Postpartum mood disorders

Abstract

Depression is a common disorder in women of childbearing age. Many women experience depressive symptoms during the postpartum period, ranging from mild postpartum blues to significant mood disorders such as postpartum depression and postpartum psychosis. The 'baby blues' are extremely common, affecting 30-75% of new mothers. This form of postpartum mood change is self-limited and requires no specific treatment other than education and support. While less common, occurring in 10-15% of births, postpartum depression has the potential for significant impact on both the health of the mother and baby. Unfortunately, affective illness in women frequently goes unrecognized and untreated. While there are effective pharmacological treatments for postpartum depression, the treatments for postpartum depression are often not utilized due to concerns about lactation. Postpartum psychosis is extremely rare, affecting one to two women per 1000 births; each case represents a true psychiatric emergency. Identifying and treating postpartum affective illness in women is critical to the health of both mother and infant. This paper reviews the literature on the diagnosis and treatment of mood disorders in the postpartum period: postpartum blues, postpartum depression and postpartum psychosis.

Implications of Timing of Maternal Depressive Symptoms for Early Cognitive and Language Development

“…In contrast to postpartum blues, however, women experiencing postpartum depression may be at greater risk for later episodes of depression (Philipps & O'Hara, 1991). That is, women at greatest risk for postpartum depression tend to have a history of psychiatric problems, are more likely to have experienced depressed mood during pregnancy and marital discord, and have fewer sources of social support (Da Costa, Larouche, Dritsa, & Brender, 2000;Honey, Bennett, & Morgan, 2003;Seyfried & Marcus, 2003).…”

“…Women across various economic and cultural backgrounds seem to be equally affected by postpartum blues (Seyfried & Marcus, 2003). Women experiencing postpartum blues seem to be somewhat more likely to have poor family or marital relations and to have experienced mood disturbances before or during pregnancy (Ballinger, Kay, Naylor, & Smith, 1982;Cutrona, 1983;Handley, Dunn, Waldron, & Baker, 1980;Kennerley & Gath, 1989b;Nott, Franklin, Armitage, & Gelder, 1976).…”

Men's experiences of having a partner who requires Mother and Baby Unit admission for first episode postpartum psychosis

“…Early symptoms such as irritability and restlessness usually occur within two weeks postpartum and rapidly progress into symptoms characteristic of psychosis (Seyfried & Marcus 2003, Heron et al 2005. Early recognition and treatment is essential; delays can result in longer, more severe and difficult to treat episodes and increased risks to mother and baby (Lewis 2007).…”

Interface of women’s mental and reproductive health

“…The etiology of postpartum depression remains unclear but is thought to be attributable to a complex interplay between hormonal-related changes, biological vulnerability, and psychosocial factors [43]. Risk factors include previous depression, especially postpartum depression (25% risk), history of depression or anxiety during pregnancy, perceived poor social supports, marital discord, and stressful life events [5••,35•, 43,44]. In women with history of postpartum-onset major depression, the risk of recurrence in 1 year following another birth is as high as 41%, with 90% of recurrences occurring by 28 weeks postpartum [45].…”

“…Depressive symptoms can be difficult to differentiate from the stresses of caring for a newborn child and normal experiences of the postpartum period. The etiology of postpartum depression remains unclear but is thought to be attributable to a complex interplay between hormonal-related changes, biological vulnerability, and psychosocial factors [43]. Risk factors include previous depression, especially postpartum depression (25% risk), history of depression or anxiety during pregnancy, perceived poor social supports, marital discord, and stressful life events [5••,35•, 43,44].…”