By Abdulrhman Fahad AL-Mutairy

OBJECTIVES  Know the types of the Postpartum Mood Disorders  Know the Epidemiology  How they present to you  How to diagnose them  How to treat them

POSTPARTUM ?  We define the postpartum period as the first 12 months after birth

TYPES OF POSTPARTUM DISORDERS  Three types of postpartum Mood Disorders 1. Postpartum blues (“baby blues”) 2. Postpartum depression 3. Postpartum psychosis

DEFINITIONS  Postpartum depression: a major depressive episode that is temporally associated with childbirth  Postpartum blues: “baby blues”, heightened emotions, peaks in 3-5 days after delivery, may last up until 14 days  Postpartum psychosis: severe postpartum depression associated with delusions

“Baby Blues” vs. Post-Partum Depression

POSTPARTUM PSYCHOSIS  Rare: occurs in % of births  Usually occurs 3-6 weeks after delivery  Higher risk associated with bipolar disorder and schizoaffective disorder patients  Postpartum Psychosis, untreated, can lead to: Child Abuse Suicide Infanticide

RISK FACTORS OF POSTPARTUM DEPRESSION History of depression Depression in pregnancy Young age Stressful life events Marital dissatisfaction Child care stress Inadequate social supports Low self-esteem

ETIOLOGY OF POSTPARTUM DEPRESSION  Various theories based in physiological changes have been postulated: hormonal excesses or deficiencies of estrogen, progesterone, prolactin, thyroxine,

ETIOLOGY OF POSTPARTUM DEPRESSION  Other theories cite numerous psychosocial factors associated with PPD: marital conflict child-care difficulties (feeding, sleeping, health problems) perception by mother of an infant with a difficult temperament history of family or personal depression

SYMPTOMS OF POSTPARTUM DEPRESSION  depressed mood  tearfulness  anhedonia  insomnia  fatigue  appetite disturbance  suicidal thoughts, and recurrent thoughts of death

DIAGNOSIS OF POSTPARTUM DEPRESSION  History  The Edinburgh Postnatal Depression Scale (EPDS)  Important to rule out medical causes of depression, such as anemia or thyroid dysfunction

Edinburgh Postnatal Depression Scale (EPDS)  Screening tool for postpartum depression  Validated in diverse populations  10-item self-rated questionnaire  Score of > 12 suggestive of depression  Suicidal ideation requires further evaluation

SAMPLE EPDS QUESTIONS  1. I have been able to laugh & see the funny side of things As much as I always could Not quite so much now Definitely not so much not Not at all

TREATMENT OF POSTPARTUM DEPRESSION  Treatments can include: Counseling/psychotherapy Medication ECT Support groups Self-help

TREATMENT OF POSTPARTUM DEPRESSION For mild to moderate symptoms, focus less on pharmacological treatment and more on counseling and group therapy.

TREATMENT OF POSTPARTUM DEPRESSION  Medications: Antidepressants Transdermal estrogen

TREATMENT OF POSTPARTUM DEPRESSION  Medications: Antidepressants 1- SSRIs 2- SNRIs 3- TCAs

SUMMARY  Postpartum depression: is relatively common may have long-term consequences for mother, infant & family is easily missed should be screened for can be treated successfully

REFERENCES  Medscape  Uptodate  Our lectures in PSCH 534

THANKS