Postpartum Depression

From UBC Wiki

Overview

Most have heard about Postpartum Depression (PPD), but few know it is the most common condition that occurs after childbirth. This condition affects 10-20% of women within their first year after childbirth .[1]. The estimated 4 million annual births in the United States, indicate that approximately half a million women suffer from PPD in the United States alone [2]. PPD is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition as “major depression with postpartum onset episodes of depression beginning within 4 weeks of giving birth” (762).[3] While this time frame corresponds with the hormonal changes that occur after childbirth, in consideration of the series of psychosocial factors that can contribute to postpartum many researchers consider the postpartum period to last up to six months after childbirth [3] . This common condition deserves more recognition and attention.

Postpartum baby2

Signs and Symptoms

A person suffering postpartum depression may experience melancholy, fatigue and sadness after giving birth to her child. Although, many women experience such symptoms after birth, the indications of postpartum depression patients are much severe. Postpartum depression causes significant difficulty in a person’s work, everyday life and relationship with her family. Furthermore, postpartum depression causes problem in building a healthy relationships with her newborn baby.

Postpartum depression patients may experience such signs and symptoms:

  • Inability to experience pleasure from interacting with your baby [4]
  • Guilt [4]
  • Insomnia [4]
  • Lethargy [4]
  • Feeling of being overwhelmed [4]
  • Inability to concentrate [4]
  • Loss of appetite [4]
  • Inability to accept a new role as a parent [4]
  • Being indecisive [4]
  • Low self-esteem [4]
  • Feeling lonely [4]
  • Sadness [4]

Diagnosis

The list of symptoms used to diagnose postpartum depression is the same as the list diagnosing non-childbirth related major and minor depression [5]. A person must experience at least five of the nine following symptoms to be diagnosed with postpartum depression[5]:

  • Usually depressed [6]
  • Loss of interest in favourable activities [6]
  • Loss of appetite, leading to weight loss (or weight gain for some patients) [6]
  • Insomnia (inability to sleep) or hypersomnia (excessive sleepiness) [6]
  • Restlessness or notable slowed movements [6]
  • Fatigue or loss of energy [6]
  • Feelings of worthlessness [6]
  • Lack of ability to think, concentrate or make decisions [6]
  • Continual thoughts of death or suicide [6]

Spectrum of the disease

Spectrum of Postpartum Depression.png

Postpartum Blues

Approximately 50% of women experience “Postpartum Blues”,  this condition occurs within 10 days after childbirth peaking around the 5th day [1].

Symptoms: In this state, most womens' emotions are heightened, and they (women) may experience feelings of irritability,(le,) anxiousness and being overwhelmed[3].

Women at Risk: Researchers have found this condition to be unrelated to an individual's psychiatric history or environmental stressors [3].

Effects: Experiencing this condition does not affect infant childcare (Sriraman).  The term “blues” is in fact a misnomer  as the emotion felt  by many women at this time is happiness [3].

Postpartum Non Psychotic Depression

Postpartum non-psychotic depression or (PPD) is a condition of deep depression that is experienced for over 14 days (Sriraman). Approximately 10-20% of women expereince PPD with in six months of childbirth [3].

Symptoms: Common symptoms for this condition include, but are not limited to, loss of appetite, irratibility, insomnia, feelings of inadequacy and incompetence as a parent, anger, restlessness, fatigue and difficulty to concentrate [7] .

Women at Risk: Risk factors which increase the chances of having PPD include, a history (ies) of depression, a lack of social support, psychosocial stress, and a history (ies) of premenstrual dysphoric disorder[3].

Postpartum Psychotic Depression / Psychosis

This condition affects approximately 1 in 500 women, it occurs within the first 2-4 weeks of delivery [8].

Symptoms: The symptoms of this condition are severe. Postpartum psychotic depression is considered to be a psychiatric emergency, women affected by this disorder are often hospitalized. Indicators for this condition include, delusions, hallucinations, poor judgment, severe mood swings, paranoia, thoughts of suicide and infanticide [8].

Women at Risk: Women who have been previously diagnosed with postpartum psychosis, or have had manic or psychotic depressive episodes in the past are more likely to have postpartum psychosis (Sriraman). Women who have family histories in bipolar disorder are also at high risk. Other risk factors include, sleep deprivation, and recent discontinuation of mood stabilizers or antidepressants [1].

Effects: Both, PPD and postpartum psychosis if left untreated can have detrimental effects on both, mother and child. For the mother, this can be an indicator for future major depressive episodes as both, PPD and postpartum psychosis have high likelihoods of reoccurrence [3] . This condition can impact a child's (ren's) behavioral, social, physical, emotional, cognitive, and interpersonal issues throughout their lives (depending on the extent of their mothers condition) [3].

Causes

Pregnancy Loss

Both, miscarriages and stillbirths result in an increased risk of postpartum depression [3]. PPD after pregnancy loss, is especially elevated for women with a history of depression [3]. Women who have had depressive episodes in the past are approximately twice as likely to suffer from major postpartum depression [3]. This risk is highest in the first six months after pregnancy loss[3]. Although cultural factors and pregnancy loss are components that may lead to post partum depression, there has been no finding on a single cause of postpartum depression. Postpartum depression could be a result of emotional, physical and/or lifestyle factors, which all play a role.

Cultural Factors

Previous studies have found an association between the amount of social support and risk of postpartum depression. Cultures that offer support in the form of; child care services, paid maternity and paternity leave, and baby bonuses to new mothers have a significantly lower rate of postpartum depression [3]. In addition, individualistic cultures such as the United states is shown to have more awareness in regards to PPD as well as an abundance of effective treatment options. On the other hand, collectivist cultures such as China perceive mental illnesses as shameful and thus, mothers suffering from post-partum often rely on Chinese medicinal remedies due to a lack of support and treatment options.

Other Factors

Research has also associated several other factors such as high stress levels, family history of mood disorders , a personal history of depression, single marital status and low economic status to increase the risk of PPD [2].

Impact of Postpartum Depression on Children

Parents' postpartum depression can bring negative impacts on their children as well. These include behaviour problems, delays in cognitive development, social problems, emotional problems, and depression.

Postpartum depression of mothers can increase the chances of behavioural problems in their children. Such behavioural problems include sleep problems, temper tantrums, aggression, and hyperactivity [9]. Depressed mothers may result in finding their child socially isolated in school or witness aggressive behaviour [9]. Babies and children who have depressed mother can suffer from impediments in cognitive development. Such impediments include mobility, verbal skills, and social skills. They may face bigger learning difficulties in general [10]. Children with depressed mothers seem to be more fearful, anxious, dependent, and have lower self-esteem compared to the other children [10]. Furthermore, in a study conducted by Stein and his colleagues children with depressed mothers show less effective sharing, lower rate of interactive behaviour, and less sociability [11]. Especially those children who have depressed mothers have higher chances of developing depression themselves [9].

Treatment

PPD treatment process

Depending on an individuals psychiatric history, the severity of PPD and the potential risk of the treatment, treatment options will differ. The most common forms of treatment for PPD are prescribed antidepressants such as tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants because of their effectiveness and low risk in toxic effects [3]. Cognitive, behavioral and interpersonal therapy has also shown to be effective in treating PPD [3]. Interpersonal therapy is effective when treating women with little social support and disrupted relationships [12] . A series of treatment processes is often necessary in more severe cases of PPD, these include “crisis intervention, pharmacotherapy, psychotherapy, and strengthening social support networks”, electroconvulsive therapy has also proven to be a very effective option for those suffering from major PPD (764) [3].

Medication

Antidepressants are the medication used to treat depression. There are any different classes and types of antidepressants. Different types bring different effects on the patients. Medication can help with symptoms such as insomnia, appetite loss, and low energy levels. However, as certain thoughts or beliefs that can fuel depression even with the influence of antidepressants, medication cannot be the ultimate solution to postpartum depression. It’s usually best to include counselling if you are taking an antidepressant medication. While it is stated safe to use antidepressants while breastfeeding, it’s important to consult with a doctor about the possible risks [13].

Counselling

Cognitive-behaviour therapy is the most common treatment for postpartum depression. This treatment is suitable for patients with mild or moderate symptoms. Cognitive-behavioural therapy helps postpartum patients realize that their thoughts, feelings, and behaviours work together. It also helps patients develop problem-solving skills, realistic thinking skills, stress management skills, and relaxation tips. Interpersonal psychotherapy focuses on relationships. This type of counselling help patients adjust to changing roles in their relationships [13].

Partner Support

A stable marital relationship helps new parents adapt to the competing demands of marriage, infant, and family [14]. In contrast, a poor marital relationship is the most consistent psychosocial predictor of PPD[15]. This is due to the mother now having to handle both the marital and maternal roles that she is now presented with. If a partner is not supportive and is not involved in raising the child, the mother often faces major psychosocial stresses that result[16]. The role of the partner is very important in prevention of PPD, as a woman’s perception of her partners support helps to increase her sense of well being as a woman, wife, and mother[17]. It also plays a large role in treatment, as having a reliable supportive partner indicates that women experience a more rapid recovery and are also more appreciative of their partner’s contribution to the relationship[18]. The role of a supportive partner greatly reduces the stresses faced by the mother, and improves the health of both parties, as the stress of PPD can cause health deterioration for both the mother and the parent. This type of treatment is preferred by many mothers for its natural, non-medicated nature, and its tendency to create stronger, healthier relationships between partners.

Stop Motion Animation

To watch the stop motion animation regarding Postpartum Depression, please visit http://goanimate.com/videos/0ZZS9KL77Fp0?utm_source=linkshare&utm_medium=linkshare&utm_campaign=usercontent

References:

  1. ↑ 1.0 1.1 1.2 [1], Sriraman, Natasha, MD. "Postpartum Depression: Why Pediatricians Should Screen New Moms." Contemporary Pediatrics 29.6 (2012): 40-46. UBC Library. Web. 18 Oct. 2014.]. Cite error: Invalid <ref> tag; name "Sriraman" defined multiple times with different content Cite error: Invalid <ref> tag; name "Sriraman" defined multiple times with different content
  2. ↑ 2.0 2.1 [2], Wisner, Katherine L., Barbara L. Parry, and Catherine M. Piontek. "Postpartum Depression." The New England journal of medicine 347.3 (2002): 194-9.. Cite error: Invalid <ref> tag; name "Wisner" defined multiple times with different content
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 [3], Miller, Laura J. "Postpartum Depression." JAMA: The Journal of the American Medical Association 287.6 (2002): 762-5.]. Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content Cite error: Invalid <ref> tag; name "Miller" defined multiple times with different content
  4. ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 [4], "Postpartum Depression." Journal of Midwifery & Women's Health 58.6 (2013): 719-20. Web. 13 Feb. 2015. Cite error: Invalid <ref> tag; name "Postpartum" defined multiple times with different content Cite error: Invalid <ref> tag; name "Postpartum" defined multiple times with different content Cite error: Invalid <ref> tag; name "Postpartum" defined multiple times with different content Cite error: Invalid <ref> tag; name "Postpartum" defined multiple times with different content Cite error: Invalid <ref> tag; name "Postpartum" defined multiple times with different content Cite error: Invalid <ref> tag; name "Postpartum" defined multiple times with different content Cite error: Invalid <ref> tag; name "Postpartum" defined multiple times with different content Cite error: Invalid <ref> tag; name "Postpartum" defined multiple times with different content Cite error: Invalid <ref> tag; name "Postpartum" defined multiple times with different content Cite error: Invalid <ref> tag; name "Postpartum" defined multiple times with different content Cite error: Invalid <ref> tag; name "Postpartum" defined multiple times with different content
  5. ↑ 5.0 5.1 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Association. 2013. Cite error: Invalid <ref> tag; name "DSM" defined multiple times with different content
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 [5], "Postpartum Depression." Tests and Diagnosis. 11 Sept. 2012. Web. 13 Feb. 2015. <http://www.mayoclinic.org/diseases-conditions/postpartum-depression/basics/tests-diagnosis/con-20029130>. Cite error: Invalid <ref> tag; name "Mayo" defined multiple times with different content Cite error: Invalid <ref> tag; name "Mayo" defined multiple times with different content Cite error: Invalid <ref> tag; name "Mayo" defined multiple times with different content Cite error: Invalid <ref> tag; name "Mayo" defined multiple times with different content Cite error: Invalid <ref> tag; name "Mayo" defined multiple times with different content Cite error: Invalid <ref> tag; name "Mayo" defined multiple times with different content Cite error: Invalid <ref> tag; name "Mayo" defined multiple times with different content Cite error: Invalid <ref> tag; name "Mayo" defined multiple times with different content
  7. ↑ [6], Abell, Sue. "Postpartum Depression." Clinical pediatrics 46.3 (2007): 290-1.
  8. ↑ 8.0 8.1 [7], Pearlstein, Teri, et al. "Postpartum Depression." Am J Obstet Gynecol 200.4 (2009): 357-64. Cite error: Invalid <ref> tag; name "Pearlstein" defined multiple times with different content
  9. ↑ 9.0 9.1 9.2 [8], Smith, Melinda, and Jeanne Segal. "Postpartum Depression and the Baby Blues." : Symptoms, Treatment, and Support for New Mothers. 1 Nov. 2014. Web. 13 Feb. 2015. <http://www.helpguide.org/articles/depression/postpartum-depression-and-the-baby-blues.htm>. Cite error: Invalid <ref> tag; name "Smith" defined multiple times with different content Cite error: Invalid <ref> tag; name "Smith" defined multiple times with different content
  10. ↑ 10.0 10.1 [9], Murray, Lynne, and Peter. J Cooper. "Effects of Postnatal Depression on Infant Developments." Disease in Childhood 77.2 (1997): 99-101. Archives of Disease in Childhood. Web. 12 Feb. 2015. <http://adc.bmj.com/content/77/2/99.full>. Cite error: Invalid <ref> tag; name "Murray" defined multiple times with different content
  11. ↑ [10], Stein, A., DH Gath, J. Bucher, A. Bond, A. Day, and PJ Cooper. "The Relationship between Postnatal Depression and Mother-child Interaction." Br J Psychiatry 158 (1991): 46-52. Br J Psych. Web. 12 Feb. 2015.< http://bjp.rcpsych.org/content/158/1/46.abstract?ijkey=678c0c4d4b6a28dd14fa9e65824a5c83439eee6d&keytype2=tf_ipsecsha>.
  12. ↑ [11], Beck, Cheryl Tatano. "Postpartum Depression." The American Journal of Nursing 106.5 (2006): 40.
  13. ↑ 13.0 13.1 [12], "Postpartum Depression - Canadian Mental Health Association." Canadian Mental Health Association. Web. 13 Feb. 2015. <http://www.cmha.ca/mental_health/postpartum-depression/#.VN2JiFPF9ew>. Cite error: Invalid <ref> tag; name "Canadian" defined multiple times with different content
  14. ↑ Misri, S., Kostaras, X., Fox, D., & Kostaras, D. (2000). The impact of partner support in the treatment of postpartum depression. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 45(6), 554-558.
  15. ↑ Misri, S., Kostaras, X., Fox, D., & Kostaras, D. (2000). The impact of partner support in the treatment of postpartum depression. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 45(6), 554-558.
  16. ↑ Misri, S., Kostaras, X., Fox, D., & Kostaras, D. (2000). The impact of partner support in the treatment of postpartum depression. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 45(6), 554-558.
  17. ↑ Misri, S., Kostaras, X., Fox, D., & Kostaras, D. (2000). The impact of partner support in the treatment of postpartum depression. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 45(6), 554-558.
  18. ↑ Misri, S., Kostaras, X., Fox, D., & Kostaras, D. (2000). The impact of partner support in the treatment of postpartum depression. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 45(6), 554-558.
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