What is postpartum depression?
Many women experience postpartum depression, where the mood shows symptoms two days after delivery, peaks on the fifth day, and returns to normal in about two weeks. Postpartum depression is now becoming more common, and the disorder can have many adverse effects on the person and the family. The most serious adverse effect is postpartum mood disorder – postpartum psychosis, which includes acute episodes of postpartum mania, mixed or depressive psychosis.
Postpartum depression is more common in.
1, Postpartum depression or postpartum depression is a momentary state that occurs in 30 to 80% of postpartum women.
2, The prevalent clinical signs of postpartum depression are probably between 7% and 19%. About one-third of postpartum depression begins during pregnancy, while about one-quarter of postpartum depression begins before pregnancy.
3. Women with bipolar disorder are at extremely high risk of developing postpartum depression after delivery, with about half of all women having clinically typical postpartum depressive episode symptoms.
Why is postpartum depression overlooked?
Much evidence suggests that postpartum depression is easily overlooked or misdiagnosed. Of the 211 women surveyed, only 15% sought help (prescription medication or hospital visits) when they experienced a mood disorder in the first year of their child’s life. Similarly, bipolar affective disorder episodes in the postpartum period may be misdiagnosed as unipolar depression. Therefore, the differential diagnosis of bipolar affective disorder and postpartum depressive episodes is important. Clinicians need to make an accurate diagnosis by taking a careful psychiatric history.
The postpartum period is supposed to be a happy time. Because they feel embarrassed or shamed and fear their child will be sent to a correctional facility, many women are reluctant to enter this mood. And specialists, like women in labor, may fail to recognize this serious illness thereby missing the opportunity for appropriate treatment.
Why does this happen?
It is important to differentiate between postpartum major depression and minor mood disorder. The illness lasts more than two weeks, the symptoms are severe, or there is a lot of impairment, all of which are helpful in confirming the diagnosis of major depression.
Untreated postpartum depression can be very damaging not only to the woman, but can also have harmful effects on the newborn (including mood, behavior and cognition) and can even lead to mood disorders in the spouse. Over the past decade, a confidential survey of maternal deaths in the UK revealed that suicide was one of the top-ranked causes of death. Problems reflected in the survey include the unrecognized severity and speed of onset of postpartum illness and misjudgment of serious non-psychiatric medical conditions and psychological symptoms.
How is postpartum depression diagnosed?
During pregnancy and the puerperium, women come into contact with a variety of health care professionals (including midwives, obstetricians, health consultants and general practitioners). Both the physical and mental health of the woman in labor should be attended to.
Although the risk of postpartum depression is highest in the weeks following delivery, those involved should remain vigilant about maternal mental health throughout the year. Postpartum depression can only be assessed through a clinical diagnosis, but there are ways to help identify cases.
The National Institute of Health and Care recommends that all women during pregnancy and the postpartum period should see a health care professional for a brief mood assessment. These three questions have a 32% positive predictive value and a 99% negative predictive value for the diagnosis of major depression, but this test lacks data support in the perinatal setting.
Brief diagnostic questions.
Question 1: In the last month, were you often troubled by low mood, depression, or helplessness?
Question 2: In the last month, have you often been bothered by having a small interest in something or feeling happy?
Question 3: What do you think you want or need help with?
Another commonly used tool is the Edinburgh Postnatal Depression Scale, a self-reported, 10-item questionnaire with a sensitivity range of 34% to 100% and specificity of 44% to 100% on different studies. The most commonly used starting score of >12 has an overall positive predictive value of 57% and a negative predictive value of 99%.
The diagnosis of postpartum depression is a comprehensive diagnostic process, but a physical examination may also be important if her past history indicates a physical health condition that may be indicative of a heart condition. For example, excessive fatigue or weight gain may indicate hypothyroidism and require a thyroid function test.
How should postpartum depression be treated?
Postpartum depression responds to treatment in the same way that other medical conditions do. Treatment options vary from general health counseling to listen to the patient, to talk therapy such as cognitive behavioral therapy or interpersonal psychotherapy, to the use of antidepressant medications to alleviate severe episodes. Although ICD-10 defines mild, moderate, and severe depression using the symptom scale described above, in clinical practice, depression can be more easily diagnosed by the impairment caused by specific symptoms (e.g., psychotic phenomena).
Postpartum women may be more reluctant to take antidepressants, especially breastfeeding women.
About postpartum antidepressant use
The decision to breastfeed or use antidepressants must be based on an individualized risk-benefit analysis. Non-individualized adverse effects have been reported in infants exposed to antidepressants through breast milk.
Examples are often reported in which infants are more likely to be excitable, irritable, or unable to breastfeed, or both, with fluoxetine than with other drugs, or more likely to be unable to sleep well with citalopram. However, no studies have shown an increased risk of such long-term adverse outcomes.
Some of the issues to consider with the medication are.
1. the benefits of breastfeeding;
2. the potential benefits of antidepressants and the impact of relapse after discontinuation;
3. the reactions of individual women to certain specific antidepressants;
4. For mothers who successfully cured depression during pregnancy, it may be better to continue using the same antidepressant medication after delivery, and stopping or changing medication may lead to relapse;
5. A side effect of sedative medication is that it may affect a mother’s ability to care for her child, especially during the night;
Severe mood disorders are a psychiatric emergency, such as postpartum psychosis. Hospital admission is often necessary. The ideal is to stay with the baby. Although emotional stabilization and the application of antipsychotics are key to the treatment of postpartum psychosis in the acute phase, psychotherapy during the recovery period is also necessary. In addition, it is helpful to expose the patient to a back-up group similar to the one used for postpartum psychosis treatment.
Key points.
1. Mood disorders are common in the postpartum period but may be overlooked or misdiagnosed.
2. Women may be reluctant to talk about emotional symptoms because of shame or they may fear that their child will be institutionalized.
3. Screening tools can help identify postpartum depression but do not replace clinical assessment.