D.

Wolocko, Daily News

By
Ricardo J. Fernandez, M.D., DFAPA
Councilor, NJ Psychiatric Association

Post!artu" De!ression#
Psychiatric Syndromes
of the
Postpartum Period

$his !resentation is %or
the e&clusi'e use o% the
New Jersey Psychiatric
Association we(site
and %or the !ur!oses o% consu"er
in%or"ation and education.
)t "ay not (e otherwise
re!roduced or !resented without
the knowled*e and consent o%
Ricardo J. Fernandez, M.D.

Wo"en are at serious risk
%or de'elo!in* a
!sychiatric illness a%ter
child(irth.
D. Wolocko, Daily News

Post!artu" "others are at
si*ni%icant risk o% de'elo!in* a
!sychiatric illness se'ere
enou*h to re+uire
hos!italization as the ne&t
slide de"onstrates.
$his increased risk lasts %or
a(out two years a%ter
child(irth.

Ad"issions to a Psychiatric ,os!ital-
. /ears Pre and Post Deli'ery
Kendell RE et al. Br J Psychiatry. 1987;150:662; presented at WMH, Berlin 2001.
0
10
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20
30
40
50
60
A
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s
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7
M
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Pregnancy
2 Years 1 Year Childbirth +1 Year +2 Years

First, let us discuss the
!ro!er ter"inolo*y %or
these disorders.

Post!artu" De!ression#
is a *eneral ter" used in
our society to descri(e
any !sychiatric illness
occurrin* a%ter child(irth.

)n reality,
Post!artu" De!ression
descri(es only one o%
%our syndro"es that can
occur a%ter child(irth.

$he %our syndro"es are-

Maternity or Post!artu" Blues

Post!artu" Psychosis

Ad8ust"ent Disorder o% the

Post!artu" Period

Ma8or De!ression in the Post!artu"

9Post!artu" De!ression:

;n%ortunately, co""on re%erence
to all %our conditions as
Post!artu" De!ression# creates
con%usion and %ear.
)t is i"!ortant to understand that
Post!artu" Psychosis, the "ost
se'ere and dan*erous condition,
is relati'ely rare and +uite
di%%erent %ro" Post!artu"
De!ression, as the ne&t slide
de"onstrates.

Cohen <=. Depress Anxiety. 1>>?-1-1?@.5.
0A
10A
.0A
20A
30A
40A
50A
60A
?0A
>0A
100A
$ransient, $ransient,
non!atholo*ic non!atholo*ic
Medical Medical
e"er*ency e"er*ency
=erious, =erious,
disa(lin* disa(lin*
Post!artu" Blues
Post!artu" De!ression
Post!artu" Psychosis
40A to 60A
10A
0.01A
2/3 have onset by
6 wks postpartum

risk for Postpartum

Depression
!" are affective
#$ipo%ar& 'a(or
Depression)
=!ectru" o% Post!artu"
Mood Chan*es
I
n
c
i
d
e
n
c
e
I
n
c
i
d
e
n
c
e

Post!artu" Psychosis
is o%ten "isla(eled
in the "edia as
Post!artu" De!ression,
creatin* "uch an&iety
and %ear in wo"en with
the less se'ere
!ost!artu" disorders.

Now, lets discuss the
s!eci%ic syndro"es.

Maternity or Post!artu"
Blues

)s not considered a !sychiatric illness and is

unrelated to !sychiatric history .

Bccurs in .5 to ?4A o% (irthin* "others. $he

e&act incidence is unclear.

Present in all cultures studied

A!!ears unrelated to en'iron"ental stressors

Maternity or Post!artu"
Blues
Blues# C hei*htened reacti'ity,
not clinical
de!ression
Mood swin*s %ro" wee!iness to e&tre"e
ha!!iness and hei*htened reacti'ity
Bccurs 2 to 4 days a%ter child(irth. )t is sel%
li"itin*, resol'in* in a(out a week.
)% occurs, increases risk %or
Post!artu" De!ression.

$he rest o%
the syndro"es to
(e descri(ed are
all considered
!sychiatric illnesses
and (ene%it %ro" clinical
treat"ent.

Post!artu" Psychosis

)s relati'ely rare, occurrin* one to three cases

!er 1000 (irths

)s a se'ere and li%e threatenin* condition %or

(oth "other and in%ant

De'elo!s soon a%ter (irth, o%ten within two

weeks, usually within a "onth

Re+uires intense treat"ent and

hos!italization- A "edical e"er*ency

)s usually %ollowed (y Post!artu" De!ression

=y"!to"s o% Post!artu"
Psychosis

Delusions- False (elie%s, o%ten o% a

reli*ious nature and 'ery %re+uently
in'ol'in* the in%ant

Perce!tual distortions- =eein* or

hearin* thin*s which are not !resent

B%ten, %eelin*s o% e&cessi'e well

(ein* or i"!ortance

Ad8ust"ent Disorder o%
the Post!artu" Period
Bccurs in a(out .0A o% (irthin* "others
(ut incidence is unclear as "any wo"en
with this !ro(le" do not seek treat"ent.
Mani%ests as excessive di%%iculties ad8ustin*
to "otherhood.
)% e"otional sy"!to"s e&ist, they are not
as se'ere as those seen in Post!artu"
De!ression
Bri*ht. Am *am Physician. 1>>3D 40- 4>4.
=uri and Burt. + Pract Psychiatry $ehav ,ea%th. 1>>6D 2- 56.

Ad8ust"ent Disorder o%
the Post!artu" Period

Can resol'e without treat"ent o'er

ti"e (ut can cause on*oin*
di%%iculties %or the "other.

Can de'elo! into

Post!artu" De!ression i% "ore
se'ere and untreated.

Res!onds well to
short ter" !sychothera!y.
Bri*ht. Am *am Physician. 1>>3D 40- 4>4.
=uri and Burt. + Pract Psychiatry $ehav ,ea%th. 1>>6D 2- 56.

Post!artu" De!ression

Bccurs in 10A o% (irthin* "others

.0A i% the "other has had Maternity

Blues.

Bccurs usually within 5 weeks o%

(irth (ut can occur u! to a year a%ter
(irth
Bri*ht. Am *am Physician. 1>>3D 40- 4>4.
=uri and Burt. + Pract Psychiatry $ehav ,ea%th. 1>>6D 2- 56.

Bnset o% =y"!to"s in
Post!artu" De!ression
$wo =tudies
2. Time of Onset of Postpartum epression in !1" Patients
$he "ore severe, the ear%ier the onset.
#
2#
!#
$#
%ithin T&o %ee's (i) %ee's (i) *onths
P
e
r
c
e
n
t
a
g
e

o
f

P
a
t
i
e
n
t
s
(e+ere, needed hospital admission
*ild, treated by general practitioner
1. Time of Onset of Postpartum epression in "1- %omen
Within 13 Days
35A
Within 5 Weeks
13A
Within 2 Months
..A
Within 5 Months
1?A

Post!artu" De!ression-
=y"!to" Bnset

30A- A%ter %irst !ostnatal 'isit

At 5 weeks

.0A- Coincided with weanin*

15A- At return o% "enstruation

At . to 2 "onths i% not (reast %eedin*

13A- )nitiation o% oral contrace!ti'es

Post!artu" De!ression

Mani%ests as sy"!to"s o%
de!ression, o%ten with "arked
an&iety7a*itation and o(sessions
a(out har" co"in* to the child.

Can de'elo! *radually or

a(ru!tly a%ter (irth
Bri*ht. Am *am Physician. 1>>3D 40- 4>4.
=uri and Burt. + Pract Psychiatry $ehav ,ea%th. 1>>6D 2- 56.

What are the sy"!to"s
o% De!ressionE

=adness o% "ood "ost o% the day, nearly e'ery day

Di"inished interest or !leasure in usual acti'ities

Ma8or chan*e in a!!etite or wei*ht

Not a(le to slee! or slee!in* too "uch

A*itation or %eelin* slowed down

Fati*ue or loss o% ener*y

Feelin*s o% worthlessness or e&cessi'e or ina!!ro!riate *uilt

Di"inished a(ility to think or concentrate, or indecisi'eness

Recurrent thou*hts o% death, dyin*, or suicide

APA Dia*nostic and =tatistical Manual. 1>>3

=y"!to"s
Fre+uently =een in
Post!artu" De!ression

Marked a*itation and an&iety

Mother can not slee! e'en when the

(a(y is slee!in*

B(sessions and co"!ulsions

a(out the (a(y

What are o(sessions and
co"!ulsionsE

An o(session is a re!etiti'e, intrusi'e and

distur(in* thou*ht that enters the "ind
and is out o% the indi'idualFs control.

A co"!ulsion is a re!etiti'e act that is

done in an atte"!t to (e rid o% the
o(sessional thou*ht.

Both cause *reat an&iety and disco"%ort

in the indi'idual.

Post!artu" o(sessions
Co""only %ocused on in%ant
$hou*hts9o(sessions: o% hurtin* the in%ant
Dro!!in* in%ant
Drownin* in%ant
=ta((in* in%ant
Puttin* in%ant in o'en or "icrowa'e
=e&ually a(usin* in%ant
$hou*hts that so"eone will steal or har"
the in%ant

Post!artu" co"!ulsions

Co""only %ollow the o(sessions as an

atte"!t to alle'iate the thou*ht

A'oid holdin* (a(y (y staircases, etc

A'oid (athin* in%ant

,ide kni'es

A'oid kitchen area

A'oid chan*in* dia!ers or (athin* in%ant

A'oid lea'in* the house

Althou*h the !resence o%
o(sessions and co"!ulsions
indicates need %or treat"ent,
these "others are rarely
dan*erous to the in%ants. $hey are
actually at hi*her risk to hurt
the"sel'es as a result o% their %ear
o% !ossi(ly hurtin* the in%ant.

,ow is Post!artu"
De!ression treatedE

Psychiatric "edication

Antide!ressants-

)n !articular, those that increase release

o% serotonin in the (rain

Medicines %or an&iety and to

hel! with slee!

)ndi'idual, cou!les and %a"ily

!sychothera!y

What a(out
(reast %eedin*E
$he incidence o% (reast
%eedin* in (irthin* "others
is increasin* as the ne&t
slide shows.

)ncidence o% Breast Feedin*
1>.5@.001
80%
49%
28%
20%
37%
52%
56A
61%
1926-
1930
1951-
1955
1966-
1970
1972 1975 1998 2000 2001
Briggs, Freeman, Yafee, Drugs in Pregnancy and Lactation, 1998
Maternity Surey, Parents Express, !"i#$,!%$, 4&01, 4&02

G
G
a reasona(le
a reasona(le
o!tion
o!tion
in Post!artu"
in Post!artu"
De!ression E
De!ression E
Breast %eedin*G
Breast %eedin*G

Althou*h all "edications
cross into (reast "ilk,
there are a %ew
antide!ressants that
a!!ear to cross less than
others and "ay (e sa%er
in (reast %eedin*.
Consult your doctor.

$here are risk %actors that
!redis!ose wo"en to
!ost!artu" disorders.

Risk Factors

First !re*nancy

/oun* a*e

Psychiatric illness durin* !re*nancy

Prior history o% !ost!artu" illness

Prior history o% "ental illness

Fa"ily history o% "ental illness

Recent stress%ul li%e e'ents

Pro(le"s in the "arria*e

)n addition, there are
"any societal and
cultural %actors that "ay
!redis!ose wo"en to
!ost!artu" !ro(le"s
includin*...

Isolation
Isolation
Diminished
extended family
Involvement.

Distorted and glamorized perceptions
of pregnancy

and of
recovery
in the
postpartum...

frequently
promoted
in the
media.

As well as unrealistic
expectations of the postpartum mother

)n su""ary, !ost!artu"
!sychiatric illness e&ists.
)t can (e de(ilitatin* and
dan*erous to (oth "other
and child.
H%%ecti'e treat"ents are
a'aila(le. =u!!ort *rou!s o%
"others in reco'ery are also
a'aila(le in "any areas
o% the country.

For "ore in%or"ation-

Consult with your doctor

Contact-

De!ression@A%ter@Deli'ery 9DAD:
www.De!ressionA%terDeli'ery.co"

De!ression and Bi!olar =u!!ort Alliance 9DB=A:

Phone- ?00@?.5@252.
We(-www.DB=Alliance.or*

New Jersey Psychiatric Association

Phone- ?00@234@0132