Postpartum Mood Disorders: Clinical Perspectives

Abstract

Mood disorders are common in women. A prepregnancy personal history of mood disorder (bipolar or major depression), premenstrual syndrome, or (possibly) postpartum blues places a woman at high risk for a postpartum exacerbation of symptoms. Untreated or unrecognized postpartum mood disorders can lead to serious psychologic and social consequences, in some cases even leading to suicide or infanticide. Women at risk for postpartum mood disorders need to be referred for psychiatric consultation before pregnancy and parturition. Informed, professional collaboration offers the best opportunities for prevention, as well as the earliest recognition and treatment of emergent symptoms.

Depression in women

“…Suicide and infanticide occur infrequently, but are more likely during episodes of severe postpartum depression [30]. Postpartum depression has also been linked to several psychosocial factors, including limited educational attainment, psychological distress, social isolation, poor social support during pregnancy, long interval between marriage and first pregnancy, marital discord, history of major depression, and unplanned or unwanted pregnancy [31][32][33].…”

“…This syndrome is considered to be a variant of bipolar disorder, with prominent cognitive impairment and bizarre behavior [33,38,39]. Symptoms include severe dysphoria or elevated mood, emotional lability, disorganized behavior, delusions, hallucinations, feelings of depersonalization, confusion, disorientation, and agitation.…”

Glucocorticoid Withdrawal Syndrome

“…Mild depression, or the "blues," occurs in as many as 60% of women, whereas an additional 13% develop fullfledged depression. 53 Women who experience hot flushes soon after menopause have lower estrogen levels than those who do not have hot flushes, 54 indicating that this could be a symptom of estrogen deficiency or withdrawal, and indeed, it can be ameliorated by estrogen replacement therapy. Yet, postmenopausal symptoms are self-limited and distinct from those of pure estrogen deficiency.…”

Stress induces equivalent remodeling of hippocampal spine synapses in a simulated postpartum environment and in a female rat model of major depression

“…The symptoms of PPD are almost identical with those of a major depressive episode and described by, among others, irritability, emotional swings, cognitive impairments, and feelings of guilt and inadequacy (Melges, 1968; Pitt, 1968; Laura and Miller, 2002; Crawley et al, 2003; O'Hara and Wisner, 2014). In extreme cases, PPD may lead to infanticide and/or suicide (Pariser et al, 1997; Spinelli, 2004), which is the most tragic manifestation of the fact that PPD is a ‘family affair’, as it also affects the offspring by being associated with various developmental problems in the cognitive and psychosocial domains (Nomura et al, 2002; Grace et al, 2003; Letourneau et al, 2012; Verbeek et al, 2012). As a result, more research is necessary into the pathomechanisms of peripartum affective illness to develop better, evidence-based therapy and to protect the offspring from enduring adverse consequences.…”