Postpartum Mood Disorders
description
Transcript of Postpartum Mood Disorders
Dr:Eman Elsheshtawy
Ass. Prof. Psychiatry
Transient
Heightened emotional reactivity
50-85% women experience baby blues
Peaks 3-5 days after delivery
Lasts up to 10-14 days
Considered normal experience of childbirth
Symptoms can be distressing
Usually don’t affect mother’s ability to function and care for child
Characteristics:Mild mood swings Irritability Anxiety Decreased concentration Insomnia Tearfulness Crying spells
Two leading hypothesis:Abrupt hormone withdrawalOvarian 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’tNeuroactive steroids (pregnanolone, allopregnanolone) decrease postpartum, affecting GABA
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
About 10% of women after delivery
Average duration 7 months
¼ still affected at child’s first
birthday
Overlooked and under diagnosed
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
Depression negatively effects:
Mother’s ability to mother
Mother—infant relationship
Emotional and cognitive
development of the child
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
Gaze less at their infants
Take longer to respond to infant’s utterances
Show fewer positive facial expressions
Lack awareness of their infants
Negative interactive patterns with infant
Children exposed to maternal psychiatric illness have:
Higher incidence of conduct
disorders
Inappropriate aggression
Cognitive and attention deficits
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
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
Noted in medical history since Hippo crates Recognized in DSM-IV in 1994
Major depression that occurs within 4 weeks of deliveryDefinition used by researchers usually
allows up to 6 months 5 symptoms, every day, at least 2
weeksAND functional impairment
Depressed moodLack of pleasure or interestAppetite disturbance or weight loss*Sleep disturbance*
Physical agitation or psychomotor slowingFatigue, loss of energy*
Feelings of worthlessness or excessive guiltDiminished concentration, or indecisiveness*
Thoughts of death or suicidal ideation ,Thoughts of harming infant
Severe Symptoms:Thoughts of dyingThoughts of suicideWanting to flee or get awayBeing unable to feel love for the babyThoughts of harming the babyThoughts of not being able to protect the
infantHopelessnes
Cause unclear
Rapid decline in reproductive
hormones
Several factors increase risk
Prior episodes depression, anxiety, OCD, bipolar d/o, eating d/oPrior depression = 25% risk PPDPrior PPD = 50% risk recurrent PPD
Stressful life events FHx mood disorders Hx of PMDD Inadequate social support
Education level
Sex of infant
Breastfeeding
Mode of delivery
Planned or unplanned pregnancy
During PregnancyA young and single motherH/O Mental illness or substance abuseFinancial or relationship difficultiesPrevious Pregnancy or postpartum depression
After BirthLabor/Birth ComplicationsLow confidence as a parentProblems with Baby’s HealthLack of supportsMajor Life change at the same time as birth of the baby
2:1,000 birthsPsychiatric emergencyUsually within 3 weeksUsually manifestation of bipolar d/o
70% women experience recurrence in PPP
Severe disturbances Rapidly evolving manic episodes Dramatic presentation Initial signs are restlessness,
irritability, insomnia Infanticide: 4% of untreated PPP Suicide: 5% of untreated PPP
Confusion/disorientationExtreme disorganization of thought Bizarre behaviorUnusual hallucinations Visual, olfactory, or tactile
Delusions (often centered on the infant)
HyperactivityNot feeling need to sleepRapid speechLoss of touch with reality
Inform the publicDepression screening in public health settingsProvide appropriate referralsPartnership with mental health, social service agenciesFollow up care (home visits, support services
“Behind the Smile: My Journey Out of Postpartum Depression”, Marie Osmond
“Down Came the Rain”, Brooke ShieldsAnne 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