Postpartum blues includes an array of psychiatric manifestations occurring in the period of post-partum, due to hormonal imbalance. Knowing in detail will help for quicker diagnosis and better outcomes. Prepared in December, 2017.

1. Postpartum Blues
Dr. V.B.Kasyapa.J (MD)
Dept. of General Medicine.

2. Introduction
• Pregnancy causes lot of stress on the mother.
• Various hormones like
– Estrogen
– Progesteron
– hCG
Play important role in causing metabolic changes, which
ultimately lead to psychological illness
Sudden drop in these hormones after removal of
placenta plays great role
• It is common, but may become an emergency.

3. Types
1. Postpartum blues/ Baby blues
2. Postpartum Psychosis
3. Postpartum Depression

4. Post-partum blues
• A self-limiting, relatively mild, mood syndrome
• 30-80% of mothers
• 3-10 days after birth; remits by 2 weeks
• Risk factors:
– No certain cause 9idiopathic)
– Primi
– Late leuteal phase dysphoria
– Depression history
– First-degree relative with depression

6. Post-partum Blues
• Symptoms:
– Mood lability
– Anxiety
– Sadness
– Crying spells
– Insomnia
– fatigue

7. Post-partum Psychosis
• Psychosis or psychotic depression in the post-partum
period
• 2 in 1000 mothers
• Within first 2 weeks to 3 months
• Risk factors:
– Considered as organic disease (hormonal imbalance,
heredity, h/o psychosis, etc..)
– Psycho social causes are secondary

8. Post-partum Psychosis
• Symptoms:
– Prodrome: worsening insomnia, without a crying baby or
physical discomfort, psychomotor agitation
– Confusion
– Memory impairment
– Irritability
– Anxiety
– Intrusive thoughts about harming the infant
– Paranoid and religious delusions
– Auditory hallucinations
– Thought insertion, withdrawal and broadcasting
– Brief periods of elation followed by inexplicable sadness or rage
– Lucid intervals can be seen

10. Post-partum Depression
• An intermediate, prolonged syndrome like
post partum blues
• 5-10% of mothers, who had postpartum blues
• Insidously, with in 3 weeks post-partum

11. Post-partum Depression
• Risk factors
– Hereditary, h/o psychiatric illness
– Psychosocial
• Marital discord
• Stressful life during pregnancy
• Ambivalence about motherhood
• Lower socio economic status
• Isolation from family or friends

12. Post-partum Depression
• Symptoms
– Blues symptoms sustain
– Crying spells
– Poor concentration
– Indecisiveness
– Profound sadness
– Thoughts like failure and inadequacy
– Suicidal ideation
– Physical signs of hypothyroidsm (cold intolerance,
fatigue, dry skin, slowed mentation, constipation, fluid
retention)

14. When to meet a doctor?
• Assess all the pregnant at their first visit to hospital
• Provide counselling regarding stress-free environment and
family support
• Counsel all the mothers, who had history of psychiatric
illness or relatives with psychiatric disorders, and their
family members regarding this disease and its symptoms
• Any undue agitation/ sadness/ insomnia/ fatigue should
not be taken lightly and immediate consultation is needed
• Other suicidal or homicidal tendencies towards the baby or
undue injuries to the baby, when alone with the mother
should bring up a doubt and immediate psychiatrist
consultation is mandatory.

15. Treatment
• Post-partum blues can be managed with re-
assurance and support of the family
• It rarely needs medication
• Other two are ‘psychiatric emergencies’
• Need to be hospitalized immediately

16. Treatment

17. • It may not be preventable
and hard to cure, but it is
not invincible.