Makindo Medical Notes

Related Subjects: |Psychiatric Emergencies |Depression |Mania |Schizophrenia |Suicide |Acute Psychosis |General Anxiety Disorder |Obsessive-Compulsive disorder |Wernicke Korsakoff Syndrome |Medically Unexplained symptoms |Postpartum/Postnatal Depression

Postpartum Depression

• Occurs in up to 20% of women within the first year following childbirth.
• Onset typically occurs within 24 hrs to 3 months postpartum, though it can develop at any point within the first year.
• Universal screening is recommended. Validated tools, such as the Edinburgh Postnatal Depression Scale (EPDS), should be used during postpartum visits to identify at-risk individuals.
• In some states, screening for postpartum depression is legally mandated during the postpartum period.
• The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), specifies that symptoms should begin within the first 4 weeks after delivery. However, many clinicians recognize postpartum depression as any major depressive episode occurring within the first year postpartum.

Diagnostic Criteria

• To diagnose postpartum depression, five or more of the following symptoms must be present for at least 2 weeks, including either a depressed mood or a loss of interest/pleasure:
  • Insomnia or excessive sleeping (hypersomnia)
  • Psychomotor agitation or slowing (retardation)
  • Fatigue or loss of energy
  • Significant changes in appetite (increase or decrease)
  • Feelings of worthlessness or excessive guilt
  • Diminished ability to concentrate or make decisions
  • Recurrent thoughts of death or suicide, suicidal ideation

Clinical

• Insomnia, Anorexia, Crying
• Acopia with daily tasks
• Exhaustion, Irritability, Anxiety, Fear of social contact
• Fear of being alone, Guilt, Low confidence
• Suicidal thoughts, “There is no joy in anything any more”

Risk Factors:

• History of depression or mental health disorders
• Adverse life events before or during pregnancy (e.g., financial stress, bereavement)
• Marital conflict or exposure to domestic violence
• Ambivalence or negative feelings about the pregnancy
• Unplanned or unintended pregnancy
• Lack of social support or isolation

It is important to note that postpartum depression is not typically caused by obstetric complications, except in cases of unplanned pregnancy, which can increase psychological stress.

Management of Postpartum Depression

• Treatment varies depending on the severity of symptoms and patient preferences. A collaborative approach between the healthcare provider and patient is essential.
• Management options include:
  • Supportive psychotherapy: Provides emotional support and helps new mothers process their feelings.
  • Counseling: Cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT) are commonly used to treat postpartum depression.
  • Antidepressant medications: Selective serotonin reuptake inhibitors (SSRIs) are typically first-line medications for postpartum depression. If breastfeeding, the risks and benefits of medication should be carefully considered.
  • Social and family support: Encouraging participation from partners, family members, and social support networks can significantly improve outcomes.