicamentosa

• MedicaMedicamentosa therapy mentosa therapy is recommended is recommended at least at least discretion over the discretion over the breastfeedingbreastfeeding..

• Recommended: Recommended: Class Class Serotonin Reuptake Serotonin Reuptake Inhibitor Selective (SSRI) version, such as Inhibitor Selective (SSRI) version, such as fluoxetin.fluoxetin.

• It is generally recommended that treatment be It is generally recommended that treatment be initiated with an SSRI because of ease of initiated with an SSRI because of ease of administration and low toxicity.administration and low toxicity.

Medicamentosa

Paroxetine and sertraline were among the Paroxetine and sertraline were among the most widely studied antidepressants for which most widely studied antidepressants for which no adverse effects on breastfeeding infants no adverse effects on breastfeeding infants were reported. were reported.

Fluoxetine should be avoided, and citalopram, Fluoxetine should be avoided, and citalopram, doxepin, and nefazodone used only cautiously, doxepin, and nefazodone used only cautiously, because adverse effects have been associated because adverse effects have been associated with their use.with their use.

Side Effects

Increased crying, vomiting, diarrhea, colic, Increased crying, vomiting, diarrhea, colic, and decreased sleep with fluoxetine.and decreased sleep with fluoxetine.

Drowsiness, lethargy, hypothermia, and poor Drowsiness, lethargy, hypothermia, and poor feeding with nefadozonefeeding with nefadozone

Dosage

Medicamentosa

Tricyclics may cause bothersome side effects. Tricyclics may cause bothersome side effects. This is why tricyclics are usually tried only This is why tricyclics are usually tried only when treatment with a selective serotonin when treatment with a selective serotonin reuptake inhibitor (SSRI) hasn't worked well.reuptake inhibitor (SSRI) hasn't worked well.

Nortriptyline is passed on to breast-feeding Nortriptyline is passed on to breast-feeding infants at very low levels.infants at very low levels.

Dosage

Baby Blues s

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