POSTNATAL DEPRESSION

ReferencesReferences

**Mental Health Foundation (2002) Mental Health Foundation (2002) Postnatal Postnatal DepressionDepression Mental Health Information New Mental Health Information New Zealand (MHINZ)Zealand (MHINZ)

*Boath,E. & Henshaw, C. (2001) The treatment*Boath,E. & Henshaw, C. (2001) The treatment depression: a comprehensive literature review,depression: a comprehensive literature review, Journal of Reproductive and InfantJournal of Reproductive and Infant PsychologyPsychology, Vol. , Vol.

19, No. 3, p215-24619, No. 3, p215-246 The Royal College of Psychiatrists. Postnatal The Royal College of Psychiatrists. Postnatal

depression.depression. www.repsych.ac.uk.. Postnatal depressionPostnatal depression www.obstetrics.co.nzwww.obstetrics.co.nz

Post natal Depression

The term postnatal depression refers to a number of emotional changes which may occur after childbirth.

These include -the “baby blues”, -postnatal depression -postnatal psychosis

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Postnatal or maternity (baby) bluesPostnatal or maternity (baby) blues

-very common – up to 80% of women -very common – up to 80% of women experience experience

-typically peaks 3-5 days after birth-typically peaks 3-5 days after birth-brief period of mother feeling down and -brief period of mother feeling down and

tearful and a feeling of not coping.tearful and a feeling of not coping.

-feeling passes after a few days-feeling passes after a few days-regarded as a normal reaction resulting from -regarded as a normal reaction resulting from

hormonal changes after birthhormonal changes after birth

..

MANAGEMENT OF “BABY BLUES”MANAGEMENT OF “BABY BLUES”

- reassurance reassurance - practical help practical help

- rest, - rest, - healthy nutritious foodhealthy nutritious food- - education- education- --- --- --

Postnatal depression (PND)Postnatal depression (PND)

-more serious than baby blues-more serious than baby blues

-10–20% of women experience PND-10–20% of women experience PND

-may occur any time during the first year -may occur any time during the first year after childbirth and may continue for as after childbirth and may continue for as long as 1-2 years. Can affect anyone.long as 1-2 years. Can affect anyone.

-combination of physical, emotional and -combination of physical, emotional and environmental factors can trigger PND.environmental factors can trigger PND.

Associated risks of PNDAssociated risks of PND

-the question as to the impact PND has -the question as to the impact PND has on the mother-baby relationship is on the mother-baby relationship is unproven. Some suggest it may affect unproven. Some suggest it may affect infant cognitive and emotional infant cognitive and emotional development. However it is unlikely development. However it is unlikely where there are other people around where there are other people around the baby and child.the baby and child.

-adverse effects on family as a whole.-adverse effects on family as a whole.

Risk factors – before pregnancy and Risk factors – before pregnancy and birthbirth

-past history of depression or mental illness.-past history of depression or mental illness.

-relationship difficulties.-relationship difficulties.

-little social support.-little social support.

-onset of depression during pregnancy.-onset of depression during pregnancy.

-stresses – financial/housing problems.-stresses – financial/housing problems.

Risk factors related to birthRisk factors related to birth

-birth complications resulting in caesarean -birth complications resulting in caesarean delivery.delivery.

-birth experience not living up to -birth experience not living up to expectations.expectations.

-birth of a baby with a congenital -birth of a baby with a congenital abnormality or a baby who is ill following abnormality or a baby who is ill following birth.birth.

Risk factors after birthRisk factors after birth

-persisting postnatal blues.-persisting postnatal blues.

……prolonged or continuing…..prolonged or continuing…..

-not wanting to hold her baby, or feeling -not wanting to hold her baby, or feeling detached or negative about her baby.detached or negative about her baby.

-sleep problems (mother).-sleep problems (mother).

-fussy baby, problems with feeding, colic.-fussy baby, problems with feeding, colic.

-lack of support.-lack of support.

-ongoing social problems.-ongoing social problems.

Physical symptoms of PNDPhysical symptoms of PND

-change in sleeping patterns-change in sleeping patterns

-change in appetite-change in appetite

-decreased energy, tiredness and fatigue-decreased energy, tiredness and fatigue

-physical slowing or agitation-physical slowing or agitation

cognitive symptoms of PNDcognitive symptoms of PND

-thoughts of worthlessness and inadequacy-thoughts of worthlessness and inadequacy

-thoughts of hopelessness and death-thoughts of hopelessness and death

-difficulty thinking clearly-difficulty thinking clearly

-anxiety symptoms – very common-anxiety symptoms – very common

-thoughts of loneliness.-thoughts of loneliness.

Symptoms – mood symptoms of PNDSymptoms – mood symptoms of PND

-persistent low, sad or depressed mood-persistent low, sad or depressed mood

-loss of interest and pleasure in usual -loss of interest and pleasure in usual activitiesactivities

-irritable mood-irritable moodhttp://www.cyh.com/HealthTopics/library/depress-2.jpg

Outlook for PNDOutlook for PND

-without treatment may last 6 months or more-without treatment may last 6 months or more

-with treatment, 70 – 80% of women will -with treatment, 70 – 80% of women will recover much sooner.recover much sooner.

-majority of women will have a complete -majority of women will have a complete recovery.recovery.

-20 – 30% will improve but still have some -20 – 30% will improve but still have some symptoms persisting for months later.symptoms persisting for months later.

-for a minority, 5 – 10%, no improvement and will remain unwell for two or more years.

Help and supportHelp and support

-General practitioner-General practitioner

-Plunket nurse / family centres / plunket line-Plunket nurse / family centres / plunket line

-Family-Family

-Counsellor/psychologist-Counsellor/psychologist

-Parent Help -Parent Help

-Maternal mental health services at local -Maternal mental health services at local hospitalhospital

-Iwi health services-Iwi health services

-Other mothers-Other mothers

TreatmentTreatment

-Counselling – supportive listening, practical -Counselling – supportive listening, practical problem solving and information giving.problem solving and information giving.

-Medication: antidepressants-Medication: antidepressants

-Combination of both.-Combination of both.

Key : mother acknowledging that she needs Key : mother acknowledging that she needs help and sensitive, non judgmental help help and sensitive, non judgmental help being available.being available.

Often mothers with PND find the greatest Often mothers with PND find the greatest support from mothers who have had PND.support from mothers who have had PND.

Postnatal psychosisPostnatal psychosis

-rare – one or two per 1000 births.-rare – one or two per 1000 births.

-usually within 1 – 3 weeks of delivery.-usually within 1 – 3 weeks of delivery.

-prompt diagnosis and expert treatment is -prompt diagnosis and expert treatment is critical.critical.

-risk factors similar to those of depression. -risk factors similar to those of depression.

-history of mood disorders.-history of mood disorders.

-no previous history-no previous history

Signs and SymptomsSigns and Symptoms Mood disturbance – depression or mania or Mood disturbance – depression or mania or

both, with symptoms of psychosis at the both, with symptoms of psychosis at the same time.same time.

Symptoms of psychosis-delusions (unusual or altered belief)-thought disturbances-hallucinations (occur when someone hears,

feels, sees, or smells something which is not there)

TreatmentTreatment

-Hospitalisation.-Hospitalisation.

-Crisis intervention.-Crisis intervention.-Medications: anti-psychotic medication or

mood stabilizer. -ongoing support …….

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In an attempt to try and identify women with PND early there are various questionnaires available.

One that has been commonly used is the Edinburgh postnatal depression scale.