““Baby Blues” vs. Post-Partum Baby Blues” vs. Post-Partum DepressionDepression

Anita Kablinger, MD

LSU Health Sciences Center

Department of Psychiatry

August 23, 2005

““Baby Blues” vs. Post-Partum Baby Blues” vs. Post-Partum DepressionDepression

OnsetOnset

Baby BluesBaby Blues Postpartum Postpartum DepressionDepression

Onset at 3Onset at 3rdrd or 4 or 4thth day day post-delivery and can post-delivery and can last from a few days last from a few days to a few weeksto a few weeks

Onset can be anytime Onset can be anytime one year after one year after deliverydelivery

““Baby Blues” vs. Post-Partum Baby Blues” vs. Post-Partum DepressionDepression

PrevalencePrevalence

Baby BluesBaby Blues Postpartum Postpartum DepressionDepression

70-80% of women will 70-80% of women will experience experience depressive symptoms depressive symptoms that disappear within that disappear within a few weeks.a few weeks.

10% experience 10% experience some degree of some degree of postpartum postpartum depression which can depression which can last a year.last a year.

Postpartum DepressionPostpartum Depression

Highest vulnerability is in first 3 months Highest vulnerability is in first 3 months after delivery after delivery

Three types of postpartum disturbances:Three types of postpartum disturbances:1.1. Postpartum blues (“baby blues”)Postpartum blues (“baby blues”)

2.2. Postpartum depressionPostpartum depression

3.3. Postpartum psychosisPostpartum psychosis Postpartum depression should be Postpartum depression should be

distinguished from postpartum distinguished from postpartum adjustmentadjustment

Post Partum PsychosisPost Partum Psychosis

Rare: occurs in 0.1-0.2% of birthsRare: occurs in 0.1-0.2% of births Usually occurs 3-6 weeks after deliveryUsually occurs 3-6 weeks after delivery Higher risk associated with bipolar disorder Higher risk associated with bipolar disorder

and schizoaffective disorder patientsand schizoaffective disorder patients Postpartum Psychosis, untreated, can lead to:Postpartum Psychosis, untreated, can lead to:

Child AbuseChild Abuse SuicideSuicide InfanticideInfanticide

Post-Partum PsychosisPost-Partum PsychosisSymptomsSymptoms

DelusionsDelusions HallucinationsHallucinations Sleep disturbancesSleep disturbances Obsessive thoughts about the babyObsessive thoughts about the baby Rapid mood swings (which mimic bipolar Rapid mood swings (which mimic bipolar

disorder)disorder) Extreme anxiety, agitationExtreme anxiety, agitation Suicidal and homicidal thoughtsSuicidal and homicidal thoughts

Post-Partum DepressionPost-Partum DepressionEmotional SymptomsEmotional Symptoms

Increased CryingIncreased Crying IrritabilityIrritability HopelessnessHopelessness LonelinessLoneliness SadnessSadness Uncontrollable mood swingsUncontrollable mood swings Feeling overwhelmedFeeling overwhelmed GuiltGuilt Fear of hurting self or babyFear of hurting self or baby

Post-Partum DepressionPost-Partum DepressionBehavioral SymptomsBehavioral Symptoms

Lack of, or too much, interest in the Lack of, or too much, interest in the babybaby

Poor self-carePoor self-care Loss of interest in otherwise normally Loss of interest in otherwise normally

stimulating activitiesstimulating activities Social withdrawal and isolationSocial withdrawal and isolation Poor concentration, confusionPoor concentration, confusion

Post-Partum DepressionPost-Partum DepressionPhysical SymptomsPhysical Symptoms

Exhaustion, fatigueExhaustion, fatigue SluggishnessSluggishness Sleeping problems (not related to Sleeping problems (not related to

screaming baby)screaming baby) Appetite changesAppetite changes HeadachesHeadaches Chest painChest pain Heart PalpitationsHeart Palpitations HyperventilationHyperventilation

Post-Partum DepressionPost-Partum DepressionRisk FactorsRisk Factors

Self or family history of mental illness Self or family history of mental illness or substance abuseor substance abuse

Marital or financial stressesMarital or financial stresses Birth complicationsBirth complications Lack of self-confidence as a parentLack of self-confidence as a parent

Post-Partum DepressionPost-Partum DepressionRisk FactorsRisk Factors

Problem’s with baby’s healthProblem’s with baby’s health Major life changes around time of Major life changes around time of

deliverydelivery Lack of support or help with babyLack of support or help with baby The mother being of young ageThe mother being of young age Severe premenstrual syndromeSevere premenstrual syndrome

Post-Partum DepressionPost-Partum DepressionCausesCauses

Exact cause not known. Levels of Exact cause not known. Levels of estrogen, progesterone, cortisol, and estrogen, progesterone, cortisol, and thyroid hormones drop sharply after thyroid hormones drop sharply after birth.birth.

The brunt of the research has been in The brunt of the research has been in testing hormonal connections; testing hormonal connections;

Post-Partum DepressionPost-Partum DepressionDiagnosisDiagnosis

The Edinburgh Postnatal Depression The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-rated Scale (EPDS) is a 10-item self-rated questionnaire used extensively for questionnaire used extensively for detection of postpartum depression. detection of postpartum depression. A score of 12 or more on EPDS or an A score of 12 or more on EPDS or an affirmative answer on question 10 affirmative answer on question 10 (presence of suicidal thoughts) (presence of suicidal thoughts) requires more thorough evaluation. requires more thorough evaluation.

Post-Partum DepressionPost-Partum DepressionDiagnosisDiagnosis

Important to rule out medical causes Important to rule out medical causes of depression, such as anemia or of depression, such as anemia or thyroid dysfunctionthyroid dysfunction

Check medical historyCheck medical history Perform physical examination/lab Perform physical examination/lab

teststests

Post-Partum DepressionPost-Partum DepressionTreatmentTreatment

Treatments can include:Treatments can include: Counseling/psychotherapyCounseling/psychotherapy MedicationMedication Support groupsSupport groups Self-helpSelf-help

For mild to moderate symptoms, focus less For mild to moderate symptoms, focus less on pharmacological treatment and more on on pharmacological treatment and more on counseling and group therapy.counseling and group therapy.

All antidepressants pass through breast All antidepressants pass through breast milk.milk.

Post-Partum DepressionPost-Partum DepressionTreatmentTreatment

Medications:Medications: First-line choices are SSRIs such as fluoxetine First-line choices are SSRIs such as fluoxetine

(Prozac) 10-60 mg/d, sertraline (Zoloft) 50-200 (Prozac) 10-60 mg/d, sertraline (Zoloft) 50-200 mg/d, paroxetine (Paxil) 20-60 mg/d, citalopram mg/d, paroxetine (Paxil) 20-60 mg/d, citalopram (Celexa) 20-60 mg/d, or escitalopram (Lexapro) (Celexa) 20-60 mg/d, or escitalopram (Lexapro) 10-20 mg/d10-20 mg/d

SNRIs such as venlafaxine (Effexor) 75-300 mg/d SNRIs such as venlafaxine (Effexor) 75-300 mg/d or duloxetine (Cymbalta) 40-60 mg/d, are also or duloxetine (Cymbalta) 40-60 mg/d, are also highly effective for depression and anxiety. highly effective for depression and anxiety.

ECT is effective for those with severe ECT is effective for those with severe depression/psychosisdepression/psychosis

Post-Partum DepressionPost-Partum DepressionTreatmentTreatment

In addition to counseling or talk-therapy In addition to counseling or talk-therapy (individual or group therapy), other steps can be (individual or group therapy), other steps can be taken by the mother to fight the depressive taken by the mother to fight the depressive symptoms:symptoms: ExerciseExercise Eat healthyEat healthy Use an outlet, such as a diary, a family Use an outlet, such as a diary, a family

member, or a friend.member, or a friend. Try not to isolate one’s selfTry not to isolate one’s self Promote sleepPromote sleep Take breaks, and make time to do the things Take breaks, and make time to do the things

you enjoyyou enjoy