This document discusses various postpartum psychiatric disorders including postpartum blues, postpartum depression, and postpartum psychosis. Postpartum blues occurs in 50% of women within 2-6 days of delivery and involves transient low mood but is typically self-limiting within a few days. Postpartum depression occurs in 10% of women within the first 6 weeks and can involve feelings of guilt, anxiety about the baby, and reluctance to care for the baby. Risk factors include a history of depression and relationship or baby related stressors. Postpartum psychosis occurs in 0.5% of women and involves an abrupt onset of affective or manic symptoms within 2-4 weeks of delivery that usually requires

1. Perinatal Psychiatry
Dr. Kamal Ghimire

2. Postpartum disorders
• Postpartum blues
• Postpartum depression
• Postpartum psychosis

3. Postpartum blues
• Occurs in 50%
• Onset: 2-6 days after delivery
• Symptoms: transient low mood, crying, irritability and worries about
coping with baby.
• self-limiting,( usually within a few days), but severe blues increase the
risk of postpartum depression.
• No specific intervention is required (apart from reassurance)
although, if symptoms do not resolve within two weeks, assess for
depression.

4. Postpartum depression
• Occurs in 10 % in first 6 weeks postpartum. Around 25% of which
persists for a year.
• Risk factors: - Mother: past history or family history of depression,
unemployed, uneducated.
- Relationships: unmarried, domestic violence, confiding
relationships
- Baby: premature, multiple births, ill baby.
• Clinical features are as for other depressive illness but may also include:
-guilt and anxiety concerning the baby
-feelings of inadequate mothering
-unreasonable fears for the baby’s health
-a reluctance to hold or feed the baby
-(more rarely) thoughts of harming the baby.

5. Management
• full psycho-social assessment (including possible risk to mother and
the baby).
• First line of treatment for mild to moderate perinatal depression is
psychological therapy and not antidepressants because of the
potential for adverse effects in the foetus or breastfeeding baby.
• In severe depression: Antidepressant.

6. Postpartum Psychosis
• Occurs in 0.5%. Abrupt onset 2-4 weeks post birth.
• Risk groups:
-in those with a previous episode of psychosis
- in first time mothers
-after instrumental delivery
-in those with family history of affective(mood) disorder
Symptoms: Usually affective, most depressive but up to one-third
manic
(postpartum onset of schizophrenia is relatively unusual).
Emotional lability and subjective confusion are common.

7. Management
• Usually requires hospitalization
• Initially : antipsychotics
• ECT( electroconvulsive therapy) is reported to be effective and
considered if antipsychotics arenot effective

8. Summary

9. Prescribing in pregnancy and breastfeeding

10. In pregnancy
• Antidepressant : low risk: TCA, Sertraline (avoid paroxetine)
• Mood stablizers should be avoided where possible. Low dose typical
antipsychotics have lowest known risk and are also preferred for bipolar
disorders
In breastfeeding
• Antidepressant : imipramine and sertraline are relatively safer
• Antipsychotics are preferred over mood stablizers for bipolar disorders.
• Breastfeeding women prescribed psychotropic drugs should be advised
how to time feeds to avoid peak drug levels in milk and how to
recognise adverse drug reactions in their babies.

12. • Thank You